Efeito de um programa de exercícios físicos em mulheres diabéticas usuárias de Unidades Básicas de Saúde da cidade de Pelotas-RS: ensaio clínico randomizado.

Abstract

Type 2 Diabetes mellitus (T2DM) is a high prevalence disease in contemporary society, causing a high mortality rate and being directly associated to cardiovascular disease, blindness, kidney failure and lower limb amputation. Although the positive effects of physical exercise for the prevention and control of T2DM are evident in the literature, there are still some shortcomings in this area, especially with respect to the contemporary models of exercise that are emerging and with regard to the applicability of community low-cost interventions. The present thesis investigated the effects of functional physical training in women with T2DM users of Primary Health Units (PHU) in the urban area of the city of Pelotas, RS, Brazil, through a randomized clinical trial conducted between 2016 and 2017. The thesis includes a systematic review and metaanalysis, a methodological paper and an original papaer with the results of the intervention. In the first article, we tried to determine the effects of interventions with structured exercises (aerobic, resisted or combined) on outcomes related to T2DM: body mass index (BMI), fasting glycemia (GLI), insulin levels (INSUL) and insulin resistance (HOMA-IR), where the results demonstrated that aerobic exercises were efficient for reducing BMI, GLI and HOMA-IR index and that the combined exercises are effective for reducing BMI and the HOMA-IR index, attenuating the impact of T2DM. The second study described the experimental protocol of the intervention, as well as the outcomes and the way in which they were evaluated, in addition to the results of characterization of the sample at study's baseline. At that time, 60 elderly women mean age of 57.5 ± 9.0 years, with a diagnosis of T2DM at 7.4 ± 7.7 years, where 93.3% used diabetes medications, hypertension as comorbidity more reported (80%), moreover, 63.5% reported not performing physical activities, based on this scenario it seemed important to conduct an intervention in this population. In the third study, the objective was to determine the effects of the functional training program on outcomes related to T2DM in PHU users through a randomized clinical trial (NCT03221868), where five PHU were randomized, two for the intervention group (GI) and three for the control group (CG). Analyzes were conducted by intention to treat (n = 41) and adherence (n = 29). At baseline, in the two types of analyzes, GI differed from CG in relation to the consumption of drugs for other diseases, other than DMT2. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced in the two groups at the end of the intervention (SBP: p = 0.01 AIT; p = 0.03 AA) (DBP: p = 0.04 AIT ; p = 0.03 AA). The two-way ANOVA indicated that limb strength increased significantly in the GI at the end of the study (IM: p <0.001 AIT, p = 0.002 AA) and was significantly better in GI than in CG (p = 0.02 AIT and AA respectively), this difference was also verified by the delta variation (p = 0.002 AIT and p = 0.001 AA). The delta variation also showed improvement in maximal aerobic fitness in GI relative to GC (APTAM; p = 0.01 AIT and p = 0.02 AA) at the end of the study. Thus, in this study, it was possible to conclude that circuit training promoted a reduction in BP and an increase in the physical fitness of the participants. In conclusion, it can be inferred that structured physical exercise can contribute in an efficient way to control some DMT2-related health outcomes and that the intervention model with circuit training was efficient for controlling blood pressure and improving fitness among elderly women who, in their majority, had as main comorbidity the hypertension and more than 2/3 did not engage in physical activities at the beginning of the study.