Efeitos de um programa de treino de força em parâmetros neuromusculares de idosos com diabetes mellitus tipo 2 : um ensaio clínico randomizado

Contexto: O exercício físico faz parte do tratamento do diabetes mellitus tipo 2 (DM2), doença que possui maior prevalência na população idosa. Maior foco tem sido dado ao efeito do treinamento de força no controle glicêmico, sendo que menor número de estudos tem como desfecho primário parâmetros neuromusculares, em idosos com DM2. Objetivo: Avaliar os efeitos de um programa de treino de força nos parâmetros neuromusculares de idosos com DM2, em relação à um grupo controle. Delineamento: ensaio clínico randomizado, com dois grupos, intervenção (GI) e controle (GC). Métodos: Quarenta e quatro participantes foram alocados nos dois grupos: GI (n=22), que realizou treinamento de força três vezes por semana, durante 12 semanas; GC (n=22), que realizou uma sessão semanal de alongamento, durante 12 semanas. O treinamento de força foi composto por 11 exercícios, com 2-3 séries de 12-10 repetições e intensidade de 15 a 12 repetições máximas. O desfecho primário do estudo foi a qualidade muscular, por tensão específica e eco intensidade, que foi avaliada antes e após as 12 semanas, assim como os demais desfechos secundários. Os dados foram análises tanto pela intenção de tratar (ITT), como pela análise por protocolo (PP), baseado em 70% ou mais de comparecimento as seções. As comparações foram realizadas com Equação de Estimação Generalizadas e ANOVA de duas vias com medidas repetidas, para as análises ITT e PP, respectivamente. Resultados: Não houve modificação (p≥0,05) da qualidade muscular avaliada por eco intensidade ou por tensão específica, no GI e GC, para ambas as análises. Foram encontradas melhorias (p≤0,05) na força máxima dinâmica para o GI e GC na análise ITT e apenas para o GI na análise PP. Não foi encontrada diferença (p≥0,05) na força máxima isométrica, no GI e GC, em ambas as análises. Na análise ITT não foram encontradas melhorias (p≥0,05) no desempenho dos testes funcionais, para ambos os grupos, enquanto na análise PP houve redução (p≤0,05) no tempo de realização do teste timed up and go e subir escada no GC, e nos testes de sentar e levantar da cadeira e subir escada para o GI. Para a espessura muscular do quadríceps femoral houve aumento (p≤0,05) dos valores para o GI, mas não para o GC, em ambas as análises. Em relação a gordura visceral, não houve modificação dos valores em ambos os grupos com a análise ITT, mas houve redução (p≤0,05) com a análise PP, para os dois grupos. Os valores de hemoglobina glicada reduziram para o GI e aumentaram (p≤0,05) para o GC na análise PP, mas não foram encontradas diferenças (p≥0,05) para a análise ITT. Redução (p≤0,05) dos níveis de triglicerídeos foi encontrada para o GI, mas não para o GC, em ambas as análises. Conclusões: o programa de treino de força proposto no presente estudo foi capaz de melhorar a força dinâmica e a espessura muscular de idosos com DM2 no período de 12 semanas, mas não causou modificações significativas na qualidade muscular durante esse período, mostrando que para alguns parâmetros neuromusculares talvez seja necessário período maior de treinamento nessa população.Context: Physical exercise is a cornerstone of diabetes mellitus type 2 (DM2) treatment, a disease that has a higher prevalence in the elderly population. Greater focus has been given to the effects of strength training on glycemic control, and a lower number of studies has investigated neuromuscular parameters as a primary endpoint in elderly with DM2. Objective: To evaluate the effects of a strength training program on the neuromuscular parameters of elderly patients with DM2, in relation to a control group. Design: Randomized clinical trial with intervention (GI) and control (CG) groups. Methods: Forty-four participants were randomized to both groups: GI (n= 22), which underwent strength training three times a week for 12 weeks, and GC (n = 22), which performed a weekly stretching session for 12 weeks. Strength training was composed of 11 exercises, with 2-3 sets of 12-10 repetitions and was set the intensity of 15 to 12 maximal repetitions. The primary outcome of the study was muscle quality measured by specific tension and eco intensity, evaluated before and after 12 weeks, as well as the other secondary outcomes. Data was analyzed by both, intention-to-treat (ITT) and per protocol (PP) analysis (based on 70% or more attendance sections). The comparisons were performed with Generalized Estimation Equation and two-way ANOVA with repeated measurements for ITT and PP analyzes, respectively. Results: No change (p≥0.05) in muscle quality assessed by echo intensity or by specific tension were found in GI and GC, in both analyzes. Increase (p≤0.05) in maximum dynamic strength was found for GI and GC in ITT analyze, but only for GI in PP analyze. No difference in maximum isometric force (p≥0.05) was found for GI and GC in both analysis. In the ITT analysis, there were no improvements (p≥0.05) in functional tests performance in both groups, whereas in the PP analysis reduction (p≤0.05) was found in the timed up and go and climb stairs tests in the GC, and in the sit to stand and climb stairs tests in the GI. Quadriceps femoris muscle thickness increased (p≤0.05) in GI in both analyzes, but not for GC. No difference was found for visceral fat, in both groups in the ITT analysis, but there was a reduction (p≤0.05) in the PP analysis for both groups, with no difference between groups. Glycated hemoglobin values was reduced (p≤0.05) in GI and significantly increased in GC in PP analysis, but no differences were found in ITT. Reduction (p≤0.05) in triglyceride levels was found in GI, but not in GC, in both analyzes. Conclusions: The strength training program used in this study was able to improve dynamic strength and muscle thickness of elderly patients with DM2 in the 12-week period, but it was not able to induce significant changes in muscle quality, indicating that for some neuromuscular parameters it may be required a longer period of training for this population

Acute and chronic effects of muscle power training on blood pressure in elderly patients with type 2 diabetes mellitus

The aim of the present study was to evaluate the effects of 12 weeks of muscle power training (MPT) on casual blood pressure (BP) (before and after each training session) and resting BP (pre- and post-training program) in type 2 diabetes mellitus (T2DM) elderly. Methods: Twelve T2DM elderly individuals (68.75 ± 7.83 years), non-insulin-dependents participated in the present study and performed the MPT program twice a week. Casual BP was measured before and after training sessions, and resting BP was measured 48 h before the first and 48 h after the last training session. Results: Significant decrease in casual systolic (SBP) (−7.08 ± 4.12 mm Hg [effect size [ES]: −1.42 to −0.11]; p 0.01) was found after training sessions, without significant effect (p > 0.05) of the week along time or casual BP × week interaction. No significant change in resting SBP (−5.08 ± 8.93 mm Hg [ES: −0.41]; p = 0.07) and DBP (0.47 ± 6.06 mm Hg [ES: +0.11]; p = 0.79) was found. Conclusion: MPT was able to reduce casual BP after training sessions. However, there was no significant reduction in resting BP after MPT. Nevertheless, although not statistically significant, there were important clinical reductions in resting SBP in T2DM elderly patients

Evaluation of bilateral deficit in isometric contractions of the knee extensors

Strength training has been reported as an important tool for enhancing and maintaining health. Resistance exercises can be executed unilaterally or bilaterally. Some studies have reported lower strength and electromyography (EMG) signal values in bilateral conditions than the sum of these values in unilateral conditions. This difference in strength and EMG is called the bilateral deficit. The aim of this study was to evaluate the strength and EMG activity of the rectus femoris and vastus lateralis during unilateral and bilateral isometric knee extension. The sample consisted of 10 non-resistance trained males aged 18 to 30 years. Strength and EMG were recorded through use of a load cell and surface electrodes, respectively. A 120º knee extension was used for the isometric knee extension test. The results showed significantly higher values for strength and EMG signal (p <0.05) in unilateral conditions, as well as bilateral deficit in both strength and EMG signal. These results suggest that unilateral training promotes greater muscle stimulation, and can thus represent an important strategy to be used in the prescription of strength training exercises.O treinamento de força tem sido referido como uma importante ferramenta para o incremento e a manutenção da saúde. Os exercícios que compõem um programa de treino podem ser executados em condição unilateral ou bilateral. Alguns estudos têm apresentado valores mais reduzidos de produção de força e sinal eletromiográfico em condições bilaterais do que o somatório desses valores em condições unilaterais. Essa diferença na produção de força, bem como no sinal eletromiográfico é denominada déficit bilateral. O objetivo do presente estudo foi avaliar a produção de força e a atividade eletromiográfica dos músculos reto da coxa e vasto lateral no exercício de extensão isométrica de joelhos, nas condições unilateral e bilateral. A amostra foi constituída de 10 indivíduos do sexo masculino, com idades entre 18 e 30 anos, não praticantes de treinamento de força. Foram registrados os valores de força e atividade elétrica com a utilização de uma célula de carga e eletrodos de superfície, respectivamente, no teste isométrico de extensão de joelhos (120º). Os resultados apontaram valores maiores (p<0,05) para a produção de força e sinal eletromiográfico na condição unilateral do exercício, reportando um déficit bilateral tanto na força como na atividade eletromiográfica. Estes resultados sugerem que o treino unilateral promove maior estímulo muscular, constituindo-se como uma importante estratégia a ser utilizada na prescrição dos exercícios de força.20221

Evaluation of bilateral deficit in isometric contractions of the knee extensors

O treinamento de força tem sido referido como uma importante ferramenta para o incremento e a manutenção da saúde. Os exercícios que compõem um programa de treino podem ser executados em condição unilateral ou bilateral. Alguns estudos têm apresentado valores mais reduzidos de produção de força e sinal eletromiográfico em condições bilaterais do que o somatório desses valores em condições unilaterais. Essa diferença na produção de força, bem como no sinal eletromiográfico é denominada déficit bilateral. O objetivo do presente estudo foi avaliar a produção de força e a atividade eletromiográfica dos músculos reto da coxa e vasto lateral no exercício de extensão isométrica de joelhos, nas condições unilateral e bilateral. A amostra foi constituída de 10 indivíduos do sexo masculino, com idades entre 18 e 30 anos, não praticantes de treinamento de força. Foram registrados os valores de força e atividade elétrica com a utilização de uma célula de carga e eletrodos de superfície, respectivamente, no teste isométrico de extensão de joelhos (120º). Os resultados apontaram valores maiores (p<0,05) para a produção de força e sinal eletromiográfico na condição unilateral do exercício, reportando um déficit bilateral tanto na força como na atividade eletromiográfica. Estes resultados sugerem que o treino unilateral promove maior estímulo muscular, constituindo-se como uma importante estratégia a ser utilizada na prescrição dos exercícios de força.Strength training has been reported as an important tool for enhancing and maintaining health. Resistance exercises can be executed unilaterally or bilaterally. Some studies have reported lower strength and electromyography (EMG) signal values in bilateral conditions than the sum of these values in unilateral conditions. This difference in strength and EMG is called the bilateral deficit. The aim of this study was to evaluate the strength and EMG activity of the rectus femoris and vastus lateralis during unilateral and bilateral isometric knee extension. The sample consisted of 10 non-resistance trained males aged 18 to 30 years. Strength and EMG were recorded through use of a load cell and surface electrodes, respectively. A 120º knee extension was used for the isometric knee extension test. The results showed significantly higher values for strength and EMG signal (p <0.05) in unilateral conditions, as well as bilateral deficit in both strength and EMG signal. These results suggest that unilateral training promotes greater muscle stimulation, and can thus represent an important strategy to be used in the prescription of strength training exercises

Recruitment methods and yield rates in a clinical trial of physical exercise for older adults with hypertension—HAEL Study : a study within a trial

Background: Although the prevalence of hypertension is high in older adults, clinical trial recruitment is a challenge. Our main aim was to describe the HAEL Study recruitment methods and yield rates. The secondary objectives were to explore the reasons for exclusion and to describe the characteristics of the enrolled participants. Methods: This is a descriptive study within a trial. The HAEL Study was a Brazilian randomized two-center, parallel trial with an estimated sample of 184 participants. The recruitment strategy was based on four methods: electronic health records, word of mouth, print and electronic flyer, and press media. The yield rate was the ratio of the number of participants who underwent randomization to the total number of volunteers screened, calculated for overall, per recruitment method, by study center and by age group and sex. Additionally, we described the reasons for exclusion in the screening phase, as well as the demographic characteristics of those enrolled. The data are presented in absolute/relative frequencies and mean ± standard deviation. Results: A total of 717 individuals were screened, and 168 were randomized over 32 months. The yield rate was higher for word of mouth (30.1%) in the overall sample. However, press media contributed the most (39.9%) to the absolute number of participants randomized in the trial. The coordinating center and participating center differed in methods with the highest yield ratios and absolute numbers of randomized participants. The main reason for exclusion in the screening phase was due to the physically active status in those intending to participate in the study (61.5%). Out of 220 participants included, 52 were excluded mainly because they did not meet the eligibility criteria (26.9%). Most of the screened volunteers were women (60.2%) age 60–69 years (59.5%), and most of the randomized participants were Caucasian/white Caucasian/white (78.0%). Conclusions: Multiple recruitment methods constituted effective strategies. We observed that approximately one of every four individuals screened was allocated to an intervention group. Even so, there were limitations in obtaining a representative sample of older Brazilian adults with hypertension. Data show an underrepresentation of race and age groups

Association between physical exercise interventions participation and functional capacity in individuals with type 2 diabetes : a systematic review and meta-analysis of controlled trials

Background: The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity. Methods: A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses. Results: Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I2 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I2 0%], and maximum oxygen consumption (VO2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I2 100%] compared with control groups. In sensitivity and subgroup analyses using VO2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO2max [p = 0.34; I2 99.6%; R2 = 2.6%]. In addition, the quality of the included studies was mostly low. Conclusion: The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates

The "Hypertension approaches in the elderly: a lifestyle study" multicenter, randomized trial (HAEL Study) : rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices

The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017

Perfil da situação de saúde dos idosos participantes de um programa municipal de atividades físicas: um estudo transversal

The assessment of health profile in users attending such public programs may optimize tailoring of interventions oriented to reduce the risk or incidence of lifestyle-driven diseases, resulting in a potential impact on public health. Therefore, this cross-sectional study aimed to characterize the health profile of the elderly participants in the physical activity public program in southern Brazil. Therefore, we included 11 community exercise centers managed by the city of Porto Alegre (Brazil). We used simple random sampling, with sample size weight by the number of participants in each individual center. Several health domains were measured by self-reported questionnaires (e.g., cardiovascular risk factors and quality of life), office blood pressure measurements, blood assessments (i.e., lipid profile and HbA1c) and functional tests (i.e., 6-minute walk test and handgrip strength) between April/2018 to February/2019. The results are mostly reported using descriptive statistics. We observed that high self-reported prevalences regarded to cardiovascular risk factors, more specifically for sleep disorder (55%), hypercholesterolemia (54%) and hypertension (49%). Among self-reported diseases, the participants listed cardiovascular diseases (14%), previous cancer (15%), diabetes (13%), arthritis (30%), and depression (19%). The results observed in the 6-minute walk test (mean±sd 498±78.95 m) and handgrip test (mean±sd 27±8.13 kg) showed the expected levels for active elderly. Overall, the prevalences presented herein allow to contrast the estimated prevalences of older adults using a public program of physical activity to other populational estimates or single studies, fostering the future monitoring of assessments and interventions in sensible conditions (e.g., hypertension, sleep disorder) for this population.&nbsp;O conhecimento do perfil de saúde dos usuários de programas públicos para promoção em saúde pode otimizar a elaboração e aperfeiçoamento de intervenções para controle doenças ou de eventos associados ao estilo de vida, com potencial impacto para a saúde pública. O objetivo deste estudo foi caracterizar o perfil da situação de saúde dos usuários idosos do programa público de atividade física, em 11 centros comunitários da cidade de Porto Alegre (RS, Brasil). Entre abril/2018 e fevereiro/2019, foram medidos domínios de saúde por questionários autoaplicados, avaliações sanguíneas e testes funcionais. O tamanho amostral foi ponderado pela quantidade de alunos atendidos por centro, com amostragem por aleatorização simples. As análises basearam-se em estatística descritiva. No total, 351 idosos (69±6 anos) foram incluídos. Houve elevadas prevalências de fatores de risco, sendo transtorno do sono (55%), hipercolesterolemia (54%), e hipertensão arterial (49%) as mais altas. Entre as doenças autorrelatadas, os participantes listaram condições cardiovasculares (14%), câncer prévio (15%), diabetes (13%), artrite reumatóide (30%) e depressão (19%). A capacidade de caminhada em 6 minutos e força de preensão manual estiveram em níveis de pessoas ativas. Este estudo possibilita contrastar as condições prevalentes dos idosos usuários de um programa público de atividade física com estimativas populacionais, servindo como levantamento inicial para futuro monitoramento de avaliações e/ou intervenções específicas às condições sensíveis nesta população