[Evaluation of a supervised physical exercise program in sedentary patients over 65 years with type 2 diabetes mellitus]

Effects of aerobic exercise on components of the metabolic syndrome in older adults with type 2 diabetes mellitus: systematic review and meta-analysis

OBJECTIVE.

To determine the effects of aerobic exercise on the components of the metabolic syndrome in older adult diabetic patients by means of a systematic review with meta-analysis.

MATERIALS AND METHODS.

We used the PubMed/Medline, Scopus, Cochrane library, Web of Science databases and the Google Scholar search engine. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Two reviewers independently determined whether studies met the inclusion criteria, extracted data, and used the Cochrane risk of bias tool (RoB 2). Quantitative analyses were performed in R v 4.0.5, using random effects.

RESULTS.

We identified 8697 studies, of which 7 RCTs were included in the qualitative synthesis. Most studies were assessed as having a high or low RoB in at least three domains. Meta-analysis showed that aerobic exercise was effective in improving glucose levels (standardized mean difference [SMD]: -1.04; 95% confidence interval [95% CI] -1.27, -0.81), systolic blood pressure (SMD: -0.79; 95% CI: -1.02, -0.56), diastolic blood pressure (SMD: -0.75; 95% CI: -0.98, -0.52), glycosylated hemoglobin (SMD: -0.57, 95% CI: -0.77, -0.37), HDL (SMD: 0.35, 95% CI: 0.15, 0.55), triglycerides (SMD: -0.26, 95% CI: -0.47, -0.06). No significant adverse effects were reported. The level of certainty of the results was low for fasting glucose, moderate for systolic and diastolic blood pressure, and very low for the other outcomes, in addition to few adverse effects. However, these results should be interpreted with caution due to the use of surrogate markers.

CONCLUSIONS.

Aerobic exercise was shown to have a significant improvement in the components of the metabolic syndrome in older diabetic adults, and no major adverse effects were reported. However, we recommend more RCTs with longer intervention time to establish the impact on symptoms and complications.

Motivation for the study. The motivation for this research arises from the high prevalence of metabolic syndrome and diabetes mellitus around the world. Despite their impact, there is a gap in knowledge regarding non-pharmacological interventions in older adults aimed at improving the metabolic profile of these patients. Main findings. Our results show a significant improvement in glucose, blood pressure, glycosylated hemoglobin, HDL, and triglyceride levels after the aerobic exercise intervention. In addition, no significant adverse effects were observed. Public health implications. Physical exercise is an affordable and globally available strategy. It improves the metabolic profile of older adult patients with metabolic syndrome.

Effects of Mind-Body Training as a Mental Health Therapy in Adults with Diabetes Mellitus Type II: A Systematic Review

The increase in the prevalence and disease burden of diabetes has highlighted the need to strengthen a comprehensive care system that includes mental health treatment. A systematic review was carried out to analyze the effectiveness of mind-body training as a therapy for the mental health management of adult patients with type 2 diabetes mellitus (T2DM) following the PRISMA 2020 guidelines. Pubmed, Scopus and Web of Science databases were consulted between November and December 2022. Eight articles were selected according to the inclusion and exclusion criteria. Only randomized controlled trials were included. The interventions focused on mindfulness and yoga with variable durations of between 8 weeks and 6 months. Four of the included studies observed statistically significant changes (p < 0.05) in anxiety. Six articles determined that mind-body training was effective for treating depression. Finally, five articles found favorable effects on stress, while one did not observe changes at 8 weeks of intervention or after 1 year of follow-up. The evidence supports the use of mind-body training to reduce stress, depression, and anxiety levels in the adult population with T2DM, which makes this type of training a valuable intervention to be included in an integral approach to diabetic pathology.

Maintenance of Physical Activity Behavior by Individuals with Prediabetes and Diabetes during the COVID-19 Pandemic after Completing an Exercise Intervention in Brazil

This cross-sectional study evaluated the perception of individuals with prediabetes/diabetes about their living conditions during the COVID-19 pandemic to identify the facilitators, barriers, and reasons to remain physically active at home and adhere to recommended exercise. It included individuals with prediabetes/diabetes who had completed an exercise intervention, which started on-site and moved to a remote home-based regime due to the COVID-19 pandemic and were advised to keep exercising at home. The outcomes were assessed by a bespoke questionnaire that was developed by the research team, the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale, and the Motives for Physical Activity Measure-Revised scale. Of 15 participants (8 female, 58 ± 11 years), most reported positive perceptions about their living conditions and few difficulties maintaining some physical activity at home. However, only 53.8% of them adhered to the recommended exercise. Time flexibility, no need for commuting, and a sense of autonomy were the main facilitators of home exercise, while a lack of adequate space was the main barrier. The descending order of median scores that were obtained in each reason for physical activity was fitness, enjoyment, competence, social, and appearance. Individuals with prediabetes/diabetes maintained some physical activity during the pandemic, mainly motivated by health concerns.

Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.

Effects of the COVID-19 pandemic on the global health of women aged 50 to 70 years

Aim/background

The most recent pandemic caused by the new coronavirus disease (COVID-19) urged dramatic changes in people's lives. Potentially, the COVID-19 pandemic affects physical and mental health as well as behavioral and social aspects. However, the direct impacts of the COVID-19 pandemic on health-related parameters are not yet known. The present study aimed to evaluate the effect of 16 weeks during the COVID-19 pandemic on health-related parameters of physically inactive women aged 50 to 70 years.

Methods

Thirty-four physically inactive women participated in the study. We performed tests to evaluate aerobic capacity and muscle strength, anthropometric measurements, blood pressure (BP), blood parameters, diet, and physical activity levels. All evaluations were carried out before and 16 weeks after the initial phase of the COVID-19 pandemic in Brazil (i.e., from March to July 2020).

Results

Systolic BP (p < .0001; effect size (ES) = 0.62), diastolic BP (p < .0001; ES = 0.71), grip strength of the right (p < .05; ES = 0.43) and left hand (p < .05; ES = 0.49), performance in six-minute walk test (p < .05; ES = 0.46), free time physical activity levels (p < .05; ES = 0.40), domestic physical activity levels (p < .05; ES = 0.39), platelet count (p < .0001; ES = 0.48), and mean corpuscular hemoglobin concentration (p < .0001; ES = 1.14) reduced in comparison to the period before the pandemic. In contrast, glycated hemoglobin levels (p < .0001; ES = 0.77), triglycerides (p < .05; ES = 0.40), and insulin levels (p < .05; ES = 0.60) increased in comparison to the period before the pandemic.

Conclusion

The COVID-19 pandemic negatively impacted the general health status of physically inactive women aged 50 to 70, potentially increasing their susceptibility to comorbidities, such as type 2 diabetes and hypertriglyceridemia.

Effects of aerobic training with and without progression on blood pressure in patients with type 2 diabetes: A systematic review with meta-analyses and meta-regressions

AIMS

To analyze the effects of aerobic training with and without progression on blood pressure in patients with type 2 diabetes.

METHODS

The databases used for the systematic search were PubMed, Cochrane Central, SPORTDiscus and LILACS. Studies which analyzed blood pressure before and after an intervention period of eight or more weeks of aerobic training compared to a control group without training in patients with type 2 diabetes were included.

RESULTS

Of the 4186 studies found, 17 clinical trials were included (912 participants). Systolic blood pressure (SBP) decreased after aerobic training with progression (-6.78 mmHg; 95% CI -8.36, -5.19; p < 0.001) and without progression (-8.07 mmHg; 95% CI -9.37, -6.77; p < 0.001). The same happened regarding diastolic blood pressure (DBP), which decreased with aerobic training with progression (-3.10 mmHg; 95% CI -4.90, -1.31; p < 0.001) and without progression (-5.71 mmHg; 95% CI -7.15, -4.28; p < 0.001).

CONCLUSION

Aerobic training is effective in reducing blood pressure in patients with type 2 diabetes, regardless of progression in training variables.

[Knowledge in the prescription of Physical Exercise by Primary Care professionals in the Region of Murcia]

OBJECTIVE

To determine if the Primary Health care professionals prescribe physical exercise (PE) using adequate knowledge criteria.

MATERIAL AND METHOD

A comparative cross-sectional descriptive and observational study carried out in 32 health centres in the Region of Murcia. A total of 476 doctors and 327 nurses were included. A questionnaire was administered to all of them, in which the variables analysed were: Level of overall and specific knowledge by blocks of pathologies (lipids, diabetes, hypertension, obesity, and generalities) on the prescribing of PE to patients with cardiovascular risk, as well as related variables associated with the quality of prescribing PE.

RESULTS

Statistically significant differences in knowledge were found in the group that recommends heart rate measurement in «30% to 70%» of their patients. Differences in the subgroups were observed in the sections on diabetes (P < 0.05), obesity (P < 0.05), and hypertension (P <0.05). When analysing the knowledge values obtained according to the proportion of patients to whom «very rarely» PE time is specified, significant differences are observed (P <0.05), showing doctors with a higher level of knowledge. The differences were accentuated between both professional groups in the group of respondents who specify time to «less than 30%» of their patients (P <0.01). There are no differences between those professionals who specify time to «more than 31%» of their patients, although the trend shows higher knowledge values among doctors.

CONCLUSIONS

The prescription of physical exercise among Primary Care professionals is not carried out using adequate knowledge criteria.

The Role of Aerobic Training Variables Progression on Glycemic Control of Patients with Type 2 Diabetes: a Systematic Review with Meta-analysis

BACKGROUND

Aerobic training (AT) improves glycemic control in patients with type 2 diabetes. However, the role of the progression of training variables remains unclear. The objective of this review was to analyze the effects of progressive AT (PAT) and non-progressive AT (NPAT) on glycated hemoglobin (HbA1c) in patients with type 2 diabetes.

METHODS

Data sources used were PubMed, Cochrane Central, Embase, SPORTDiscus, and LILACS. Studies that evaluated the effect of at least 12 weeks of PAT and NPAT compared to a control condition on HbA1c levels in type 2 diabetes patients were eligible for analysis. Two independent reviewers screened the search results, extracted the data, and assessed the risk of bias. Effect sizes (ESs) were calculated using the standardized mean difference in HbA1c levels between the intervention and control groups using a random-effect model.

RESULTS

Of 5848 articles retrieved, 24 randomized clinical trials (825 participants) were included. Among the included studies, 92% reported to have performed a randomization process, 8% presented allocation concealment, 21% reported blinding of outcome assessment, and 38% reported complete outcome data. AT reduced HbA1c levels by 0.65% (ES: - 1.037; 95% confidence interval [CI]: - 1.386, - 0.688; p < 0.001). The reduction in HbA1c induced by PAT was 0.84% (ES: - 1.478; 95% CI - 2.197, - 0.759; p < 0.001), and NPAT was 0.45% (ES: - 0.920; 95% CI - 1.329, - 0.512; p < 0.001). Subgroup analysis of the different forms of progression showed a reduction in HbA1c levels of 0.94% (ES: - 1.967; 95% CI - 3.783, - 0.151; p = 0.034) with progression in volume, 0.41% (ES: - 1.277; 95% CI - 2.499, - 0.056; p = 0.040) with progression in intensity, and 1.27% (ES: - 1.422; 95% CI - 2.544, - 0.300; p = 0.013) with progression in both volume and intensity. Subgroup analysis of the different modalities of AT showed a reduction of 0.69% (ES: - 1.078; 95% CI - 1.817, - 0.340; p = 0.004) with walking and/or running and of 1.12% (ES: - 2.614; 95% CI - 4.206, - 1.022; p = 0.001) with mixed protocols while progressive training was adopted. In non-progressive protocols, a significant HbA1c reduction was only found with walking and/or running (- 0.43%; ES: - 1.292; 95% CI - 1.856, - 0.72; p < 0.001).

CONCLUSION

The effect of PAT on glycemic control was greater than that of NPAT, especially when volume and intensity were progressively incremented throughout the interventions.