Comparison of Quadriceps and Hamstring Muscle Strength after Exercises with and without Blood Flow Restriction following Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial.

BACKGROUND: Muscle mass loss occurs following anterior cruciate ligament reconstruction surgery. OBJECTIVE: To compare the gain in muscle strength in the quadriceps and hamstring muscles in patients following anterior cruciate ligament reconstruction surgery, using exercises with and without blood flow restriction. METHODS: This is a randomized controlled trial, in which 50% (n = 14) of the participants were allocated to the intervention group and the remaining 50% (n = 14) to the control group. The study included the participation of postoperative patients, with reconstruction of the anterior cruciate ligament. RESULTS: After comparing the rehabilitation of the groups, a statistical difference was observed in the quadriceps with an increase in muscle strength (p < 0.01) after 12 weeks and an increase in muscle strength hamstrings (p < 0.01) after 8 and 12 weeks in the injured legs of the intervention group compared to the control. In the analysis of the participants' physical function, there was an significant increase difference in the Lysholm questionnaire (p < 0.01) after 8 and 12 weeks, in the KOOS pain questionnaire (p < 0.01) after 4 weeks a decrease was observed, symptoms and daily activities (p < 0.01) after 8 and 12 weeks, quality of life (p < 0.01) after 12 weeks, and in the IKDC questionnaire (p < 0.01) after 8 and 12 weeks there was an significant increase difference of the intervention group compared to the control. CONCLUSION: After anterior cruciate ligament surgery, exercises with blood flow restriction proved more efficient for improving the muscle strength of the quadriceps and hamstrings, and the physical function of the knee than the same exercises without blood flow restriction.

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.

Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country.

BACKGROUND: Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin). METHODS: This is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period. RESULTS: We studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8 + 1.8% to 8.7 ± 1.7% (basal vs 1st year; ns) and to 8.5 ± 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22 ± 0.12 to 0.32 ± 0.24 IU/kg of body weight/day (basal vs 1st year; p < 0.001) and to 0.39 ± 0.26 IU/kg of body weight/day (basal vs 2nd year; p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% (after 1 year; p = 0.001) and 62.2% (after 2 years; ns). CONCLUSION: Clinical inertia prevalence ranged from 56.2 to 78.5% at different moments of the insulin therapy (first 2 years and long term) of T2DM patients followed at a tertiary public Diabetes Center from an upper-middle income country with limited pharmacologic armamentarium.

Aerobic exercise capacity in normal adolescents and those with type 1 diabetes mellitus.

OBJECTIVE: To compare the aerobic exercise capacity between normal adolescents and those with type 1 diabetes mellitus (T1DM). METHODS: An experimental group with 72 individuals diagnosed with T1DM aged 9--20, time from diagnosis 4.9 +/- 3.6 yr, without clinical cardiopulmonary disease or anemia and a control group (C) with 46 healthy individuals aged 10--18, matched by age, weight, height, body mass index, and lean and fat mass (kg), underwent an incremental aerobic exercising test on a motorized treadmill, where gas exchange variables - peak pulmonary ventilation (VE), peak oxygen consumption (VO(2)), and carbon dioxide production (CO(2)) - as well as their heart rate (HR) and time to exhaustion were recorded. RESULTS: Body mass composition had no significant difference between experimental and control groups, and male and female subjects had similar exercising performances. The mean of hemoglobin A1c in the control group was 5.2+/- 0.9% and in the diabetic group 8.1+/- 2.2%; p=0.000. The patients with T1DM showed lower levels of aerobic capacity than the control group. Their respective values for each variable were as follows: (i) maximal VO(2) (T1DM: 41.57+/-7.68 vs. C: 51.12+/- 9.94 mL/kg/min; p< 0.001) and (ii) maximal VE (T1DM: 76.39+/-19.93 vs. C: 96.90 +/- 25.72 mL/kg/min; p< 0.001). Patients with T1DM also had an earlier time to exhaustion (T1DM: 8.75+/-1.60 vs. 10.82+/-1.44 min). CONCLUSIONS: Adolescent patients with T1DM showed a reduced aerobic exercising capacity when compared to healthy peers matched to anthropometric conditions. This potential condition should be taken into consideration by the time of evaluation of the aerobic performance of these patients with glycemic control level.