Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis.

Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes. Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2 max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2 max (-5.84 mL.kg-1.min-1, 95% CI -6.93, -4.76 mL.kg-1.min-1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (-93.30 meters, 95% CI -141.2, -45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2 max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

Análise da situação de saúde dos idosos usuários de uma política municipal de atividades físicas / Analysis of health status of older adults users of a municipal physical activity program / Análisis de la situación de salud de los adultos ancianos de una política municipal de actividad física

Introdução: Políticas públicas intersetoriais em saúde são intervenções populacionais (e de cunho ecológico) muito utilizadas para a redução da carga global de doença e otimização de recursos tanto financeiros quanto humanos. Objetivo: O objetivo deste estudo foi analisar a situação de saúde de usuários idosos de uma política municipal de atividades físicas. Métodos: Trata-se de um estudo transversal com amostragem baseada em centros comunitários (N dispositivos comunitários=11), que disponibilizam práticas de movimentos corporais e outros, subsidiados pela Secretaria Municipal de Desenvolvimento Social e Esporte (SMDSE), Prefeitura Municipal de Porto Alegre (RS). A amostragem de usuários foi ponderada para o total de usuários atendidos por centro, adotando seleção aleatória simples. A coleta de dados ocorreu entre abril de 2018 e fevereiro de 2019, em que a equipe de coleta se deslocou ao território adscrito dos usuários para a condução de inquérito de saúde autoaplicado e a avaliação funcional; de forma contrária, os usuários compareceram a um centro de coleta para a série laboratorial (sem jejum). Resultados: Foram incluídos e analisados 351 usuários (média±desvio padrão, 70±6 anos). Para fatores de risco cardiovasculares, a prevalência de hipercolesterolemia foi de 54,2% e de 49,3% para hipertensão arterial sistêmica ­ as mais elevadas. O transtorno de sono foi prevalente em 55,3% da amostra. Entre as doenças autorrelatadas, os participantes listaram as cardiovasculares (14,3%), câncer prévio (14,6%), diabetes (13,2%), artrite reumatoide/ reumatismo (29,6%) e depressão (sem discriminador de depressão maior/ menor) (18,6%). A capacidade funcional, estimada pelo teste de caminhada em 6 minutos e a força de preensão manual, preditores de mortalidade cardiovascular e agravos, tiveram valores médios encontrados de 498,05±78,96 m e 27,08±8,14 kg, respectivamente. Conclusão: Os achados do presente estudo permitem contrastar prevalências estimadas em idosos participantes de um programa público de atividades físicas com outras estimativas em grupos de comparação, possibilitando a análise de situação de saúde com base em diferentes comportamentos e fatores de risco. Por fim, o trabalho viabilizou a monitorização de intervenções públicas para idosos em nível comunitário, sendo um ponto de base para acompanhamento futuro.

Introduction: Intersectoral public policies on health are population (and ecological) interventions widely used to reduce the global burden of disease and optimize both financial and human resources. Objective: The objective of this study was to analyze the health status of older adults users of a municipal policy on physical activities. Methods: This is a cross-sectional study with a sample based on community centers (N community centers=11), which provide body movement practices and others, funded by the Municipal Department of Social Development and Sports (SMDSE), City Hall of Porto Alegre (state of Rio Grande do Sul ­ RS, Brazil). The users' sample was weighted by the number of users of each center, by simple random sampling. Data collection took place between April 2018 and February 2019, in which the collection team went to the users' assigned territory to conduct a self-administered health survey and functional assessment; conversely, the users attended a collection center for laboratory tests (without fasting). Results: A total of 351 users (mean±SD, 70±6 years old) were included. For cardiovascular risk factors, the prevalence of hypercholesterolemia was 54.2% and 49.3% for systemic arterial hypertension ­ the highest levels. Sleep disorder was prevalent in 55.3% of the sample. Among the self-reported diseases, participants listed cardiovascular (14.3%), previous cancer (14.6%), diabetes (13.2%), rheumatoid arthritis/rheumatism (29.6%), and depression (without major/minor depression discrimination) (18.6%). Functional capacity, estimated by the six-minute walk test, and handgrip strength, predictors of cardiovascular mortality and injuries, had mean values of 498.05±78.96 m and 27.08±8.14 kg, respectively. Conclusions: The findings of this study allow contrasting prevalence rates estimated in older adults participants of a public physical activity program with other estimates in comparison groups, enabling the analysis of health status based on different behaviors and risk factors. All in all, our study enabled to monitor public interventions for older adults at the community level, serving as a baseline for future monitoring.

Introducción: Las políticas de salud pública intersectoriales tienen el potencial de destacar la reducción de la carga global de enfermedad y la optimización de los recursos financieros y humanos. Objetivo: El objetivo de este estudio fue analizar la situación de salud de los usuarios, ancianos, de una política municipal de actividades físicas. Métodos: Se trata de un estudio transversal con muestreo a partir de centros comunitarios (N dispositivos comunitarios=11), que brindan prácticas de movimiento corporal y otras, subsidiadas por la Secretaria Municipal de Desenvolvimento Social e Esporte (SMDSE), Prefeitura Municipal de Porto Alegre (RS). El muestreo de usuarios fue ponderado por el total de usuarios atendidos por centro, adoptando selección aleatoria simple. La recolección de datos ocurrió entre abril/2018 y febrero/2019, cuando el equipo de recolección viajó al territorio asignado de los usuarios para realizar una encuesta de salud auto aplicada y evaluación funcional; por el contrario, los usuarios acudían a un centro de recogida de series de laboratorio (sin ayuno). Resultados: Se incluyeron y analizaron 351 usuarios (media±DP, 70±6 años). Para los factores de riesgo cardiovascular, la prevalencia de hipercolesterolemia fue de 54,2% y de hipertensión arterial sistémica de 49,3%, la más alta. El trastorno del sueño fue prevalente en el 55,3% de la muestra. Entre las enfermedades auto informadas, los participantes enumeraron enfermedades cardiovasculares (14,3%), cáncer previo (14,6%), diabetes (13,2%), artritis reumatoide/reumatismo (29,6%) y depresión (sin discriminación de depresión mayor/menor) (18,6%). La capacidad funcional, estimada por la prueba de la marcha de 6 minutos, y la fuerza de prensión manual, predictores de mortalidad y lesiones cardiovasculares, tuvieron valores medios de 498,05±78,96 m y 27,08±8,14 kg, respectivamente. Conclusiones: Los hallazgos de este estudio permiten contrastar las prevalencias estimadas en participantes ancianos de un programa público de actividades físicas con otras estimaciones en grupos de comparación, lo que permite el análisis de la situación de salud basado en diferentes comportamientos y factores de riesgo. Por último, el trabajo ha facilitado la monitorización de intervenciones públicas para personas mayores a nivel comunitario, sirviendo como punto de partida para un seguimiento futuro.

Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? - A Retrospective Cohort Study

Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials.

BACKGROUND: The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity. METHODS: A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses. RESULTS: Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I2 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I2 0%], and maximum oxygen consumption (VO2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I2 100%] compared with control groups. In sensitivity and subgroup analyses using VO2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO2max [p = 0.34; I2 99.6%; R2 = 2.6%]. In addition, the quality of the included studies was mostly low. CONCLUSION: The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates. Trial registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint https://doi.org/10.31219/osf.io/kpg2m ).

Methodological quality and reporting standards in systematic reviews with meta-analysis of physical activity studies: a report from the Strengthening the Evidence in Exercise Sciences Initiative (SEES Initiative).

BACKGROUND: Several resources have been developed (e.g., reporting guidelines) to promote high-standard practices in health research. However, there was no continuous and systematic assessment of recommended practices in published systematic reviews with meta-analysis (SRMAs), which increases the usability of the available resources. Therefore, we aimed to assess the methodological and reporting standards in SRMAs of physical activity studies. This report presents the main results of the SEES Initiative in 2019. METHODS: Our approach is based on a prospective systematic review methodology to implement post-publication surveillance of research practices in exercise sciences. Briefly, during the year 2019, pre-specified searches were conducted monthly (PubMed/MEDLINE) in journals from the exercise sciences (n = 9) and medicine (n = 5). The assessments were independently conducted by two authors, based on 36 items/practices derived from established statements/tools (PRISMA, AMSTAR 2, ROBIS). To be eligible, SRMAs should summarize studies that had, at least, one arm consisting of physical activity interventions/exposures and one health or behavioral outcome. RESULTS: Out of 1028 studies assessed for eligibility, 103 SRMAs were included. The minimum adherence was 13/36 items, whereas only one SRMA adhered to all items. Some highly contemplated items included identification of title as SRMA (97.1%) and descriptions of the main outcome in the abstract (95.1%) and risk of bias (RoB) assessment (95.1%). Some poorly contemplated items included publicly available protocol (4.9%), discussion of the results in light of RoB in studies included (32.0%), and data sharing statements (35.9%). CONCLUSION: In summary, there is a suboptimal adherence to recommended practices on methodological quality and reporting standards in the SRMAs of physical activity intervention/exposure evaluated from the selected journals in 2019, which likely reduce the reproducibility and usefulness of these studies. This incipient evidence from our first 12 months of post-publication surveillance should serve as a call for attention and action for multiple stakeholders (e.g., authors, reviewers, editors, funders, academic institutions) in this important health research field.

Atividade física para gestantes e mulheres no pós-parto: Guia de Atividade Física para a População Brasileira / Physical activity for pregnant and postpartum women: Physical Activity Guidelines for the Brazilian Population

Este artigo tem por objetivo apresentar as recomendações de atividade física para gestantes e mu-lheres no pós-parto desenvolvidas para o Guia de Atividade Física para a População Brasileira. Para isso, utilizou-se uma abordagem de métodos mistos que incluiu quatro etapas: 1) levantamento das diretrizes internacionais mais recentes; 2) revisão narrativa de literatura sobre efeitos da prática de atividade física durante a gestação para a saúde da mulher e do bebê; 3) escuta com gestantes, mu-lheres no pós-parto, profissionais e pesquisadores; 4) consulta pública. As evidências sumarizadas suportam que a prática de atividade física durante a gestação e no período pós-parto é segura, traz be-nefícios à saúde da mãe e do bebê, e reduz os riscos de algumas complicações relacionadas à gestação. Gestantes devem ser incentivadas a realizar pelo menos 150 minutos por semana de atividade física de intensidade moderada. Gestantes com contraindicações devem procurar auxílio de profissionais qualificados. Em alguns casos, a prática de atividade física durante a gestação não é recomendada. Este documento servirá como ferramenta para nortear profissionais de saúde que atuam com ges-tantes e mulheres no pós-parto e irá orientar a população-alvo quanto a prática de atividade física

This manuscript aims to present the recommendations of physical activity for pregnant and postpartum women developed for the Physical Activity Guidelines for the Brazilian Population. A mixed-method ap-proach that included four steps was used: 1) review of the most recent international guidelines for physical activity during pregnancy; 2) narrative literature review on the effects of physical activity during pregnancy on the health of the woman and the baby; 3) consultation with pregnant women, postpartum women, pro-fessionals and researchers; 4) public consultation. The summarized evidence supports that physical activity during pregnancy and in the postpartum is safe, has benefits to the health of the mother and baby, and reduces the risks of some complications related to pregnancy. Pregnancy should be encouraged to do at least 150 min-utes a week of moderate intensity physical activity. Pregnancy women with contraindications should seek help from qualified professionals. In some cases, physical activity during pregnancy is not recommended. This document will be used as a tool to guide health professionals who work with pregnant women and women in the postpartum period. Also, it will inform and guide women during pregnancy and postpartum about the benefits of physical activity

Health profile of elderly users of a town public program of physical activity: a cross-sectional study / Perfil da situação de saúde dos idosos participantes de um programa municipal de atividades físicas: um estudo transversal

The assessment of health profile in users attending such public programs may optimize tailoring of interventions oriented to reduce the risk or incidence of lifestyle-driven diseases, resulting in a potential impact on public health. Therefore, this cross-sectional study aimed to characterize the health profile of the elderly participants in the physical activity public program in southern Brazil. Therefore, we included 11 community exercise centers managed by the city of Porto Alegre (Brazil). We used simple random sampling, with sample size weight by the number of participants in each individual center. Several health domains were measured by self-reported questionnaires (e.g., cardiovascular risk factors and quality of life), office blood pressure measurements, blood assessments (i.e., lipid profile and HbA1c) and functional tests (i.e., 6-minute walk test and handgrip strength) between April/2018 to February/2019. The results are mostly reported using descriptive statistics. We observed that high self-reported prevalences regarded to cardiovascular risk factors, more specifically for sleep disorder (55%), hypercholesterolemia (54%) and hypertension (49%). Among self-reported diseases, the participants listed cardiovascular diseases (14%), previous cancer (15%), diabetes (13%), arthritis (30%), and depression (19%). The results observed in the 6-minute walk test (mean±sd 498±78.95 m) and handgrip test (mean±sd 27±8.13 kg) showed the expected levels for active elderly. Overall, the prevalences presented herein allow to contrast the estimated prevalences of older adults using a public program of physical activity to other populational estimates or single studies, fostering the future monitoring of assessments and interventions in sensible conditions (e.g., hypertension, sleep disorder) for this population. 

O conhecimento do perfil de saúde dos usuários de programas públicos para promoção em saúde pode otimizar a elaboração e aperfeiçoamento de intervenções para controle doenças ou de eventos associados ao estilo de vida, com potencial impacto para a saúde pública. O objetivo deste estudo foi caracterizar o perfil da situação de saúde dos usuários idosos do programa público de atividade física, em 11 centros comunitários da cidade de Porto Alegre (RS, Brasil). Entre abril/2018 e fevereiro/2019, foram medidos domínios de saúde por questionários autoaplicados, avaliações sanguíneas e testes funcionais. O tamanho amostral foi ponderado pela quantidade de alunos atendidos por centro, com amostragem por aleatorização simples. As análises basearam-se em estatística descritiva. No total, 351 idosos (69±6 anos) foram incluídos. Houve elevadas prevalências de fatores de risco, sendo transtorno do sono (55%), hipercolesterolemia (54%), e hipertensão arterial (49%) as mais altas. Entre as doenças autorrelatadas, os participantes listaram condições cardiovasculares (14%), câncer prévio (15%), diabetes (13%), artrite reumatóide (30%) e depressão (19%). A capacidade de caminhada em 6 minutos e força de preensão manual estiveram em níveis de pessoas ativas. Este estudo possibilita contrastar as condições prevalentes dos idosos usuários de um programa público de atividade física com estimativas populacionais, servindo como levantamento inicial para futuro monitoramento de avaliações e/ou intervenções específicas às condições sensíveis nesta população.

Acute and chronic effects of muscle power training on blood pressure in elderly patients with type 2 diabetes mellitus.

The aim of the present study was to evaluate the effects of 12 weeks of muscle power training (MPT) on casual blood pressure (BP) (before and after each training session) and resting BP (pre- and post-training program) in type 2 diabetes mellitus (T2DM) elderly.Methods: Twelve T2DM elderly individuals (68.75 ± 7.83 years), non-insulin-dependents participated in the present study and performed the MPT program twice a week. Casual BP was measured before and after training sessions, and resting BP was measured 48 h before the first and 48 h after the last training session.Results: Significant decrease in casual systolic (SBP) (-7.08 ± 4.12 mm Hg [effect size [ES]: -1.42 to -0.11]; p < 0.01) and diastolic (DBP) BP (-3.14 ± 1.24 mm Hg [ES: -1.24 to -0.18]; p > 0.01) was found after training sessions, without significant effect (p > 0.05) of the week along time or casual BP × week interaction. No significant change in resting SBP (-5.08 ± 8.93 mm Hg [ES: -0.41]; p = 0.07) and DBP (0.47 ± 6.06 mm Hg [ES: +0.11]; p = 0.79) was found.Conclusion: MPT was able to reduce casual BP after training sessions. However, there was no significant reduction in resting BP after MPT. Nevertheless, although not statistically significant, there were important clinical reductions in resting SBP in T2DM elderly patients.

The "Hypertension Approaches in the Elderly: a Lifestyle study" multicenter, randomized trial (HAEL Study): rationale and methodological protocol.

BACKGROUND: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. METHODS: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. DISCUSSION: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. TRIAL REGISTRATION: NCT03264443 . Registered on 29 August, 2017.

Effects of short-term resistance training on endothelial function and inflammation markers in elderly patients with type 2 diabetes: A randomized controlled trial.

PURPOSE: To evaluate the effects of 12-weeks of strength training on endothelial function and inflammatory markers in elderly individuals with T2DM. METHODS: Forty-four elderly patients with T2DM were screened for participation. After completion of the baseline assessment, participants were randomly assigned to either the resistance training group (RT) or an active control group (AC). Inflammatory (TNF-α, IL-6, IL-1ß, IL-10 and CRP) and blood lipid profiles, glycated hemoglobin, basal artery diameter and flow mediated dilation were evaluated before and after the intervention. Comparisons between groups were obtained from the generalized estimation equation and all tests were two-tailed and the alpha level for significance set at 0.05. RESULTS: TNF-α and IL-1ß were decreased in both groups, while no interactions were found for flow mediated dilation and basal artery diameter. No significant differences were found for blood lipid profile and glycated hemoglobin for both groups after the intervention period. CONCLUSIONS: No significant changes were found between the RT and AC groups, regarding inflammatory profile and endothelial function, which does not prove the superiority of this intervention model in the studied period.

Heat-induced extracellular HSP72 release is blunted in elderly diabetic people compared with healthy middle-aged and older adults, but it is partially restored by resistance training.

Recent evidence suggests that the anti-inflammatory heat shock response (HSR) is reduced in aging and diabetes. In this study we compared HSR between healthy middle-aged adults, healthy elderly and type 2 diabetic (T2DM) elderly, and tested whether resistance training (RT) could improve the HSR in T2DM group. Thirty sedentary participants volunteered for this study. HSR (assessed as the capacity to export HSP72 during heat stress) was measured in the blood and compared between the groups. HSR was similar between healthy middle-aged and healthy elderly volunteers, but diminished in elderly T2DM (p < 0.001). Hence, T2DM subjects (n = 12) were submitted to a 12-week RT program, because exercise is a physiological HSR inducer. HSR, cytokines, metabolic parameters and visceral adipose tissue (VAT) were measured before and after the RT. Remarkably, VAT was negatively correlated with HSR (r = - 0.49, p < 0.01) while RT improved the HSR and reduced inflammation [TNF-α: from 51.5 ±â€¯9 to 40.7 ±â€¯4 pg/mL and TNF-α/IL-10 ratio: from 1.55 ±â€¯0.3 to 1.16 ±â€¯0.2 (p < 0.001)], without affecting other parameters. All together, these findings confirm the hypothesis that the anti-inflammatory HSR is depressed in elderly diabetic people, but can be partially restored by RT.

Functional and physiological adaptations following concurrent training using sets with and without concentric failure in elderly men: A randomized clinical trial.

This study compared the functional and physiological adaptations induced by concurrent training (CT) performed with repetitions to concentric failure and not to failure in elderly men. Fifty-two individuals (66.2 ±â€¯5.2 years) completed the pre- and post-measurements and were divided into three groups: repetitions to failure (RFG, n = 17); repetitions not to failure (NFG, n = 20); and repetitions not to failure with total volume equalized to that in the RFG (ENFG, n = 15). The participants' sit-to-stand ability, timed-up-and-go (TUG), muscle power output in squat jump (SJ) and countermovement jump (CMJ), peak oxygen uptake (VO2peak), blood lipids and glucose, as well as blood pressure levels were assessed. A subsample of our participants (n = 22) also underwent assessment of body composition by dual X-ray absorptiometry (DXA). CT was performed twice weekly for over 12 weeks. In addition to the specific strength training (ST) programme, each group also underwent endurance training (ET) in the same session (i.e., ST immediately followed by ET). After training, all groups improved similarly and significantly in their sit-to-stand ability (P < 0.01), muscle power output relative to body mass in SJ and CMJ (P < 0.001), VO2peak (P < 0.01) and HDL cholesterol levels (P < 0.001). There were reductions in the total, leg and trunk percent fat mass as well as increases in the total, leg and trunk percent lean mass (P values ranging from P < 0.05 to P < 0.01). Independent of performing repetitions until concentric failure and greater ST volumes, all CT groups exhibited improved sit-to-stand ability, muscle power output, VO2peak and HDL cholesterol levels. In addition, our preliminary data suggest that there are no differences in the effects of the assessed CT approaches on body composition outcomes. We therefore highlight the need for additional well-powered studies to assess whether repetitions to failure could underlie distinct effects on body composition.

Concurrent strength and endurance training exercise sequence does not affect neuromuscular adaptations in older men.

Concurrent training is an effective method for increasing skeletal muscle performance in aging individuals, but controversy exists as to whether chronic neuromuscular and functional adaptations are affected by the intra-session exercise sequence. Therefore the aim of this study was to evaluate the effect of concurrent endurance and power-like strength training exercise sequence on muscular and functional adaptations of older participants. Thirty-six healthy older men not engaged in systematic exercise training programs for at least 6 months were divided into a control group (CON; 65.8±5.3 years), or in the training groups: endurance-strength (ES; 63.2±3.3 years), or strength-endurance (SE; 67.1±6.1 years). Training groups underwent 12 weeks of concurrent endurance and power-like strength training, starting every exercise session with either endurance (in ES) or strength (in SE) exercises. Measurements included knee extension one repetition maximum (1RM), knee extension power, 30 second sit-to-stand test (30SS), maximum vastus lateralis surface electromyographic activity, and rectus femoris echo intensity (RFEI). Significant increases in maximal strength (ES +18±11.3%; SE +14.2±6.0%; p≤0.05), peak power (ES +22.2±19.4%; SE +26.3±31.3%; p≤0.05), and 30SS performance (ES +15.2±7.2%; SE +13.2±11.8%; p≤0.05) were observed only in the training groups, with no differences between ES and SE. Maximum muscular activity was greater after 12weeks at training groups (p≤0.05), and reductions in RFEI were found only in ES and SE (p≤0.05). These results demonstrate that concurrent strength and endurance training performed twice a week effectively increases muscular performance and functional capacity in older men, independent of the intra-session exercise sequence. Additionally, the RFEI decreases indicate an additional adaptation to concurrent training.

Relationship between quadriceps femoris echo intensity, muscle power, and functional capacity of older men.

Increased proportion of non-contractile elements can be observed during aging by enhanced skeletal muscle echo intensity (EI). Studies have demonstrated that an increase in rectus femoris EI may affect physical performance. However, it is still unknown whether the whole quadriceps femoris EI (QEI) influences strength, power, and functional capacity of an older population. Therefore, the aim of the present study was to determine the correlation between QEI, the four individual quadriceps portions EI, and muscular performance of older men. Fifty sedentary healthy men (66.1 ± 4.5 years, 1.75 ± 0.06 m, 80.2 ± 11.0 kg) volunteered for the present study. The QEI and EI of the four quadriceps portions were calculated by ultrasound imaging. Knee extension one repetition maximum (1RM), isometric peak torque (PT), and rate of torque development (RTD) were obtained as measures of muscular strength. Muscular power was determined by knee extension with 60 % of 1RM and countermovement jump (CMJ). The 30-s sit-to-stand test was evaluated as a functional capacity parameter. QEI and all individual EI were correlated to functional capacity and power during CMJ (p ≤ 0.05), but rectus femoris EI was not related to knee extension average power (p > 0.05). There were significant correlations between all EI variables, 1RM, PT, and RTD at 0.2 s (p ≤ 0.05), but only vastus medialis EI and QEI were correlated to RTD at 0.05 s (p ≤ 0.05). The results of the present study suggest that QEI is related to muscular power and functional capacity of older subjects, but the EI of some individual quadriceps portions may underestimate the correlations with muscular performance.

Déficit bilateral: origem, mecanismos e implicações para o treino de força / Bilateral deficit: origins, mechanisms, and implications for strength training

Vários estudos têm demonstrado uma menor capacidade de gerar força quando os exercícios de um programa de treinamento são executados bilateralmente em relação à soma da força executada pelos membros separadamente. Esse fenômeno, que tem sido bem descrito na literatura científica, é chamado de déficit bilateral. Os mecanismos causadores do déficit não são totalmente claros, mas parecem estar relacionados a mecanismos neurais, como um bloqueio dos hemisférios cerebrais ocorrido durante a contração bilateral que reduz a ativação de unidades motoras e a força produzida. Em relação a cada forma de execução (unilateral e bilateral) a longo prazo, as adaptações parecem ser específicas ao tipo de contração utilizada durante o treinamento. Portanto, em consideração à relevância da realização de exercícios executados unilateralmente e bilateralmente dentro de um programa de treino de força, assim como o efeito de cada forma de execução a longo prazo nas adaptações morfológicas e neurológicas do treinamento, esse artigo teve como objetivos caracterizar o fenômeno déficit bilateral, explorar seus principais mecanismos causadores, bem como discutir a influência de cada tipo de treinamento (unilateral e bilateral) nas adaptações do treinamento de força.

Several studies have demonstrated a lower capacity to generate force when the exercises of the training program are performed bilaterally than when compared to the sum of the strength produced by each limb separately. This phenomenon, one that has been well documented in the scientific literature, is called "bilateral deficit." The underlying mechanisms of the bilateral deficit are not fully clear, but they seem to be related to neural mechanisms, such as a blockage of the brain hemispheres, that may occur during bilateral contractions thus reducing the activation of motor units and therefore the strength produced. In relation to each execution form (unilateral and bilateral) in the long term, the adaptations appear to be specific to the type of contraction performed in the training. Therefore, due to the relevance of the exercises performed unilaterally and bilaterally in the strength training program, as well as the long-term effect of each execution form in the morphological and neurological adaptations to training, the aim of this article is to characterize the bilateral deficit phenomenon, to explore its main causative mechanisms, and to discuss the influence of each training type (unilateral and bilateral) in the adaptations of strength training.

Avaliação do déficit bilateral em contrações isométricas dos extensores de joelhos / Evaluation of bilateral deficit in isometric contractions of the knee extensors

O treinamento de força tem sido referido como uma importante ferramenta para o incremento e a manutenção da saúde. Os exercícios que compõem um programa de treino podem ser executados em condição unilateral ou bilateral. Alguns estudos têm apresentado valores mais reduzidos de produção de força e sinal eletromiográfico em condições bilaterais do que o somatório desses valores em condições unilaterais. Essa diferença na produção de força, bem como no sinal eletromiográfico é denominada déficit bilateral. O objetivo do presente estudo foi avaliar a produção de força e a atividade eletromiográfica dos músculos reto da coxa e vasto lateral no exercício de extensão isométrica de joelhos, nas condições unilateral e bilateral. A amostra foi constituída de 10 indivíduos do sexo masculino, com idades entre 18 e 30 anos, não praticantes de treinamento de força. Foram registrados os valores de força e atividade elétrica com a utilização de uma célula de carga e eletrodos de superfície, respectivamente, no teste isométrico de extensão de joelhos (120º). Os resultados apontaram valores maiores (p<0,05) para a produção de força e sinal eletromiográfico na condição unilateral do exercício, reportando um déficit bilateral tanto na força como na atividade eletromiográfica. Estes resultados sugerem que o treino unilateral promove maior estímulo muscular, constituindo-se como uma importante estratégia a ser utilizada na prescrição dos exercícios de força.

Strength training has been reported as an important tool for enhancing and maintaining health. Resistance exercises can be executed unilaterally or bilaterally. Some studies have reported lower strength and electromyography (EMG) signal values in bilateral conditions than the sum of these values in unilateral conditions. This difference in strength and EMG is called the bilateral deficit. The aim of this study was to evaluate the strength and EMG activity of the rectus femoris and vastus lateralis during unilateral and bilateral isometric knee extension. The sample consisted of 10 non-resistance trained males aged 18 to 30 years. Strength and EMG were recorded through use of a load cell and surface electrodes, respectively. A 120º knee extension was used for the isometric knee extension test. The results showed significantly higher values for strength and EMG signal (p <0.05) in unilateral conditions, as well as bilateral deficit in both strength and EMG signal. These results suggest that unilateral training promotes greater muscle stimulation, and can thus represent an important strategy to be used in the prescription of strength training exercises.