2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes.

INTRODUCTION: For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021-2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. METHODS: SBD designated 9 specialists from its "Department of Diabetes, Exercise & Sports" to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021-2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. RESULTS: 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts' opinions. In respect to Recommendation Classes, the following criteria were adopted: I. "Recommended": Meaning there was a consent of more than 90% of the panel; IIa. "Must be considered": meaning there is a general preference of the panel which 70-90% agrees; IIb. "Can be considered". 50-70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. CONCLUSION: Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.

Fatores de adesão e permanência de idosos com diabetes tipo 2 a um programa de exercício físico / Factors influencing the initiation and continuation of physical exercise programs by elderly individuals with type 2 diabetes

Introdução: Grande parte dos idosos com diabetes tipo 2 não praticam exercício físico regular. Objetivos: Identificar os fatores que influenciam idosos com diabetes tipo 2 a praticarem exercícios físicos. Métodos: Trata-se de um estudo descritivo e analítico, transversal quantitativo. A amostra foi composta por 49 idosos, com diagnóstico de diabetes tipo 2. Foram aplicados questionários sobre adesão, permanência e desistência ao exercício e sintomas depressivos. Para análise dos dados foi calculado o alpha de Cronbach e foi realizada análise fatorial e correlação dos dados. Resultados: Os motivos para aderir a um programa de exercício físico foram indicação de amigos e familiares, intenção de melhorar a autoestima ou a autoimagem, indicação médica; e os motivos para permanecer ativo foram aliviar tensão, fazer amigos, desenvolver competências, queimar calorias, manter a flexibilidade. Conclusão: Os fatores extrínsecos são os que mais influenciaram idosos com diabetes mellitus tipo 2 a aderir a um programa de exercícios físico e a se manterem na prática.

Introduction: A great proportion of elderly people with type 2 diabetic do not regularly practice any type of physical exercise. Objectives: To identify factors that influence elderly people with type 2 diabetes to exercise. Methods: A descriptive and analytical cross-sectional quantitative study was conducted. The sample consisted of 49 elderly individuals diagnosed with type 2 diabetes. Questionnaires were applied regarding beginning, continuing and quitting exercise programs, as well as depressive symptoms. For the data analysis, Cronbach's alpha was calculated, and factor analysis and correlation of the data were performed. Results: The following reasons for beginning a physical exercise program were discovered: encouragement by friends and family, desire to improve self-esteem or self-image and medical referral. The reasons for staying active were to relieve tension, make friends, develop skills, obtain self-reward, burn calories and maintain flexibility. Conclusion: The results showed that extrinsic factors are the ones that most influence elderly people with type 2 diabetes to begin a physical exercise program and to continue with it.

Hipoglicemia em diabéticos tipo 2 praticantes de exercício físico / Hypoglycemia in diabetic type 2 practitioners physical exercise

Introdução: A hipoglicemia é, de fato, o mais frequente efeito secundário do tratamento da diabetes, e o principal obstáculo para a otimização do controle glicêmico. Objetivo: O Objetivo deste estudo foi identificar episódios de hipoglicemia em diabéticos tipo 2 praticantes de exercício físico. Métodos: Pesquisa descritiva, quase-experimental. Amostra foi composta por 18 mulheres com diabetes tipo 2, participantes do Projeto Doce Vida-Programa de Exercício Físico Supervisionado para Diabéticos da ESEF/UPE. O programa de treinamento aeróbio, resistido e combinado, teve duração de 38 semanas. A monitorização da glicemia foi realizada antes e imediatamente após as sessões de treino. Análise estatística foi à descritiva, com avaliação da frequência absoluta. Resultados: Após análise de todos os treinamentos, identificou-se 233 hipoglicemias, sendo 19 hipoglicemias moderadas, 214 hipoglicemias leves. Não ocorreram casos de hipoglicemias grave. Conclusão: Por fim, conclui-se que o treinamento físico aeróbio, resistido e combinado podem causar hipoglicemias de leves a moderadas em diabéticos tipo 2 desta amostra, principalmente o treinamento físico aeróbio, que obteve um maior número de hipoglicemias.

Introduction: Hypoglycaemia is, in fact, the most frequent side effect of diabetes treatment, and the main obstacle to optimizing glycemic control. Objective: The objective of this study was to identify episodes of hypoglycemia in type 2 diabetics practicing physical exercise. Methods: Descriptive, quasi-experimental research. Sample was composed of 18 women with type 2 diabetes, participants of the Sweet Life Project - Supervised Exercise Exercise for Diabetics of the ESEF / UPE. The combined aerobic training program lasted 38 weeks. Blood glucose monitoring was performed before and immediately after the training sessions. Statistical analysis was descriptive, with absolute frequency evaluation. Results: After analyzing all the training, 233 hypoglycemia was identified, 19 moderate hypoglycemia, 214 mild hypoglycaemia. There were no cases of severe hypoglycemia. Conclusion: Finally, aerobic, resisted and combined physical training may cause mild to moderate hypoglycemia in type 2 diabetics of this sample, mainly aerobic physical training, which obtained a greater number of hypoglycemias.

Development and validation of a predictive model of acute glucose response to exercise in individuals with type 2 diabetes.

BACKGROUND: Our purpose was to develop and test a predictive model of the acute glucose response to exercise in individuals with type 2 diabetes. DESIGN AND METHODS: Data from three previous exercise studies (56 subjects, 488 exercise sessions) were combined and used as a development dataset. A mixed-effects Least Absolute Shrinkage Selection Operator (LASSO) was used to select predictors among 12 potential predictors. Tests of the relative importance of each predictor were conducted using the Lindemann Merenda and Gold (LMG) algorithm. Model structure was tested using likelihood ratio tests. Model accuracy in the development dataset was assessed by leave-one-out cross-validation.Prospectively captured data (47 individuals, 436 sessions) was used as a test dataset. Model accuracy was calculated as the percentage of predictions within measurement error. Overall model utility was assessed as the number of subjects with ≤1 model error after the third exercise session. Model accuracy across individuals was assessed graphically. In a post-hoc analysis, a mixed-effects logistic regression tested the association of individuals' attributes with model error. RESULTS: Minutes since eating, a non-linear transformation of minutes since eating, post-prandial state, hemoglobin A1c, sulfonylurea status, age, and exercise session number were identified as novel predictors. Minutes since eating, its transformations, and hemoglobin A1c combined to account for 19.6% of the variance in glucose response. Sulfonylurea status, age, and exercise session each accounted for <1.0% of the variance. In the development dataset, a model with random slopes for pre-exercise glucose improved fit over a model with random intercepts only (likelihood ratio 34.5, p < 0.001). Cross-validated model accuracy was 83.3%.In the test dataset, overall accuracy was 80.2%. The model was more accurate in pre-prandial than postprandial exercise (83.6% vs. 74.5% accuracy respectively). 31/47 subjects had ≤1 model error after the third exercise session. Model error varied across individuals and was weakly associated with within-subject variability in pre-exercise glucose (Odds ratio 1.49, 95% Confidence interval 1.23-1.75). CONCLUSIONS: The preliminary development and test of a predictive model of acute glucose response to exercise is presented. Further work to improve this model is discussed.

Motivação do diabético tipo 2 para o tratamento não farmacológico / Motivation for a diabetic type 2 patient to adhere a non-pharmacological treatment

O presente estudo teve como objetivo verificar o que motiva o indivíduo diabético a frequentar um programa de exercício físico supervisionado. Esta investigação trata-se de uma pesquisa de cunho descritivo-quantiqualitativo de campo, em que foram avaliados 19 diabéticos do tipo2 (DM2); o instrumento utilizado foi um questionário validado para Escala de Motivação para o Tratamento (EMT) adaptada para a população diabética. A escala é constituída de 19 itens dos quais 13 avaliam a motivação intrínseca para o tratamento e 06 itens restantes avaliam a motivação extrínseca. Para análise estatística, utilizou-se o pacote SPSS 16.0 e os dados foram descritos em valores percentuais. Os motivos intrínsecos que apresentaram uma frequência elevada estavam relacionados com os fatores psicossociais (84,2%) e de saúde e qualidade de vida (73,7%), estes comprometem o ingresso e/ou permanência no tratamento do indivíduo DM2 na aderência ao tratamento. Ao mesmo tempo, os motivos extrínsecos que apresentaram maior frequência foram fatores interpessoais (57,9%) o que demonstra o quanto é determinante o apoio das pessoas que fazem parte do convívio do DM2 no auxílio ao tratamento. Com isso, pôde-se concluir que a motivação intrínseca, especificamente nos aspectos cognitivos e de mudança de comportamento são fatores determinantes para aderência ao tratamento não farmacológico.

This study aimed to determine what motivates the diabetic to attend a supervised physical exercise program. This investigation is a search for a descriptive quanti-qualitative of , which evaluated 19 diabetic single type 2 (DM2), the instrument was a validated questionnaire for Motivation Scale for Treatment (EMT) adapted to the diabetic population. The scale is constituted of 19 items, where 13 evaluate intrinsic motivation for treatment and the remaining 6 items measure extrinsic motivation for treatment. For statistical analysis was used SPSS 16.0 and the data was described in percentages. The intrinsic reasons that showed a high frequency are related to psychosocial factors (84.2%) and health and quality of life (73.7%), they undertake to enter and / or permanence of the DM2 in the treatment adherence. At the same time, the extrinsic reasons factors was shower more high frequency were the interpersonal factors (57.9%) that demonstrates how crucial is the support of people who are part of the conviviality of T2DM in aid treatment. Consequently, we concluded that the intrinsic motivation, specifically in the cognitive aspects and behavioral change are key factors relevant to adherence to non-pharmacological treatment.

Effect of frequency of physical exercise on glycemic control and body composition in type 2 diabetic patients.

BACKGROUND: Diabetes and cardiovascular disease have emerged as key threats to human health, and the risk is increased in individuals with visceral obesity. The consensus is that physical exercise should be part of the treatment of diabetes mellitus (DM). OBJECTIVE: To compare the influence of guided and structured physical exercise programs (SPEP), three to five times per week, during a period of 20 weeks, on glycemic control and body composition of type 2 diabetic patients (DM2). METHODS: The research was conducted at the Universidade Federal de São Paulo (Federal University School of Medicine in São Paulo). At the clinical visit, patients from the Control Group (CG) n=17, mean age 55.8 years, were encouraged to engage in a physical exercise program. Patients from Group 3x (G3), n=14, mean age 57.4 years, were to engage in 1 hour of physical exercise, 3x/week, and Group 5x (G5), n=9, mean age 58.8 years, followed the same protocol but 5x/week. Mean of 5 years since diagnosis in all groups. Classes consisted of a 5-minute warm-up, 30-minute treadmill walk at 70% of maximum heart rate, and 10-minute relaxation. BMI, abdominal circumference (AC), percentage of body fat (BF), capillary glycemia (CG), fasting glycemia (FG), and glycated hemoglobin (HbA1c) were assessed. RESULTS: A comparison was made between the baseline time point (B) and the 20th week (20th). BMI in G3 (B:29.5+/-2.9 vs. 20th: 28.3 +/- 2.2 Kg/sqm, p=0.005) and G5 (B:29.7+/-4.4 vs. 20th: 29.1 +/- 4.3 Kg/sqm, p=0.025); abdominal circumference in G5 (B:100.5+/-11.9 vs. 20th: 933 +/- 11.7 cm, p=0.001); BF in G3 (B:31+/-5.1 vs 20th: 26+/-5%, p=0.001) and G5 (B:32.4 +/- 5.4 vs. 20th: 30.3 +/- 6.9%, p=0.001); FG, G5 (B:150.8 +/- 47.5 vs. 20th: 109.2+/- 30.5 mg/dL, p=0.034), showed statistically significant differences. CG did not show statistically significant differences for these variables. CG showed a tendency to drop after physical exercise in G5. HbA1c showed no statistically significant differences in the three groups. CONCLUSION: G5 did better than G3 in most parameters assessed. However, results failed to show a decrease of HbA1c in DM2 patients.

Efeito da freqüência do exercício físico no controle glicêmico e composição corporal de diabéticos tipo 2 / El efecto de la frecuencia del ejercicio físico en el control glucémico y composición corporal de diabéticos tipo 2 / Effect of frequency of physical exercise on glycemic control and body composition in type 2 diabetic patients

FUNDAMENTO: O diabete e a doença cardiovascular emergiram como ameaças principais à saúde humana, e o risco está aumentado nos indivíduos com obesidade visceral. É consenso que o exercício físico deve fazer parte do tratamento do diabete melito (DM). OBJETIVO: Comparar a influência de programas de exercício físico orientados e estruturados (PEOE) com freqüência de três e cinco vezes por semana, no período de 20 semanas, no controle glicêmico e composição corporal de diabéticos tipo 2 (DM2). MÉTODOS: A pesquisa realizou-se na Universidade Federal de São Paulo. Grupo Controle (GC), n=17, idade (Mi: 55,8 anos), recebeu incentivo, na consulta médica, para o exercício físico. Grupo 3x (G3), n=14, idade (Mi: 57,4 anos), uma hora de exercício físico, 3x/semana. Grupo 5x (G5), n=9, idade (Mi: 58,8 anos), mesmo protocolo, mas 5x/semana. Tempo de diagnóstico: Mi: 5 anos, em todos os grupos. Aula constava de 5 min aquecimento, 30 min caminhada (esteira) a 70 por cento da freqüência cardíaca máxima e 10 min relaxamento. IMC, cintura, porcentual de gordura (PG), glicemia capilar (Gcap), glicemia de jejum (GJ), hemoglobina glicada (HbA1c) foram avaliados. RESULTADOS: Realizou-se uma comparação entre o instante Basal (B) e 20ª semana (20ª). IMC no G3(B: 29,5±2,9 vs 20ª: 28,3±2,2 kg/m², p=0,005) e G5 (B: 29,7±4,4 vs 20ª: 29,1±4,3 kg/m², p=0,025); cintura G5 (B: 100,5±11,9 vs 20ª: 933±11,7 cm, p=0,001); PG no G3 (B: 31±5,1 vs 20ª: 26±5 por cento, p=0,001) e G5 (B: 32,4±5,4 vs 20ª: 30,3±6,9 por cento, p=0,001); GJ, G5 (B: 150,8±47,5 vs 20ª: 109,2±30,5 mg/dl, p=0,034), apresentaram diferenças estatisticamente significativas. GC não apresentou diferenças estatisticamente significativas, nessas variáveis. Gcap apresentou uma tendência de queda no pós-exercício físico no G5. HbA1c não apresentou diferenças estatisticamente significativas nos três grupos. CONCLUSÃO: O G5 foi melhor que o G3, na maioria dos parâmetros avaliados. Porém, os resultados não apresentaram...

BACKGROUND: Diabetes and cardiovascular disease have emerged as key threats to human health, and the risk is increased in individuals with visceral obesity. The consensus is that physical exercise should be part of the treatment of diabetes mellitus (DM). OBJECTIVE: To compare the influence of guided and structured physical exercise programs (SPEP), three to five times per week, during a period of 20 weeks, on glycemic control and body composition of type 2 diabetic patients (DM2). METHODS: The research was conducted at the Universidade Federal de São Paulo (Federal University School of Medicine in São Paulo). At the clinical visit, patients from the Control Group (CG) n=17, mean age 55.8 years, were encouraged to engage in a physical exercise program. Patients from Group 3x (G3), n=14, mean age 57.4 years, were to engage in 1 hour of physical exercise, 3x/week, and Group 5x (G5), n=9, mean age 58.8 years, followed the same protocol but 5x/week. Mean of 5 years since diagnosis in all groups. Classes consisted of a 5-minute warm-up, 30-minute treadmill walk at 70 percent of maximum heart rate, and 10-minute relaxation. BMI, abdominal circumference (AC), percentage of body fat (BF), capillary glycemia (CG), fasting glycemia (FG), and glycated hemoglobin (HbA1c) were assessed. RESULTS: A comparison was made between the baseline time point (B) and the 20th week (20th). BMI in G3 (B:29.5±2.9 vs. 20th: 28.3 ± 2.2 Kg/sqm, p=0.005) and G5 (B:29.7±4.4 vs. 20th: 29.1 ± 4.3 Kg/sqm, p=0.025); abdominal circumference in G5 (B:100.5±11.9 vs. 20th: 933 ± 11.7 cm, p=0.001); BF in G3 (B:31±5.1 vs 20th: 26±5 percent, p=0.001) and G5 (B:32.4 ± 5.4 vs. 20th: 30.3 ± 6.9 percent, p=0.001); FG, G5 (B:150.8 ± 47.5 vs. 20th: 109.2± 30.5 mg/dL, p=0.034), showed statistically significant differences. CG did not show statistically significant differences for these variables. CG showed a tendency to drop after physical exercise in G5. HbA1c showed no statistically...

FUNDAMENTO: La diabetes y la enfermedad cardiovascular surgieron como principales amenazas a la salud humana, y el riesgo crece en los individuos con obesidad visceral. Es un consenso que el ejercicio físico debe formar parte del tratamiento de la diabetes mellitus (DM). OBJETIVO: Comparar la influencia de programas de ejercicio físico orientados y estructurados (PEOE) con frecuencia de tres y cinco veces por semana, en el período de 20 semanas, en el control glucémico y la composición corporal de diabéticos tipo 2 (DM2). MÉTODOS: La investigación se realizó en la Universidad Federal de São Paulo. Grupo Control (GC), n=17, edad (edad promedio (EP): 55,8 años), recibió incentivo en la consulta médica para la realización de ejercicio físico. Grupo 3x (G3), n=14, edad (EP: 57,4 años), una hora de ejercicio físico, 3x/semana. Grupo 5x (G5), n=9, edad (EP: 58,8 años), mismo protocolo, pero 5x/semana. Tiempo de diagnóstico: EP: 5 años, en todos los grupos. La clase constaba de 5 min calentamiento, 30 min caminata en estera rodante hasta el 70 por ciento de la frecuencia cardiaca máxima y 10 min relajamiento. Se analizó IMC, cintura, porcentual de grasa (PG), glucemia capilar (GCap), glucemia de ayuno (GA), hemoglobina glucosilada (HbA1c). RESULTADOS: Se realizó una comparación entre el instante Basal (B) y la 20ª semana (20ª). Presentaron diferencias estadísticamente significativas: IMC en el G3(B: 29,5±2,9 vs 20ª: 28,3±2,2 kg/m², p=0,005) y el G5 (B: 29,7±4,4 vs 20ª: 29,1±4,3 kg/m², p=0,025); cintura G5 (B: 100,5±11,9 vs 20ª: 933±11,7 cm, p=0,001); PG en el G3 (B: 31±5,1 vs 20ª: 26±5 por ciento, p=0,001) y G5 (B: 32,4±5,4 vs 20ª: 30,3±6,9 por ciento, p=0,001); GA, G5 (B: 150,8±47,5 vs 20ª: 109,2±30,5 mg/dl, p=0,034). El GC no presentó diferencias estadísticamente significativas, en estas variables. La GCap presentó una tendencia de caída en el post ejercicio físico en G5. La HbA1c no presentó diferencias estadísticamente significativas en...