Racial health disparities: a population-based analysis of physical activity and diabetes-related complications in Brazil.

OBJECTIVES: Racial disparity in physical activity in people with diabetes in Brazil remains scarcely investigated. We examined the association between physical activity and diabetes-related complications according to race in the Brazilian population. STUDY DESIGN: Cross-sectional. METHODS: We analyzed data from the 2019 National Health Survey, a population-based survey of Brazilian adults. We used a self-reported questionnaire to assess physical activity during commuting, leisure-time, domestic, and occupational activities. Diabetes-related complications included vision, kidney, and circulatory impairment, foot ulcers, diabetic coma, and all-cause complications. We used robust Poisson regression models with restricted cubic splines to examine the association between physical activity and diabetes-related complications. RESULTS: We included 2529 adults with diabetes (48.9% women; mean age: 53.5 ± 11.9 years). One-third experienced diabetes-related complications. Black adults performed less leisure-time and more occupational and commuting physical activity than White participants. Black participants showed a higher probability of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) compared to White participants independent of physical activity status. Only leisure-time physical activity was associated with a reduced probability of all-cause complications (PR: 0.78; 0.71, 0.86) whereas commuting and occupational physical activity were not associated with any diabetes-related complications. Physically inactive, Brown adults showed a higher probability of kidney, circulatory, vision, and all-cause complications than active, White adults. However, physical activity attenuated the probability of these complications in Brown participants. CONCLUSION: The association between physical activity and diabetes-related complications is domain-specific. We revealed a racial disparity in physical activity in people with diabetes in Brazil.

Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis.

AIMS/HYPOTHESIS: Supervised exercise programmes improve glycaemic control in type 2 diabetes, but training characteristics associated with reduction in HbA(1c) remain unclear. We conducted a systematic review with meta-regression analysis of randomised clinical trials (RCTs) assessing the association between intensity and volume of exercise training (aerobic, resistance or combined) and HbA(1c) changes in patients with type 2 diabetes. METHODS: Five electronic databases were searched (1980-2012) to retrieve RCTs of at least 12 weeks' duration, consisting of supervised exercise training vs no intervention, that reported HbA(1c) changes and exercise characteristics. Two independent reviewers conducted study selection and data extraction. RESULTS: Twenty-six RCTs (2,253 patients) met the inclusion criteria. In multivariate analysis, baseline HbA(1c) and exercise frequency explained nearly 58% of between-study variance. Baseline HbA(1c) was inversely correlated with HbA(1c) reductions after the three types of exercise training. In aerobic training, exercise volume (represented by frequency of sessions) was associated with changes in HbA(1c) (weighted r = -0.64), while no variables were correlated with glycaemic control induced by resistance training. In combined training, weekly volume of resistance exercise explained heterogeneity in multivariate analysis and was associated with changes in HbA(1c) levels (weighted r = -0.70). CONCLUSIONS/INTERPRETATION: Reduction in HbA(1c) is associated with exercise frequency in supervised aerobic training, and with weekly volume of resistance exercise in supervised combined training. Therefore, exercise volume is a major determinant of glycaemic control in patients with type 2 diabetes.

Impact of blood pressure cuff inflation rates on flow-mediated dilatation and contralateral arm response.

Flow-mediated dilatation (FMD) is widely used as an index of nitric oxide-mediated vasodilator function, yet its methodology has not been well established. Previous research indicates that a rapid inflation of a blood pressure cuff evokes systemic vasoconstriction, as it was observed even on non-occluded contralateral arm. This would potentially contribute to the variability of FMD readings and complicate the emerging evidence that non-occluded contralateral arm fingertip temperature responses during the FMD procedure may be an indicator of the presence of coronary artery disease. To test the hypotheses that rapid inflation of a blood pressure cuff could reduce FMD values and influence contralateral vasodilatory states, 33 apparently healthy adults (18 males and 15 females, 29±6 years) were studied in two randomized FMD trials. The blood flow-occluding cuff was inflated rapidly (<1 s) in one trial or slowly over 10 s in the other trial. Arterial diameter, fingertip temperature and infrared thermography were obtained throughout each session. FMD values were not different between the rapid and slow cuff inflation trials (5.9±0.6 vs 5.9±0.4%). There were no differences in reactive hyperaemia (6.4±1.6 vs 6.2±1.7 AU), shear stress (80±20 vs 77±17 dyn cm(-2)) and fingertip temperature rebound (TR; 1.8±1.2 vs 1.9±1.0 °C) between the rapid and slow inflation. Changes in finger temperature on the contralateral (non-occluded) arm were positively associated with those on the occluded arm (r=0.26 to 0.61, P<0.05). We concluded that rates of inflating a blood pressure cuff do not affect FMD and TR response, and that neurovascular-induced vasodilatation of the contralateral arm was not observed regardless of cuff inflation rates.

Effects of two different patterns of estradiol replacement on the sexual behavior of rhesus monkeys.

Seven pairs of rhesus monkeys consisting of adult males and adult, ovariectomized females were tested for sexual behavior. Behavioral tests were conducted under two patterns of estradiol treatment of the females. Under the "constant estrogen" condition, females were given SC injections of 10 micrograms estradiol benzoate on 28 consecutive days. Under the "cyclic estrogen" condition, females were given 28 days of estradiol treatment at varying doses based upon the artificial menstrual cycle devised by Michael, Zumpe and Bonsall (6). Rates of male mounting, hip-touch (incomplete mounts), and male threaten-away behavior (redirected aggression) increased during estradiol administration. Mounting peaked at the time of the highest estrogen dosage in the cyclic treatment condition, but was highest during the first portion of the period of constant treatment. Hip-touch and threaten-away behaviors were more frequent in the constant condition than during cyclic treatment. The high levels of these behaviors during the constant treatment suggest a lack of coordination between male and female motivation which is overcome by providing estradiol stimulation in a pattern which mimics the menstrual cycle.