Physical exercise as treatment for adults with type 2 diabetes: a rapid review.

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of disability-adjusted life years (DALY). Physical exercise is an effective non-pharmacological intervention to promote glycaemic control in T2DM. However, the optimal exercise parameters for glycemic control in individuals with T2DM remain unclear. Objective: This study aimed to analyze the relationship between physical training variables - frequency, intensity, type, duration, volume, and progression - and glycemic control in individuals with T2DM. Methods: A rapid systematic literature review was conducted on PubMed and LILACS databases. The PICOT strategy was employed to define the inclusion criteria. Eligible studies had to assess the impact of exercise parameters (frequency, intensity, type, duration, volume, and progression) on glycemic control indicators, primarily glycosylated hemoglobin (HbA1c). Randomized and non-randomized clinical trials were included in the review. The methodological quality of each study was assessed using the PEDro scale (PROSPERO - CRD 42021262614). Results: Out of 1188 papers initially identified, 18 reports met the inclusion criteria and were included in the analysis. A total of 1,228 participants with T2DM (1086 in exercise groups) were included in the selected studies. Among these studies, 16 (88.9%) were RCTs and 2 (11.1%) were nRCTs. The age of participants ranged from 43.1 and 68.9 years, and the average intervention duration was 16.8 weeks. Data on adherence to the intervention, adverse events, detailed intervention protocol, and its impacts on glycaemic control, lipid profile, blood pressure, anthropometric measures, medication, body composition, and physical fitness are reported. Conclusion: The evidence supports the safety and effectiveness of physical exercises as non-pharmacological interventions for glycemic control. Aerobic, resistance and combined training interventions were associated with reductions in HbA1c and fasting glucose. The diversity of the physical exercise intervention protocols investigated in the studies included in this review is an important limitation to generalizing evidence-based practice. The call for action is mandatory to implement large-scale education programs on the prevention of diabetes and public health policies aimed to include well-planned and supervised exercise programs as an essential part of the primary prevention of type 2 diabetes. Systematic Review Registration: PROSPERO, identifier (CRD42021262614).

Five-year survival rate and prognostic factors in women with breast cancer treated at a reference hospital in the Brazilian Amazon.

Breast cancer is the most prevalent malignant neoplasm and the leading cause cancer of death among women globally. In Brazil, survival rates vary according to the region and few studies have been conducted on breast cancer survival in less developed areas, such as the Amazon region. The aim of this study was to analyze the five-year survival rate and prognostic factors in women treated for breast cancer in the city of Belém in northern Brazil. A retrospective hospital-based cohort study was conducted (2007-2013). Sociodemographic, clinical/tumor, and treatment variables were obtained from the records at the Ophir Loyola Hospital. Survival analysis involved the Kaplan-Meier statistical method and Cox regression analysis was performed. The significance level was 5% (p <0.05). A total of 1,430 cases were analyzed. Mean survival time was 51.71 (± 17.22) months, with an estimated overall survival of 79.4%. In the multivariate analysis, referral from the public health care system, advanced clinical stage, lymph node involvement and metastasis were associated with worse prognosis and lower survival rate. Radiotherapy and hormone therapy were associated with increased survival. These findings can contribute to the development of regional strategies for early detection of breast cancer, reducing the incidence and mortality rates and increasing survival time.

Physical training on glycemia and oxidative stress in type 2 diabetes: a systematic review / Treinamento físico na glicemia e estresse oxidativo em diabetes tipo 2: revisão sistemática / Entrenamiento físico en la glucemia y estrés oxidativo en diabetes tipo 2: revisión sistemática

ABSTRACT Introduction: Diabetes mellitus is accompanied by increased formation of reactive oxygen species (ROS) and decreased antioxidant capacity, leading to oxidative damage to cellular components. There is evidence to suggest that regular physical training positively changes oxidative homeostasis in the cells and tissues by lowering basal levels of oxidative damage, increasing resistance to oxidative stress. Objective: To verify the possible effects of aerobic physical training and resistance on glycemia and oxidative metabolism, and to determine whether there is any difference in outcomes resulting from different types of training in sedentary people with Type 2 Diabetes Mellitus (T2DM). Methods: A systematic review of controlled and randomized trials based on PRISMA. The databases LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect and BIREME were searched, combining the descriptors type 2 diabetes mellitus, resistance training, aerobic exercise and oxidative stress in Portuguese, English and Spanish. The methodological quality of the papers was assessed by the PEDro scale. The data were read, analyzed, extracted and summarized. Results: Of the 1386 papers retrieved, only five met the inclusion criteria. The five selected papers, consisting of controlled and randomized clinical trials, were summarized. Conclusion: There have been many published studies reporting on exercises and diabetes. However, there is limitation when it comes to comparing their results. The variability of research methods and measurement instruments used makes it difficult to draw conclusions as to which physical training modality is most effective in reducing glycemic levels and oxidative stress in sedentary individuals with T2DM, considering that in each study analyzed in this review, the response to these variables is different. In future research, it would be important to standardize exercise modality, intensity, training time and evaluation parameters. Level of evidence I; Systematic review of RCTs (Randomized controlled trials).

RESUMO Introdução: A diabetes mellitus é acompanhada por um aumento da formação de espécies reativas de oxigênio (EROs) e diminuição da capacidade antioxidante, levando a danos oxidativos dos componentes celulares. Há evidência sugerindo que o treinamento físico regular altera positivamente a homeostase oxidativa nas células e tecidos, ao diminuir os níveis basais de danos oxidativos, aumentando a resistência ao estresse oxidativo. Objetivo: Verificar possíveis efeitos do treinamento físico aeróbio e de resistência sobre a glicemia e o metabolismo oxidativo e determinar se há diferença nos desfechos dos diferentes tipos de treinamento em indivíduos sedentários com Diabetes Mellitus tipo 2 (DM2). Métodos: Revisão sistemática de estudos controlados e randomizados baseada no PRISMA. Foram utilizadas as bases de dados LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect e BIREME combinando os descritores diabetes mellitus tipo 2, treinamento de resistência, exercício aeróbio e estresse oxidativo em português, inglês e espanhol. A qualidade metodológica dos artigos foi avaliada pela escala PEDro. Realizou-se a leitura, análise, extração e síntese dos dados. Resultados: De 1386 artigos consultados, apenas cinco atenderam aos critérios de inclusão. Foi realizada a síntese dos cinco artigos selecionados, os quais consistem em ensaios clínicos controlados e randomizados. Conclusão: Há muitos estudos publicados relacionando exercícios e diabetes, entretanto, há limitação quando se pretende comparar seus resultados. A variabilidade dos métodos de pesquisa e dos instrumentos de medição utilizados tornam difícil concluir sobre qual modalidade de treinamento físico é mais eficaz em relação à redução dos níveis glicêmicos e do estresse oxidativo em indivíduos sedentários com DM2, considerando que, em cada estudo analisado nessa revisão, a resposta para essas variáveis é diferente. Em futuras pesquisas seria importante padronizar a modalidade de exercício, intensidade, o tempo de treinamento e os parâmetros avaliativos. Nível de evidência I; Revisão sistemática de ECRC (Estudos clínicos randomizados e controlados).

RESUMEN Introducción: La diabetes mellitus es acompañada por un aumento de la formación de especies reactivas de oxígeno (ROS) y disminución de la capacidad antioxidante, llevando a daños oxidativos de los componentes celulares. Algunas evidencias sugieren que el entrenamiento físico regular altera positivamente la homeostasis oxidativa en las células y tejidos, al disminuir los niveles basales de daños oxidativos, aumentando la resistencia al estrés oxidativo. Objetivo: Verificar posibles efectos del entrenamiento físico aeróbico y de resistencia sobre la glucemia y el metabolismo oxidativo, y determinar si hay diferencia en los desenlaces de los diferentes tipos de entrenamiento en individuos sedentarios con Diabetes Mellitus tipo 2 (DM2). Métodos: Revisión sistemática de estudios controlados y aleatorizados, con base en el PRISMA. Se utilizaron las bases de datos LILACS, IBECS, Pubmed/MEDLINE, Cochrane Library, SciELO, PEDro, ScienceDirect y BIREME combinando los descriptores diabetes mellitus tipo 2, entrenamiento de resistencia, ejercicio aeróbico y estrés oxidativo en portugués, inglés y español. La calidad metodológica de los artículos fue evaluada por la escala PEDro. Se procedió a la lectura, análisis, extracción y síntesis de los datos. Resultados: De 1386 artículos consultados, sólo cinco cumplieron los criterios de inclusión. Se hizo la síntesis de los cinco artículos seleccionados, que consisten en ensayos clínicos controlados y aleatorizados. Conclusión: Hay muchos estudios publicados relacionando ejercicios y diabetes, entretanto, existe limitación cuando se pretende comparar sus resultados. La variabilidad de los métodos de investigación y de los instrumentos de medición utilizados hacen que sea difícil concluir sobre qué modalidad de entrenamiento físico es más eficaz con relación a la reducción de los niveles glucémicos y del estrés oxidativo en individuos sedentarios con DM2, considerando que, en cada estudio analizado en esta revisión, la respuesta a estas variables es diferente. En futuras investigaciones sería importante estandarizar la modalidad de ejercicio, intensidad, el tiempo de entrenamiento y los parámetros evaluativos. Nivel de evidencia I; Revisión sistemática de ECAC (Estudios clínicos aleatorizados y controlados).

Técnicas de higiene brônquica em recém-nascidos e lactentes na unidade de terapia intensiva: revisão sistemática de ensaios clínicos / Bronchic hygiene techniques in newborns and infants in the intensive care unit: systematic review of clinical trials

INTRODUÇÃO: A fisioterapia respiratória tem obtido um importante espaço e reconhecimento ao possibilitar resultados de grande eficácia no tratamento intensivo do recém-nascido (RN) e do lactente. Um dos importantes objetos de trabalho da fisioterapia na Unidade de Terapia Intensiva (UTI) neonatal e pediátrica são as técnicas de higiene brônquica rotineiramente utilizadas, as quais apresentam grande variabilidade. OBJETIVO: Verificar as evidências científicas a respeito dos possíveis efeitos benéficos ou adversos, indicações e contraindicações das técnicas de higiene brônquica mais utilizadas no RN e no lactente na UTI. MATERIAIS E MÉTODOS: Trata-se de uma revisão sistemática, utilizando ensaios clínicos, sem delimitação temporal, baseada no protocolo PRISMA. Foram utilizadas as seguintes bases de dados: PubMed, LILACS, SciELO, PEDro e ScienceDirect. RESULTADOS: Foram identificados um total de 154 artigos, apenas 10 atenderam aos critérios de inclusão. Destes 5 (50%) associam tapotagem/percussão torácica, drenagem postural, aspiração de vias aéreas superiores e/ou traqueal e vibração e/ou vibrocompressão torácica manual; 1 (10%) associa drenagem, vibração e percussão; 1 (10%) associa vibrocompressão e aspiração nasotraqueal; 1 (10%) associa percussão e vibração torácica; 1 (10%) estudo utiliza a aspiração traqueal e 1 (10%) utiliza a vibrocompressão torácica manual. CONCLUSÃO: A maioria dos estudos encontrados não relataram contraindicações relevantes para impedir o uso de técnicas de higiene brônquica na UTI neonatal e pediátrica, entretanto, alguns resultados foram controversos quanto a sua correta e eficaz indicação. [AU]

INTRODUCTION: Respiratory physiotherapy has been an important space and is capable of great efforts in the treatment of the newborn (NB) and the infant. The main work items of neonatal and pediatric intensive care unit (ICU) are the routinely used bronchial hygiene techniques, such as those with great variability. OBJECTIVE: To verify the scientific evidences regarding the possible beneficial or adverse effects, indications and contraindications of the bronchic hygiene techniques most used in the NB and the infant in the ICU. MATERIALS AND METHODS: It is a systematic review, using clinical trials, without temporal delimitation, based on the PRISMA protocol. The following databases were used: PubMed, LILACS, SciELO, PEDro and ScienceDirect. RESULTS: A total of 154 articles were identified, only 10 met the inclusion criteria. These 5 (50%) associate tapping/thoracic percussion, postural drainage, aspiration of upper airways and/or tracheal and vibration and/or manual thoracic vibrocompression; 1 (10%) associates drainage, vibration and percussion; 1 (10%) associated vibrocompression and nasotracheal aspiration; 1 (10%) associates percussion and thoracic vibration; 1 (10%) study uses tracheal aspiration and 1 (10%) uses manual thoracic vibrocompression. CONCLUSION: Most studies found no relevant reported contraindications to prevent the use of bronchic hygiene techniques in the neonatal and pediatric ICU, however, some results were controversial as its correct and effective statement. [AU]