Acute changes in glucose induced by continuous or intermittent exercise in children and adolescents with type 1 diabetes

ABSTRACT Objective: To estimate the rate of change during exercise and during recovery in moderate-continuous exercise (MCE) and high-intensity intermittent exercise (HIIE) in children and adolescents with type 1 diabetes (T1D). Subjects and methods: Participants performed 2 sessions of exercise: thirty minutes of continuous activity on a cycle ergometer (60% of VO2max) and thirty minutes (60% VO2max) interspersed with five bouts of maximum intensity lasting ten seconds every five minutes. Capillary blood glucose was measured before and after each test. The glucose rate of change in exercise (RoCE) was calculated (final blood glucose - onset blood glucose/exercise time), and the glucose rate of change in recovery (RoCR) (blood glucose 30 minutes after exercise - end of exercise blood glucose/recovery time). Results: The study included thirty-one participants (aged 13 ± 1.88 years). A lower blood glucose reduction was observed in the HIIE group, as well as better recovery values before, after, and thirty minutes after the test, respectively (333.14 ± 69.53, 226.19 ± 68.05 and 201.77 ± 66.84 versus 211.36 ± 91.03, 155.98 ± 82,68 and 165.76 ± 72.94). Covariance analyses showed a significant difference in glycemic variation between continuous and intermittent protocols immediately after exercise (−2.90 versus −2.08) and during the recovery period (−0.677 versus −0.389). Conclusions: HIIE led to a lower glucose reduction rate per minute during exercise and better recovery in the first 30 minutes after exercise compared to MCE in children and adolescents with T1D.

Acute changes in glucose induced by continuous or intermittent exercise in children and adolescents with type 1 diabetes.

Objective: To estimate the rate of change during exercise and during recovery in moderate-continuous exercise (MCE) and high-intensity intermittent exercise (HIIE) in children and adolescents with type 1 diabetes (T1D). Methods: Participants performed 2 sessions of exercise: thirty minutes of continuous activity on a cycle ergometer (60% of VO2max) and thirty minutes (60% VO2max) interspersed with five bouts of maximum intensity lasting ten seconds every five minutes. Capillary blood glucose was measured before and after each test. The glucose rate of change in exercise (RoCE) was calculated (final blood glucose - onset blood glucose/exercise time), and the glucose rate of change in recovery (RoCR) (blood glucose 30 minutes after exercise - end of exercise blood glucose/recovery time). Results: The study included thirty-one participants (aged 13 ± 1.88 years). A lower blood glucose reduction was observed in the HIIE group, as well as better recovery values before, after, and thirty minutes after the test, respectively (333.14 ± 69.53, 226.19 ± 68.05 and 201.77 ± 66.84 versus 211.36 ± 91.03, 155.98 ± 82,68 and 165.76 ± 72.94). Covariance analyses showed a significant difference in glycemic variation between continuous and intermittent protocols immediately after exercise (-2.90 versus -2.08) and during the recovery period (-0.677 versus -0.389). Conclusion: HIIE led to a lower glucose reduction rate per minute during exercise and better recovery in the first 30 minutes after exercise compared to MCE in children and adolescents with T1D.

Different amounts of moderate to vigorous physical activity and change in glycemic variability in adolescents with type 1 diabetes: is there dose-response relationship?

OBJECTIVE: To identify the level of physical activity and glycemic variability of adolescents with type 1 diabetes mellitus and to compare glycemic variability on days with different amounts of moderate to vigorous physical activity (MVPA). SUBJECTS AND METHODS: A sample of 34 subjects aged 10 to 15 years, 18 (52.94%) female; age: 13.04 ± 1.94; HbA1c: 9.76 ± 1.51. Physical activity was measured by wGT3X accelerometer. The glucose data were obtained using continuous glucose monitoring, and the following glycemic variability measures were calculated: standard deviation (SD), low blood glucose index (LBGI), high blood glucose index (HBGI), mean amplitude of glycemic excursions (MAGE), glycemic risk assessment in diabetes equation (GRADE) and coefficient of variation (CV). The most and least active days (the days with greater and lesser time dedicated to physical activities of moderate to vigorous intensity, respectively) were identified. In addition, based on the whole period of accelerometer use, daily means of time spent in MVPA were identified among participants, who were then divided into three groups: up to 100 minutes; from 101 to 200 minutes and above 201 minutes. Then, the measures of glycemic variability were compared among the most and least active days and among the groups too. RESULTS: The amount of MVPA was significantly different between the days evaluated (237.49 ± 93.29 vs. 125.21 ± 58.10 minutes), but glycemic variability measures did not present a significant difference. CONCLUSION: Despite the significant differences in the amount of MVPA between the two days evaluated, the glycemic variability did not change significantly. Arch Endocrinol Metab. 2020;64(3):312-8.

Comparação da qualidade de vida e sono de adolescentes portadores e não portadores de diabetes mellitus tipo 1 / Comparison of quality of life and sleep of adolescents with and without type 1 diabetes mellitus

RESUMO A Diabetes Mellitus Tipo 1 (DM1) é uma doença autoimune que afeta milhares de pessoas atualmente, com maior concentração de casos na adolescência. O tratamento implica alterações no estilo de vida que podem apresentar influência negativa sobre a qualidade do sono (QS) e qualidade de vida (QV). O propósito do estudo foi comparar a QS e QV entre adolescentes portadores e não portadores de DM1. Participaram do estudo 74 adolescentes divididos por grupos e sexo: GDM1-F (n=19), GDM1-M (n=18), GC-F (n=21) e GC-M (n=16). Os instrumentos utilizados foram o Índice de Qualidade do Sono de Pittsburgh e WHOQOL-bref. Para comparar os grupos foi utilizado Análise de Covariância, ajustada pela idade, com Post Hoc de Bonferroni. Os resultados sinalizam que os participantes do GDM1-F e GDM1-M, portadores de DM1, apresentaram maiores escores em todas as avaliações, com diferença significativa com o CG-F nas variáveis: QS global, Domínios Físico, Psicológico e Relações Sociais e QV total. Portanto, foi possível observar que os adolescentes portadores de DM1 apresentaram melhor avaliação da QS e QV em comparação as meninas sem DM1, independentemente da idade.

ABSTRACT Type 1 Diabetes Mellitus (DM1) is an autoimmune disease that affects thousands of people today, with a higher concentration of cases in adolescence. Treatment involves lifestyle changes that can have a negative influence on quality of sleep (QS) and quality of life (QL). The purpose of the study was to compare QS and QL among adolescents with and without DM1. Seventy-four adolescents participated in the study divided by groups and sex: GDM1-F (n=19), GDM1-M (n=18), GC-F (n=21) and GC-M (n=16). The instruments used were the Pittsburgh Sleep Quality Index and WHOQOL-bref. Age-adjusted Covariance Analysis with Bonferroni Post Hoc was used to compare the groups. The results show that the participants of GDM1-F and GDM1-M, with DM1, had higher scores in all evaluations, with significant difference with CG-F in the variables: global QS, Physical, Psychological and Social Relationships and total QL. Therefore, it was possible to observe that adolescents with DM1 had better QS and QL evaluations than girls without DM1, regardless of age.

Influence of acute physical exercise on cognitive and motor behavior in an experimental model of alzheimer's disease / Influência do exercício físico agudo no comportamento cognitivo e motor em modelo experimental de alzheimer / Influencia del ejercicio físico agudo en el comportamiento cognitivo y motor en modelo experimental de alzheimer

ABSTRACT Introduction: Aging causes alterations in various executive and cognitive functions, mainly related to the incidence of dementia, especially Alzheimer's disease (AD). Several studies mention physical exercise as a preventive resource for depressive symptoms. Objective: To investigate the cognitive and behavioral alterations related to AD that are capable of slowing disease progression and its complications. Methods: The sample consisted of 10 male Wistar rats, divided into 2 groups (n = 5), swimming and Alzheimer + swimming, with a 6-day intervention protocol. The elevated plus maze test was used to assess anxiety, the Morris water maze for spatial memory, the isolation box for aversive memory, and the open field test to assay motor behavior. Results: There was improvement in spatial memory in the Swimming group (169 ± 142.9 x 24.2 ± 31.3), but motor behavior deteriorated after exercise. An increase in anxious behavior (8 ± 13.03 x 67.8 ± 48.1) was observed in the animals with AD. This is a relevant characteristic of the disease, which did not improve after acute exercise. By analyzing the size effect, it was possible to observe a difference in the Alzheimer + swimming group in terms of reduced anxiety and improved motor behavior after exercise. Despite the benefits of physical exercise for AD symptoms, there is still no consensus on the type of physical exercise and length of intervention necessary to achieve a positive response as a treatment method, since studies are yet to confirm this fact in an acute or chronic manner. Conclusion: Acute physical exercise was not fully effective as a means of treating behavioral alterations related to AD, but had a mean effect on the size effect analysis of motor behavior and anxiety, specifically. Level of evidence IV; Investigation of treatment outcomes.

RESUMO Introdução: O envelhecimento causa alterações de diversas funções executivas e cognitivas, principalmente relacionadas à incidência de demências, em especial, a doença Alzheimer (DA). Diversos estudos mencionam o exercício físico como um recurso preventivo de sintomas de depressão. Objetivo: Investigar as alterações cognitivas e comportamentais relacionadas à DA capazes de retardar a progressão da doença e suas complicações. Métodos: A amostra foi composta por 10 ratos Wistar machos divididos em 2 grupos (n = 5), Natação e Alzheimer+Natação, com protocolo de 6 dias de intervenção. Foram realizadas avaliações da ansiedade pelo teste de labirinto elevado em cruz, memória espacial pelo labirinto aquático de Morris, memória aversiva pelo teste de aversão em caixa de isolamento e comportamento motor por meio do teste Open Field. Resultados: No grupo Natação houve melhora na memória espacial (169 ± 142,9 x 24,2 ± 31,3), porém verificou-se comportamento motor pior depois do exercício. Igualmente, observou-se aumento do comportamento de ansiedade (8 ± 13,03 x 67,8 ± 48,1) nos animais com DA, característica relevante da doença, que não apresentou melhora após o exercício agudo. Através da análise do Size effect foi possível observar que houve diferença no grupo Alzheimer+Natação na diminuição da ansiedade e melhora do comportamento motor após o exercício. Apesar dos benefícios do exercício físico para os sintomas da DA, ainda não existe um consenso sobre o tipo de exercício e o tempo de intervenção necessários para que se tenha uma resposta positiva como método de tratamento, uma vez que ainda não existem estudos que comprovem esse fato de maneira aguda ou crônica. Conclusão: O exercício físico de forma aguda não se mostrou totalmente eficaz como tratamento das alterações comportamentais com relação à DA, porém obteve um efeito médio na análise pelo Size effect sobre o comportamento motor e a ansiedade, especificamente. Nível de evidência IV; Investigação dos resultados do tratamento.

RESUMEN Introducción: El envejecimiento causa cambios de diversas funciones ejecutivas y cognitivas, relacionadas con la incidencia de demencias, en especial, la enfermedad de Alzheimer (EA). Diversos estudios mencionan el ejercicio físico como un recurso preventivo de síntomas de depresión. Objetivo: Investigar las alteraciones cognitivas y de comportamiento relacionadas a la EA capaces de retardar la progresión de la enfermedad y sus complicaciones. Métodos: Diez ratas Wistar machos divididas en 2 grupos (n = 5), Natación y Alzheimer+natación, con protocolo de intervención de 6 días. Se realizaron evaluaciones de la ansiedad por la prueba del laberinto elevado en cruz, memoria espacial por el laberinto acuático de Morris, memoria aversiva por la prueba de aversión en caja de aislamiento y comportamiento motor por de la prueba de campo abierto. Resultados: En el grupo Natación hubo mejoría en la memoria espacial (169 ± 142,9 x 24,2 ± 31,3), pero se observó comportamiento motor peor después del ejercicio. También se observó un aumento del comportamiento de ansiedad (8 ± 13,03 x 67,8 ± 48,1) en los animales con EA, característica relevante de la enfermedad, que no presentó mejoría después del ejercicio agudo. A través del análisis del Size effect fue posible observar que hubo diferencia en el grupo Alzheimer+Natación en la reducción de la ansiedad y de mejora del comportamiento motor después del ejercicio. A pesar de los beneficios del ejercicio físico en los síntomas de la EA, todavía no hay consenso sobre el tipo de ejercicio físico y el tiempo de intervención necesarios para tener una respuesta positiva como método de tratamiento, ya que aún no existen estudios que demuestren ese tipo de hecho agudo o crónico. Conclusión: El ejercicio físico de forma aguda no fue totalmente eficaz como tratamiento de las alteraciones de comportamiento con relación a la EA, pero obtuvo un efecto promedio en el análisis por el Size effect sobre el comportamiento motor y la ansiedad, específicamente. Nivel de evidencia IV; Investigación de los resultados del tratamiento.

Applicability of the body adiposity index to estimate body fat in adolescents with type-1 diabetes mellitus / Aplicabilidade do índice de adiposidade corporal na estimativa do percentual de gordura de adolescentes com diabetes mellitus tipo 1

ABSTRACT The aim of the present study was to verify the level of concordance between Body Adiposity Index (BAI) and Dual-energy X-ray Absorptiometry (DEXA) in the evaluation of body fat percentage in adolescents with type-1 diabetes mellitus (DM1). The sample consisted of 34 adolescents (16 boys and 18 girls) aged 10-15 years. Height and hip circumference data were collected for BAI calculation, and fat percentage was evaluated using DEXA. The Shapiro Wilk test was used to verify data normality. The Wilcoxon test was performed to compare age, anthropometric and BMI, BAI z score and DEXA between sexes. The correlation of variables (BAI vs DEXA) was evaluated by the Spearman correlation coefficient. For the analysis of residual scores, the Bland-Altman test was applied. The Kappa coefficient (k) was performed to assess the level of concordance between BAI and DEXA. Therefore, weak and non-significant correlation between BAI and DEXA in boys (r= 0.19, p= 0.46), and girls (r= 0.10, p= 0.73) was observed. Thus, weak concordance was observed (k= 0.09) for both sexes. It was concluded that BAI is not recommended to estimate fat percentage in adolescents with DM1.

Resumo O objetivo do presente estudo foi verificar o nível de concordância entre o Absortometria de Raio-x de Dupla Energia (DEXA) na avaliação do percentual de gordura de adolescentes com diabetes mellitus tipo 1 (DM1). A amostra foi constituída por 34 adolescentes (16 meninos e 18 meninas) com idades entre 10 e 15 anos. Coletaram-se os dados de estatura e circunferência do quadril para cálculo do IAC, bem como avaliação do percentual de gordura via DEXA. O teste de Shapiro Wilk foi utilizado para verificar a normalidade dos dados. O teste de Wilcoxon foi realizado para comparar as variáveis de idade, antropométricas e IMC score Z, IAC e DEXA entre sexos. A correlação das variáveis (IAC vs DEXA) foi avaliada pelo coeficiente de correlação de Spearman. Para análise dos escores residuais aplicou-se o teste de Bland-Altman. O coeficiente de Kappa (k) foi realizado para avaliar o nível de concordância entre o IAC e DEXA. Sendo assim, foi encontrada correlação fraca e não significante entre IAC e DEXA tanto nos meninos (r=0,19; p=0,46), quanto nas meninas (r=0,10; p=0,73). Dessa forma, foi possível perceber concordância fraca (k= 0,09) para ambos os sexos. Conclui-se que o IAC não é recomendado para estimar percentual de gordura em adolescentes com DM1.

Efeito de um programa de fisioterapia aquática no equilíbrio e capacidade funcional de idosos / Effect of an aquatic physiotherapy program on balance and functional capacity in elderly

O objetivo do estudo foi avaliar o efeito de um programa de fisioterapia aquática para o equilíbrio e capacidade funcional de idosos. Trata-se de um estudo clínico, prospectivo e de delineamento longitudinal com idosos cadastrados em um grupo de hipertensos e diabéticos (n= 11). O equilíbrio foi avaliado por meio do teste de Tinetti e a capacidade funcional foi avaliada através do teste de caminhada de 6 minutos. A intervenção consistiu de 3 sessões semanais de fisioterapia aquática com duração de 40 minutos cada, por um período de dois meses. Foram realizados testes pré e pós-intervenção, com inclusão de grupo-controle. A análise estatística foi realizada com auxílio do software SPSS-16. As variáveis quantitativas foram avaliadas pelo teste de normalidade Kolmogorov-Smirnov. Diante da normalidade, foi utilizado o teste T pareado com nível de significância de 0,05. O grupo experimental apresentou diferenças significativas (p<0,05) no teste de equilíbrio, enquanto no teste que avaliou a capacidade funcional não houve diferença estatisticamente significativa (p> 0.05). Entretanto, observou-se melhora nos resultados pós-intervenção. O grupo estudado não apresentou melhoras significativas com relação à capacidade funcional, porém a fisioterapia aquática melhorou estatisticamente o equilíbrio dos idosos participantes. Neste sentido, a hidroterapia pode ser incluída em programas de promoção à saúde e prevenção de doenças, minimizando o impacto do processo de envelhecimento.

This study aims to assess the effect of aquatic physiotherapy for balance and functional capacity of elderly. This is a clinical, prospective, longitudinal study with elderly people enrolled in a group of hypertensive and diabetic patients (n= 11). The balance was assessed using the Tinetti test and the functional capacity through the 6-minute walk test. The intervention consisted of 3 weekly sessions of 40 minutes each of aquatic physiotherapy during 2 months. Pre and post intervention tests were performed, including with a control group. The statistical analysis was performed using SPSS-16 software. The quantitative variables were assessed by the Kolmogorov-Smirnov test. Face the normality, the paired T-test was utilized with a significance level of 0.05 The experimental group presented significant differences (p <0.05) in the balance test, while there was no statistically significant difference in the functional capacity test (p> 0.05). However, it was noted an improvement in the post-intervention results. The group studied did not present significant improvements in regarding the functional capacity, but the aquatic physiotherapy statistically improved the balance of the elderly who participated of the study. In this regard, the hydrotherapy can be included in health promotion and disease prevention programs, minimizing the impact of the aging process.

Comparação das pressões respiratórias máximas em idosos que praticam exercícios no solo e água / Comparison of maximal respiratory pressures in elderly subjects who practice exercises in soil and water / Comparación de la fuerza muscular respiratoria en adultos mayores que hacen ejercicio en el suelo y agua

O objetivo do estudo foi comparar a força muscular respiratória em idosos saudáveis praticantes de exercícios em dois meios, solo e água. A amostra foi composta por 20 idosos de ambos os gêneros, que foram divididos em dois grupos, GS (Grupo-Solo) e GA (Grupo-Água). As avaliações das pressões inspiratórias máximas (PImáx) e pressões expiratórias máximas (PEmáx) foram realizadas através do aparelho manovacuômetro manual. Os resultados demonstraram não haver alterações significativas na musculatura respiratória de ambos os grupos.

The objective of this study was to compare respiratory muscle strength in healthy elderly exercise practitioners in two media, soil and water. The sample consisted of 20 elderly of both genders, who were divided into two groups, GS (Soil Group) and GA (Water Group). The maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) were evaluated using the manual manometer instrument. The results showed no significant changes in the respiratory muscles of both groups.

El objetivo del estudio fue comparar la fuerza muscular respiratoria en ancianos sanos practicantes los ejercicios en dos maneras, el suelo y el agua. La muestra fue constituida por 20 ancianos de ambos sexos, que fueron divididos en dos grupos, GS (Grupo Suelo) y GA (Grupo Agua). Las evaluaciones de la presión inspiratoria máxima (PIM) y la presión espiratoria máxima (PEM) se realizaron usando aparato manómetro de vacío manual. Los resultados no mostraron cambios significativos en los músculos respiratorios de ambos grupos.