Estudo piloto em Portugal

Introdução: A atividade física (AF) é considerada uma ferramenta terapêutica fundamental para atingir o controlo metabólico e reduzir o risco cardiovascular dos doentes com diabetes tipo 2. Este estudo tem por objetivo caracterizar a prática de exercício físico e os níveis de AF habitual de doentes com diabetes tipo 2 e analisar a influência da prática de exercício e de alguns fatores sociodemográficos como a idade, género, meio habitacional e situação profissional na AF habitual e nas suas componentes. Metodologia: Cento e um doentes com diabetes tipo 2 foram entrevistados (65.96 ± 9.34 anos de idade). Foram questionados quanto à prática de exercício regular e suas características, e os níveis de AF habitual foram avaliados através do International Physical Activity Questionnaire. Resultados: A prevalência de prática de exercício regular era de 40.59%. Apenas 2.44% dos praticantes referiram praticar uma combinação de exercício aeróbio e exercício resistido. Quanto à avaliação dos níveis de AF Habitual, 34.65% apresentavam um nível baixo, 43.56% apresentavam um nível moderado e 21.78% apresentavam um nível elevado. Não foram identificadas diferenças significativas na AF Habitual entre praticantes e não praticantes de exercício. Foi observada uma correlação negativa e significativa entre a Idade e a AF Habitual e entre a Idade e a AF Vida Diária. Foram identificadas diferenças significativas na AF Habitual entre habitantes do meio rural e habitantes do meio urbano e diferenças significativas na AF Habitual e na AF Vida Diária entre indivíduos profissionalmente ativos e não ativos. Conclusões: A prevalência de prática de exercício e os níveis de AF Habitual dos doentes com diabetes tipo 2 portugueses são claramente insuficientes. Praticar exercício não é sinónimo de ter uma AF Habitual minimamente saudável. O avançar da idade, habitar em meio urbano e perder a atividade profissional parecem ser fatores de risco para um estilo de vida sedentário e importantes alvos de intervenção.Introduction: Physical activity (PA) is considered an important therapeutic tool to achieve metabolic control and reduce cardiovascular risk in patients with type 2 diabetes. This study aims to characterize exercise practice and levels of habitual PA of patients with type 2 diabetes and analyze the influence of exercise practice and sociodemographic factors such as age, gender, residential area and employment status in habitual PA and its components. Methodology: One hundred and one patients with type 2 diabetes were interviewed (65.96 ± 9.34 years of age). They were questioned about their regular exercise practice and its characteristics, and habitual PA levels were evaluated with International Physical Activity Questionnaire. Results: The prevalence of regular exercise practice was 40.59%. Only 2.44% of the practitioners reported practicing a combination of aerobic exercise and resistance exercise. When evaluating Habitual PA levels, 34.65% had a low level, 43.56% had a moderate level and 21.78% had a high level. No significant differences were identified in Habitual PA between practitioners and non-practitioners of exercise. It was observed a significant negative correlation between age and Habitual PA and between Age and Daily Life PA. Significant differences were identified in Habitual PA between rural and urban residents and significant differences in Habitual PA and Daily Life PA between professionally active and non-active individuals. Conclusions: Prevalence of exercise practice and Habitual PA levels of portuguese patients with type 2 diabetes are far from sufficient. Practicing exercise is not synonym of having a minimally healthy Habitual PA. Ageing, living in urban areas and the loss of professional activity appear to be risk factors for a sedentary lifestyle and important intervention targets

Diabetes em Movimento®-programa comunitário de exercício para pessoas com diabetes tipo 2: efeitos no controlo glicémico, fatores de risco cardiovascular e aptidão física

Tese de Doutoramento em Ciências do DesportoA 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

Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health among Older People with Type 2 Diabetes: A Qualitative Interview Study

The COVID-19 pandemic has resulted in significant alterations to and implications for the lives of millions of people, and especially for those with pre-existing medical conditions. The aim of this study was to explore the lived experience of older people with type 2 diabetes mellitus (T2DM) throughout the first 9 months of the pandemic, with emphasis on the habits of physical exercise. We conducted a qualitative study using semi-structured interviews. The data consist of telephone interviews of seventeen older people with T2DM (10 women and 7 men, aged 62–76 years). Using thematic analysis, five themes were generated: (1) an altered social and relational life; (2) changes in routine and attitude regarding physical activity behaviour; (3) home-related activities gained relevance; (4) health and well-being impact and management; and (5) thoughts about the post-pandemic period. The increase in the number of cases and the fear of becoming infected with COVID-19 limited the social (i.e., contact with family and/or friends) and functional (i.e., daily routine, the habit of exercising) lives of these people, reverberating negatively on their health and well-being. Feelings of isolation, loneliness, anxiety were common. The findings of this study help to better understand the impact of the pandemic and determine areas of need for future interventions. A multidisciplinary approach is necessary to provide support for older people with T2DM and tackle the negative effect of the pandemic, including the reduction in physical activity

Impact of a supervised multicomponent physical exercise program on cognitive functions in patients with type 2 diabetes

This study evaluated the impact of a multicomponent exercise program on cognitive functions in participants with Type 2 Diabetes. Participants (n = 70, 65.6 ± 5.9 years) engaged in the program (75 min per session; 3 x week) for 32 weeks. A battery of cognitive tests was performed at baseline and study completion. Two groups were formed according to their attendance rate (low and high attendance), and statistical comparisons were computed on their changes in cognitive performance. Such changes were also associated with the attendance rate for all participants. Results showed no significant differences between groups in their change scores, although there were some within-group differences in both groups. Correlation analysis showed that the attendance rate was not associated with cognitive performance changes, except for one variable. As the exercise program did not improve cognitive function, we discuss the potential of future interventions to incorporate dual-task activities merging physical and cognitive stimulation.info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56\u20131.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion