Exercise interventions for patients with type 1 diabetes mellitus: A narrative review with practical recommendations.

Type 1 diabetes mellitus (T1DM) is a chronic endocrine disease that results from autoimmune destruction of pancreatic insulin-producing ß cells, which can lead to microvascular (e.g., retinopathy, neuropathy, and nephropathy) and macro-vascular complications (e.g., coronary arterial disease, peripheral artery disease, stroke, and heart failure) as a consequence of chronic hyperglycemia. Despite the widely available and compelling evidence that regular exercise is an efficient strategy to prevent cardiovascular disease and to improve functional capacity and psychological well-being in people with T1DM, over 60% of individuals with T1DM do not exercise regularly. It is, therefore, crucial to devise approaches to motivate patients with T1DM to exercise, to adhere to a training program, and to inform them of its specific characteristics (e.g., exercise mode, intensity, volume, and frequency). Moreover, given the metabolic alterations that occur during acute bouts of exercise in T1DM patients, exercise prescription in this population should be carefully analyzed to maximize its benefits and to reduce its potential risks.

Validity and Reliability of Inertial Measurement System for Linear Movement Velocity in Flywheel Squat Exercise.

The aim of this study was to examine the validity and reliability of an Inertial Measurement System integrated into a secondary pulley (IMS) for determining linear velocity during flywheel squat exercises. Thirty-one male participants who were highly experienced in a flywheel resistance exercise training performed flywheel squat exercises with three incremental loads, and mean velocity (MV), mean propulsive velocity (MPV) and max velocity (Vmax) of the exercises were simultaneously recorded with a validated linear encoder and the IMS, in two different sessions. Validity was analyzed using ordinary least products regression (OLP), Lin's concordance correlation coefficient (CCC), and Hedge's g for the values from the linear encoder and the IMS. Test-retest reliability was determined by coefficient of variation (CV), Intraclass correlation coefficient (ICC), and standard error of measurement (SEM). Results showed a high degree of validity (OLP intercept = -0.09-0.00, OLP slope = 0.95-1.04, CCC = 0.96-0.99, Hedge's g < 0.192, SEM = 0.04-0.08) and reliability (CV < 0.21%, ICC > 0.88, SEM < 0.08). These results confirm that the IMS provides valid and reliable measures of movement velocity during flywheel squat exercises.

Effect of High-Intensity Interval Training on Quality of Life, Sleep Quality, Exercise Motivation and Enjoyment in Sedentary People with Type 1 Diabetes Mellitus.

(1) Background: Type 1 diabetes mellitus (T1DM) people's health-related quality of life (HRQoL) is affected by glycemic control. Regular exercise is strongly recommended to these patients due to its cardiovascular and metabolic benefits. However, a large percentage of patients with T1DM people present a sedentary behavior because of the fear of a post-exercise hypoglycemia event, lack of time, lack of motivation and the complicated management of exercise, glycemic and insulin dose interaction. High-intensity interval training (HIIT) is an efficient and safe methodology since it prevents hypoglycemia and does not require much time, which are the main barriers for this population to doing exercise and increasing physical conditioning. (2) Methods: Nineteen sedentary adults (37 ± 6.5 years) with T1DM, were randomly assigned to 6 weeks of either HIIT (12-16-20 × 30-s intervals interspersed with 1-min rest periods) performed thrice weekly, or to the control group, which did not train. HRQoL, sleep quality, exercise motivation and enjoyment were measured as psychological variables. (4) Results: HRQoL improved in physical and social domains, PF (1.9%); PR (80.3%); GH (16.6); SF (34.1%). Sleep quality improved in the HIIT group by 21.4%. Enjoyment improved by 7% and intrinsic motivation was increased by 13%. (5) Conclusions: We suggest that the 6-week HIIT program used in the present study is safe, since no severe hypoglycemia were reported, and an effective strategy in improving HRQoL, sleep quality, exercise motivation and enjoyment which are important psychological well-being factors in T1DM people.

Effects of a HIIT Protocol on Cardiovascular Risk Factors in a Type 1 Diabetes Mellitus Population.

Cardiovascular complications are important causes of morbidity and mortality of Type 1 Diabetes Mellitus (T1DM) people. Regular exercise is strongly recommended to these patients due to its preventive action against this type of disease. However, a large percentage of patients with T1DM people present a sedentary behavior, mainly, because of the fear of a post-exercise hypoglycemia event and lack of time. High-intensity interval training (HIIT) is an efficient and safe methodology since it prevents hypoglycemia and does not require much time, which are the main barriers for this population to doing exercise and increasing physical conditioning. Nineteen sedentary adults (37 ± 6.5 years) with T1DM were randomly assigned to 6 weeks of either HIIT, 12 bouts first 2 weeks, 16 bouts in weeks 3 and 4, and 20 bouts in the last two weeks x 30-s intervals interspersed with 1-min rest periods, performed thrice weekly or to control group, which did not train. VO2max, body composition, heart rate variability (HRV), and fasting glucose were measured as cardiovascular risk factors. We suggest that the 6-week HIIT program used in the present study is safe since no severe hypoglycemia was reported and is an effective strategy in improving VO2max, body composition, HRV, and fasting glucose, which are important cardiovascular risk factors in T1DM people.

Effect of a HIIT protocol on the lower limb muscle power, ankle dorsiflexion and dynamic balance in a sedentary type 1 diabetes mellitus population: a pilot study.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is commonly associated with premature loss of muscle function, ankle dorsiflexion and dynamic balance. Those impairments, usually, lead to physical functionality deterioration. High-intensity interval training is an efficient and safety methodology since it prevents hypoglycemia and not requires much time, which are the main barriers for this population to practice exercise and increase physical conditioning. We hypothesized that a 6-week HIIT program performed on a cycle ergometer would increase lower limb muscle power, ankle dorsiflexion range of motion and dynamic balance without hypoglycemic situations. METHODS: A total of 19 diagnosed T1DM subjects were randomly assigned to HIIT group (n = 11; 6-week HIIT protocol) or Control group (n = 8; no treatment). Lower limb strength was evaluated through velocity execution in squat with three different overloads. Weight bearing lunge test (WBLT) was performed to test ankle dorsiflexion range of motion and Y-Balance test (YBT) was the test conducted to analyze dynamic balance performance. RESULTS: Velocity in squat improved a 11.3%, 9.4% and 10.1% (p < 0.05) with the 50%, 60% and 70% of their own body mass overload respectively, WBLT performance increased a 10.43% in the right limb and 15.45% in the left limb. YBT showed improvements in all directions (right limb-left limb): Anterior (4.3-6.1%), Posteromedial (1.8-5.2%) and Posterolateral (3.4-4.5%) in HIIT group (p < 0.05), unlike control group that did not experience any significant change in any of the variables (p > 0.05). CONCLUSION: A 6-week HIIT program is safe and effective to improve execution velocity in squat movement, a fundamental skill in daily living activities, as well as ankle dorsiflexion range of motion and dynamic balance to reduce foot ulcers, risk falls and functional impairments. HIIT seems an efficient and safety training methodology not only for overcome T1DM barriers for exercising but also for improving functional capacities in T1DM people.