Conhecimento geral, atitude psicológica e sua associação com a concentração de HbA1C em pacientes portadores de Diabetes Mellitus tipo 2 / General knowledge, psychological attitude and its association with the concentration of HbA1C in patients with Type 2 Diabetes Mellitus

Objetivo: Diabetes mellitus (DM) é uma doença relacionada a várias complicações e alta morbimortalidade, com comprometimento significativo da qualidade de vida do paciente, afetando sua saúde física e mental, bem como sua motivação ao autocuidado. Este estudo objetivou avaliar o conhecimento geral e a atitude psicológica para o DM, correlacionando a concentração de hemoglobina glicada (HbA1C) com escores do DKN-A e ATT-19 de pacientes portadores de DM tipo 2 (DM2). Métodos: Estudo observacional transversal com amostra de 65 participantes, 24,6% homens e 75,4% mulheres, com idade média de 57±12, avaliados entre novembro/2016 e fevereiro/2017. A avaliação do conhecimento geral e da atitude psicológica para o DM foi realizada pela aplicação do Diabetes Knowledge Questionnaire (DKN-A) e do Diabetes Attitude Questionnaire (ATT-19). O SPSS 20.0 foi utilizado para as análises estatísticas. Resultados: Para os escores de conhecimento (r=0,005; p=0,966) e de atitude (r=0,034; p=0,790) não houve correlação significante com a HbA1C, sendo que (94%) dos pacientes não atingiram o ponto de corte do ATT-19. Considerando o grupo com pontuação >8 para o escore de conhecimento, foi observada diferença negativa e significativa entre este escore e o de atitude (r=-0,444; p=0,0018). Conclusão: O conhecimento em relação à doença não traduziu em melhor controle da glicemia na população estudada, sugerindo que o controle eficiente da HbA1C não depende exclusivamente do conhecimento sobre a doença, mas sim de diversos outros fatores, que também precisam ser considerados na conduta do DM2.

Objective: Diabetes mellitus (DM) is a disease related to several complications and high morbidity and mortality, with significant impairment of the patient's quality of life, affecting his physical and mental health, as well as his motivation to self-care. The aim of this study was to evaluate the knowledge and attitude about type 2 DM (DM2) in its patients, correlating Diabetes Knowledge Questionnaire (DKN-A) and Diabetes Attitudes Questionnaire (ATT-19) scores with the concentration of glycated hemoglobin (HbA1c). Methods: Cross-sectional observational study with a sample of 65 participants, 24.6% male and 75.4% female, with a mean age of 57 ± 12, with low schooling, between November / 2016 and February / 2017. The evaluation of the knowledge and attitude about DM was carried out by the application of the DKN-A and ATT-19. SPSS 20.0 was used for statistical analysis. Results: There were no statistically significant correlations with HbA1c (r = 0.005, p = 0.966) and attitude (r = 0.034, p = 0.790), and 61 patients (94%) did not reach the cutoff point of ATT-19. Considering the group with scores higher than 8 points for the knowledge score, a negative and significant correlation was observed between this score and the attitude score (r = -0.444; p = 0.0018). Conclusion: Knowledge and attitude towards the disease did not translate into better glycemic control in the study population. The efficient control of HbA1c is multifactorial, involving genetic, comorbid, behavioral, drugs, health services, among others, that should be considered in the conduct.

Comparação da frequência cardíaca máxima entre teste máximo na natação e equações de predição

RESUMO O objetivo desse estudo foi verificar diferenças entre a frequência cardíaca máxima (FCM) obtida na natação em testes de 200 metros nas técnicas de nado crawl e peito e comparar a FCM dos testes com as obtidas através de 53 equações de predição. A amostra foi composta por dois grupos de nadadores, todos do sexo masculino, oito (22,87 ± 2,03 anos) fizeram o nado crawl e 14 (22±2,94 anos) o nado peito. Não houve diferenças significantes (p = 0,530) em relação às técnicas de nado. Comparando-se a FCM obtida e calculada, através do modelo de Bland Altman, foi observado que apenas para o nado crawl são indicadas equações de predição para a estimativa da FCM, na impossibilidade de feitura do teste máximo. Entre as equações, recomenda-se a FCM = 204-1,07 x idade.

ABSTRACT The aim of this study was to verify the differences between the Maximum Heart Rate (MHR) obtained in swimming in tests of 200 meters in two swimming strokes frontcrawl and breaststroke and to compare FCM of the tests with the obtained through 53 prediction equations. The sample consisted of two groups of swimmers, all male, 8 (22.87±2.03 years) performed freestyle and 14 (22±2.94 years) breaststroke. There were no significant differences (p=0.530) regarding the swimming strokes. Comparing the MHR obtained and calculated through the Bland Altman model, it was observed that only for freestyle are indicated prediction equations for the MHR estimation, in the impossibility of to perform a maximum test. Among the equations, the MHR = 204-1.07 x age is recommended.

RESUMEN El objetivo del estudio fue comprobar las diferencias entre la frecuencia cardíaca máxima (FCM) obtenida en natación en pruebas de 200 metros en las técnicas de crol y braza, y comparar las FCM de las pruebas con las obtenidas a través de 53 ecuaciones de predicción. La muestra estaba compuesta por dos grupos de nadadores, todos del sexo masculino, y 8 (22,87 ± 2,03 años) nadaron con estilo crol y 14 (22 ± 2,94 años) nadaron a braza. No hubo diferencias importantes (p = 0,530) en relación con las técnicas de natación. En comparación con la FCM obtenida y calculada, a través del modelo de Bland Altman, se observó que las ecuaciones de predicción para la estimación de la FCM solo estaban indicadas para crol, por la imposibilidad de realizar la prueba máxima. Entre las ecuaciones, se recomienda la FCM = 204-1,07 × edad.

Validade e confiabilidade de testes para a obtenção da frequência cardíaca máxima em natação

RESUMO O desenvolvimento de um protocolo específico na natação para detectar a Frequência cardíaca máxima (FCmáx) pode qualificar a prescrição e controle de treinamento na natação. Dessa forma, o estudo objetivou validar um teste específico para obtenção da FCmáx em natação, para o nado crawl. Onze nadadores masculinos, de nível universitário, nadaram as distâncias de 100 e 200 metros crawl, em velocidade máxima, com monitoramento da FC, através de um monitor cardíaco. A validade foi avaliada pela relação entre FCmáx e lactato e a confiabilidade por teste e reteste de cada distância. A FCmáx dos 100 e 200 metros no teste foi de 187,6 ± 7,23 e 187,6 ± 7,54 bpm (p > 0,05) e no reteste de 188,3 ± 8,3 e 189,5 ± 8 bpm (p > 0,05). Encontraram-se altos valores de correlação para FCmáx obtida e concentração de lactato nos dois testes (100 e 200 metros). Correlações positivas significativas entre teste e reteste mostraram a confiabilidade dos testes (100 metros - 0,910, p < 0,001 e 200 metros - 0,950, p < 0,001). Conclui-se que os testes propostos são capazes de gerar, com precisão, a FCmáx de nadadores de nível universitário, são uma importante variável usada para cálculo das zonas de intensidade do treinamento e ferramenta para monitoramento da evolução do atleta durante a temporada.

ABSTRACT The development of a specific protocol to detect swimming Maximum Heart Rate (HRmax) can qualify the prescription and control training in swimming. Thus, the aim of this study was to validate a specific test to obtain HRmax in swimming, to freestyle. Eleven male swimmers, college-level, swam the distances of 100 and 200 meters at maximum speed, with heart rate monitoring, through a cardiac monitor. The validity was evaluated by the relation between HRmax and lactate, and the reliability by test and retest of each distance. The HRmax of the 100 and 200 meters in the test was 187.6±7.23 and 187.6±7.54 bpm (p>0.05) and in the retest of 188.3±8.3 and 189.5±8 bpm (p>0.05). High correlation values were found for HRmax obtained and lactate concentration in both tests (100 and 200 meters). Significant positive correlations between test and retest showed the reliability of the tests (100 meters - 0.910, p<0.001 e 200 meters - 0.950, p<0.001). It is concluded that the proposed tests are capable of generating, with accuracy, the HRmax of college-level swimmers, being an important variable used to calculate training intensity zones and a tool to monitor the evolution of the athlete during the season.

RESUMEN El desarrollo de un protocolo específico en natación para detectar la frecuencia cardíaca máxima (FCmáx) puede condicionar la prescripción y el control del entrenamiento en natación. De esta forma, el objetivo del estudio fue validar una prueba específica para la obtención de la FCmáx en natación, en el estilo crol. Once nadadores masculinos, de nivel universitario, nadaron las distancias de 100 y 200 metros a toda velocidad, con control de la frecuencia cardíaca mediante un monitor cardíaco. La validez se evaluó por la relación entre la FCmáx y el lactato, y la fiabilidad por la relación entre el test y el retest de cada distancia. La FCmáx de 100 y 200 metros en el test fue 187,6 ± 7,23 y 187,6 ± 7,54 lpm (p > 0,05) y en el retest, 188,3 ± 8,3 y 189,5 ± 8 lpm (p > 0,05). Se encontraron elevados valores de correlación obtenidos para la FCmáx y la concentración de lactato en las dos pruebas (100 y 200 metros). Correlaciones positivas importantes entre el test y el retest mostraron la fiabilidad de las pruebas (100 metros: 0,910; p < 0,001 y 200 metros: 0,950; p < 0,001). Se concluye que las pruebas propuestas son capaces de generar, con precisión, la FCmáx de nadadores de nivel universitario y son una importante variable usada para calcular las zonas de intensidad del entrenamiento y una herramienta para el control de la evolución del nadador durante la temporada.

Evaluating the effects of exercise on cognitive function in hypertensive and diabetic patients using the mental test and training system.

OBJECTIVES: Systemic arterial hypertension (SAH) and diabetes mellitus (DM) are important risk factors for developing cognitive impairment. General life-style changes including physical training are known to reduce elevated blood pressure and sugar levels, as well as improve mental health. The objective of this study was to evaluate whether supervised physical exercise enhances the cognitive status of patients with chronic diseases. METHODS: Volunteers with SAH, DM or SAH + DM participated in either aerobic or resistance training during a period of 12 weeks. Several domains of cognitive functions were evaluated using the mental test and training system before and after the 3 months. RESULTS: Participants with either of these chronic diseases demonstrated significantly improved attention and concentration, but not reaction time, following the supervised exercise. CONCLUSIONS: Structured physical training promotes several aspects of cognitive functions in diabetic and hypertensive patients.

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes.

BACKGROUND: The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90-95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes. METHODS: The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval. RESULTS: Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c. CONCLUSION: Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and the estimated average glucose, which are important parameters in controlling diabetes, thus signaling an important consequence of adhering to an exercise routine for type 2 diabetic patients.

Psychological and Cognitive Profile of Hypertensive and Diabetic Patients.

Chronic disorders such as hypertension and diabetes mellitus are often associated with depressive and anxiety symptoms, as well as cognitive decline. Once developed, psychological support is essential for improving the quality of life. This study is aimed at identifying impaired mental health in connection with these systemic metabolic disorders. A total of 34 patients were included in this cross-sectional study: 17 hypertensive individuals with a mean age of 59 ± 10 years, and 17 diabetic patients aged 54 ± 10 years. The following psychometric tests were used: Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and self-reporting questionnaire (SRQ-20). A large number of patients with high blood pressure or diabetes was associated with mental health problems (82% or 65%, respectively; p = 0.246). Affective disorder, especially moderate to severe depression, was seen mainly in diabetic patients (76%), whereas hypertensive individuals had higher prevalence of anxiety (64%). There was no cognitive impairment in this middle-aged population. This study shows a high proportion of depression and anxiety symptoms in patients with hypertension or diabetes mellitus, reinforcing the importance of psychiatric support for appropriate control of these metabolic disorders.

Improved cognitive, affective and anxiety measures in patients with chronic systemic disorders following structured physical activity.

Mental illnesses are frequent co-morbid conditions in chronic systemic diseases. High incidences of depression, anxiety and cognitive impairment complicate cardiovascular and metabolic disorders such as hypertension and diabetes mellitus. Lifestyle changes including regular exercise have been advocated to reduce blood pressure and improve glycaemic control. The purpose of this project was to evaluate the effect of physical training on the most prevalent corollary psychiatric problems in patients with chronic organic ailments. This longitudinal study assessed the mental health of hypertensive (age: 57 ± 8 years) and/or diabetic (age: 53 ± 8 years) patients using mini-mental state examination, Beck's depression inventory, Beck's anxiety inventory and self-reporting questionnaire-20 before and after a 3-month supervised resistance and aerobic exercise programme comprising structured physical activity three times a week. Clinically relevant improvement was observed in the Beck's depression inventory and Beck's anxiety inventory scores following the 12-week training (61%, p = 0.001, and 53%, p = 0.02, respectively). Even though statistically not significant (p = 0.398), the cognitive performance of this relatively young patient population also benefited from the programme. These results demonstrate positive effects of active lifestyle on non-psychotic mental disorders in patients with chronic systemic diseases, recommending exercise as an alternative treatment option.

Manifestação da ansiedade pré-competitiva em nadadores amadores / Expressions of anxiety in amateur pre-competitive swimmers

No presente artigo investigou-se a manifestação da ansiedade competitiva no contexto da natação bem como a interferência dos fatores gênero, experiência e categoria nessa variável. Foram utilizados questionários fechados, especificamente, os questionários de autorrelato SCAT e CSAI - 2, aplicados antes das competições na etapa final da II Copa MG Natação. A amostra contou com 51 atletas, com média de idade de 17,8 anos (± 2,8 anos), sendo 33 do sexo masculino e 18 do sexo feminino. Os resultados apontaram que atletas do sexo feminino, os mais jovens e aqueles com menor experiência competitiva apresentam maior ansiedade-estado somática e cognitiva, que há diferença em autoconfiança entre atletas de maior e menor experiência competitiva e que mulheres apresentam maiores índices de ansiedade-traço competitiva, assim como atletas mais jovens. Apesar das diferenças estatisticamente significantes, os níveis de ansiedade-estado e traço são considerados moderados, não diferindo de outras publicações.

In this paper, we investigate the manifestation of competitive anxiety in the context of swimming, aiming at the interference of the different factors such as gender, experience and category on this variable. Closed questionnaires were used, specifically the self-report SCAT and CSAI - 2, applied before the competition in the final stage of II COPA MG NATAÇÃO. The sample consisted of 51 athletes, with an average age of 17.82 years (± 2.85 years) being 33 males and 18 females. The results pointed that the female athletes, the young and those with less competitive experience present a higher cognitive and somatic state anxiety. There is a difference between self-confidence in athletes with lower and higher competitive experience, women have higher rates of competitive trait anxiety as well as younger athletes. Despite statistically significant differences, the levels of state and trait anxiety are considered moderate and did not differ from other publications.