Aquatic Aerobic and Combined Training in Management of Type 2 Diabetes: The Diabetes and Aquatic Training Study (DATS): A Randomized Clinical Trial.

BACKGROUND: To compare the effects of aquatic aerobic and combined (aerobic more resistance) training on glycemic control and other cardiometabolic outcomes in patients with type 2 diabetes. METHODS: Patients were randomized to an aquatic aerobic training (AERO, n = 19; 57.5 [7.4] y; 9 [47%] women), or an aquatic combined training (COMBI, n = 19; 60.9 [7.4] y; 10 [53%] women), or an aquatic active procedure control (n = 19; 58.6 [9.7] y; 10 [53%] women) in 3 weekly sessions (50 min each), during 15 weeks. Glycated hemoglobin was the primary outcome, whereas insulin resistance markers, lipid profile, systemic inflammation, renin concentration, blood pressure, physical activity levels, and sitting time were secondary outcomes. RESULTS: Glycated hemoglobin was reduced in all groups (P = .021), although changes were more marked in AERO (-0.36%) and COMBI (-0.44%) than in active control (-0.26%) group. Lipid profile was similarly modified in all groups. Diastolic blood pressure and renin concentration were also reduced in all groups; however, renin showed more marked reductions in AERO (-17.7 uIU/mL) and COMBI (-15.1 uIU/mL) than in active control (0.2 uIU/mL) group. Fasting insulin, triglycerides, C-reactive protein, systolic blood pressure, walking time, and sitting time on weekends were not modified. CONCLUSION: AERO and COMBI presented similar effect to improve glycemic control and some cardiometabolic risk factors in patients with type 2 diabetes.

Effects of 2 Models of Aquatic Exercise Training on Cardiorespiratory Responses of Patients With Type 2 Diabetes: The Diabetes and Aquatic Training Study-A Randomized Controlled Trial.

BACKGROUND: There are a lack of clinical trials with suitable methodological quality that compare aquatic exercise training types in type 2 diabetes (T2D) treatment. This study aimed to compare the effects of aerobic and combined aquatic training on cardiorespiratory outcomes in patients with T2D. METHODS: Untrained patients with T2D were randomized to receive an aerobic aquatic training, a combined aquatic training, or a procedure control in 3 weekly sessions for 15 weeks. The sessions were 50 minutes long. The intensities were from 85% to 100% of heart rate of anaerobic threshold and at maximal velocity for aerobic and resistance parts, respectively. Resting heart rate, peak oxygen uptake (VO2peak), and oxygen uptake corresponding to second ventilatory threshold and its relation with VO2peak were evaluated. RESULTS: Participants were 59.0 (8.2) years old and 51% women. Intervention groups increased in VO2peak (aerobic aquatic training group: 4.48 mL·kg-1·min-1, P = .004; combined aquatic training group: 5.27 mL·kg-1·min-1; P = .006) and oxygen uptake corresponding to second ventilatory threshold, whereas the control group presented an increase in oxygen uptake corresponding to second ventilatory threshold and minimal change in VO2peak. CONCLUSIONS: Aerobic and combined aquatic exercise interventions improve the cardiorespiratory fitness of patients with T2D.

The Role of Aerobic Training Variables Progression on Glycemic Control of Patients with Type 2 Diabetes: a Systematic Review with Meta-analysis.

BACKGROUND: Aerobic training (AT) improves glycemic control in patients with type 2 diabetes. However, the role of the progression of training variables remains unclear. The objective of this review was to analyze the effects of progressive AT (PAT) and non-progressive AT (NPAT) on glycated hemoglobin (HbA1c) in patients with type 2 diabetes. METHODS: Data sources used were PubMed, Cochrane Central, Embase, SPORTDiscus, and LILACS. Studies that evaluated the effect of at least 12 weeks of PAT and NPAT compared to a control condition on HbA1c levels in type 2 diabetes patients were eligible for analysis. Two independent reviewers screened the search results, extracted the data, and assessed the risk of bias. Effect sizes (ESs) were calculated using the standardized mean difference in HbA1c levels between the intervention and control groups using a random-effect model. RESULTS: Of 5848 articles retrieved, 24 randomized clinical trials (825 participants) were included. Among the included studies, 92% reported to have performed a randomization process, 8% presented allocation concealment, 21% reported blinding of outcome assessment, and 38% reported complete outcome data. AT reduced HbA1c levels by 0.65% (ES: - 1.037; 95% confidence interval [CI]: - 1.386, - 0.688; p < 0.001). The reduction in HbA1c induced by PAT was 0.84% (ES: - 1.478; 95% CI - 2.197, - 0.759; p < 0.001), and NPAT was 0.45% (ES: - 0.920; 95% CI - 1.329, - 0.512; p < 0.001). Subgroup analysis of the different forms of progression showed a reduction in HbA1c levels of 0.94% (ES: - 1.967; 95% CI - 3.783, - 0.151; p = 0.034) with progression in volume, 0.41% (ES: - 1.277; 95% CI - 2.499, - 0.056; p = 0.040) with progression in intensity, and 1.27% (ES: - 1.422; 95% CI - 2.544, - 0.300; p = 0.013) with progression in both volume and intensity. Subgroup analysis of the different modalities of AT showed a reduction of 0.69% (ES: - 1.078; 95% CI - 1.817, - 0.340; p = 0.004) with walking and/or running and of 1.12% (ES: - 2.614; 95% CI - 4.206, - 1.022; p = 0.001) with mixed protocols while progressive training was adopted. In non-progressive protocols, a significant HbA1c reduction was only found with walking and/or running (- 0.43%; ES: - 1.292; 95% CI - 1.856, - 0.72; p < 0.001). CONCLUSION: The effect of PAT on glycemic control was greater than that of NPAT, especially when volume and intensity were progressively incremented throughout the interventions.

Glycemic Threshold as an Alternative Method to Identify the Anaerobic Threshold in Patients With Type 2 Diabetes.

Purpose: To analyze the agreement between the velocity, heart rate, and oxygen uptake values corresponding to second ventilatory threshold and glycemic threshold in patients with type 2 diabetes. Methods: Twenty-four untrained patients (55.1 ± 8.9 years) were evaluated. Three different parameters of training intensity corresponding to anaerobic threshold, one mechanical (velocity) and two physiological (heart rate and oxygen uptake) parameters, were identified by a classical method (second ventilatory threshold) and by an alternative method (glycemic threshold). To determine the threshold values, patients performed an incremental treadmill test, with an initial velocity of 3 km.h-1 for 3 min, that was then increased by 1 km.h-1 every 2 min. Comparisons between mean values and the degree of agreement between second ventilatory threshold and glycemic threshold were analyzed using the paired t-test and Bland-Altman test, respectively. Results: All patients performed the tests appropriately, and no adverse effects were recorded. Patients demonstrated similar mean velocity (p = 0.25), heart rate (p = 0.97) and oxygen uptake (p = 0.71) between the ventilatory threshold (6.4 ± 0.6 km.h-1, 130.1 ± 18.7 bpm, 15.2 ± 3.5 ml.kg.min-1) and the glycemic threshold (6.2 ± 0.9 km.h-1, 130.2 ± 12.8 bpm, 15.0 ± 3.8 ml.kg.min-1). Conclusion: The present study indicates an agreement between the glycemic and second ventilatory methods in determination of the anaerobic threshold of patients with type 2 diabetes; and thus, either method may be used for these patients.

Quality of life and sleep quality are similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial.

OBJECTIVES: To compare the effects of two aerobic training models in water and on dry-land on quality of life, depressive symptoms and sleep quality in patients with type 2 diabetes. DESIGN: Randomized clinical trial. METHODS: Thirty-five patients with type 2 diabetes were randomly assigned to aquatic aerobic training group (n=17) or dry-land aerobic training group (n=18). Exercise training length was of 12 weeks, performed in three weekly sessions (45min/session), with intensity progressing from 85% to 100% of heart rate of anaerobic threshold during interventions. All outcomes were evaluated at baseline and 12 weeks later. RESULTS: In per protocol analysis, physical and psychological domains of quality of life improved in both groups (p<0.05) without between-group differences. Overall quality of life and sleep quality improved in both groups (p<0.05), without between-group differences in per protocol and intention to treat analysis. No changes on depressive symptoms were observed in both groups at follow-up. CONCLUSIONS: Aerobic training in an aquatic environment provides similar effects to aerobic training in a dry-land environment on quality of life, depressive symptoms and sleep quality in patients with type 2 diabetes. Clinical trial reg. no. NCT01956357, clinicaltrials.gov.

Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic review and meta-analysis.

OBJECTIVE: To assess the associations of aerobic, resistance, and combined exercise with changes in insulin resistance, fasting glucose, and fasting insulin in children and adolescents who are overweight or obese. DATA SEARCHES: MEDLINE via Pubmed, Cochrane-CENTRAL, SPORTDiscus, and LILACS. STUDY SELECTION: Randomized clinical trials of at least six weeks of duration that evaluated the ability of exercise training to lower at least one of the following outcomes: insulin resistance-HOMA, fasting glucose, and fasting insulin in children and/or adolescents classified as obese or overweight. DATA EXTRACTION AND ANALYSIS: Two independent reviewers extracted data and assessed the quality of the included studies. Differences (exercise training group minus control group) in the outcomes evaluated were analyzed using a random effects model. RESULTS: Of 1853 articles retrieved, 17 studies were included. The meta-analysis showed that physical training in general was not associated with a reduction in fasting glucose levels compared to the control, but it was associated with reductions in fasting insulin levels (-3.37µU/ml; CI 95%, -5.16µU/ml to -1.57µU/ml; I2, 54%, p=0.003) and HOMA (-0.61; CI 95%, -1.19 to -0.02; I2, 49%, p=0.040). In addition, each modality (aerobic, resistance, and combined) was compared to the control group. Aerobic exercise was associated with declines in fasting insulin levels (-4.52µU/ml; CI 95%, -7.40 to -1.65; I2, 65%, p=0.002) and in HOMA (-1.33; 95% confidence interval, -2.47 to -0.18; I2, 73%, p=0.005). CONCLUSIONS: Exercise training, especially aerobic training, is associated with the reduction of fasting insulin levels and HOMA in children and adolescents with obesity and overweight, and may prevent metabolic syndrome and type 2 diabetes.

Glycemic reductions following water- and land-based exercise in patients with type 2 diabetes mellitus.

PURPOSE: To assess the acute glucose responses to the first sessions of three mesocycles of water- and land-based aerobic exercise. METHODS: The water-based exercise group (WBE, n = 14; 54.1 ± 9.1 years) performed deep water walking and/or running, while the land-based exercise group (LBE, n = 11; 60.1 ± 7.3 years) performed walking and/or running on athletic track. In the first mesocycle, patients trained at 85-90% of their anaerobic threshold (AT) for 35 min, progressing to 90-95% of the AT in the second mesocycle, and 95-100% of the AT in the last mesocycle. Capillary glucose was assessed before and immediately after the first session of each mesocycle. RESULTS: There was glycemic reduction (p < 0.001) in all sessions, with relative reductions of 19%, 29% and 24% for the WBE and 24%, 29% and 27% for the LBE in the mesocycles 1, 2 and 3, respectively. There were no found differences between groups and between mesocycles. CONCLUSIONS: The acute response of blood glucose to aerobic training between 85 and 100% of the heart rate of AT is effective and independent of the environment in which it is performed. Clinical trial reg. no. NCT01956357, clinicaltrials.gov.

Acute glycemic outcomes along the aerobic training in deep water in patients with type 2 diabetes / Respuestas de la glucemia aguda a lo largo del entrenamiento aeróbico en aguas profundas en pacientes con diabetes tipo 2

Aims: The present study aimed to analyze the acute glucose responses in the first and last sessions of four mesocycles along an aquatic aerobic training periodization. Methods: Fourteen patients (6 men and 8 women; 54.3 ± 9.0 years; body mass index of 34.5 ± 3.9 kg/m2) with type 2 diabetes underwent a 12-week training program involving deep-water running. This exercise training was performed by an interval training method, with a frequency of 3 times a week, session duration of 35 minutes and intensity progressing from 85 to 90% to 95 to 100% of the anaerobic threshold heart rate (ATHR) along the periodization. Capillary glucose was assessed before and immediately after the first and last session of each mesocycle. A generalized estimated equation (time x session x mesocycle) was used to assess reductions in glucose levels in different sessions (first and last) along four mesocycles (α = 0.05). Results: All sessions resulted in a reduction in glucose levels (time effect: p <0.001), without differences between the first and last session of each mesocycle (session effect: p = 0.738). With regard to the mesocycles (mesocycle effect: p = 0.003), significant differences were found between mesocycles 2 and 3. In time mesocycle interaction (p = 0.002), in most comparisons, post-session values were lowest that pre-session values, regardless of mesocycle, except for the post-session value of mesocycle 3, which was similar to the pre-values of mesocycles 2 and 4. Conclusion: Aerobic training in deep water with crescent linear periodization over 12 weeks is able to reduce glucose levels in patients with type 2 diabetes

Objetivo: Analizar las respuestas de glucemia aguda en las primeras y últimas sesiones de cuatro mesociclos a lo largo de una periodización de entrenamiento aeróbico acuático. Métodos: Catorce pacientes (6 hombres y 8 mujeres; 54,3 ± 9,0 años; índice de masa corporal de 34,5 ± 3,9 kg/m2) con diabetes tipo 2 fueron sometidos a un programa de entrenamiento de 12 semanas de carrera en aguas profundas. Se realizó un entrenamiento aeróbico de intervalos, realizado 3 veces por semana, con sesiones de 35 minutos y la intensidad progresando a lo largo de la periodización desde 85% - 90% a 95% - 100% de la frecuencia cardiaca del umbral anaeróbico (FCUA). La glucosa capilar fue evaluada antes e inmediatamente después de la primera y la última sesión de cada mesociclo. Se utilizó una ecuación generalizada estimada (tiempo x sesión x mesociclo) para evaluar las reducciones en los niveles de glucosa en las diferentes sesiones (primera y última) a lo largo de cuatro mesociclos (α = 0.05). Resultados: todas las sesiones resultaran en una reducción en los niveles de glucosa (efecto tiempo: p<0,001), sin diferencias entre la primera y la última sesión de cada mesociclo (efecto de sesión: p = 0,738). Con respecto a los mesociclos (efecto mesociclo: p=0,003) se encontraron diferencias significativas entre los mesociclos 2 y 3. En la interacción tiempo mesociclo (p=0,002), en la mayor.a de las comparaciones, los valores post-sesión fueron menores de los valores pre-sesión, independientemente de mesociclo, excepto para el valor después de la sesión del mesociclo 3, que fue similar a los valores antes de la sesión de los mesociclos 2 y 4. Conclusión: Doce semanas de entrenamiento aeróbico en aguas profundas con la periodización linear y creciente es capaz de reducir los niveles de glucosa en pacientes con diabetes tipo 2

Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial.

OBJECTIVES: To compare the effects of two aerobic training methods in water and on dry-land on glycemic, lipid, inflammatory, hormonal, cardiorespiratory, and functional outcomes in patients with type 2 diabetes. DESIGN: Randomized clinical trial. METHODS: Thirty-five patients with type 2 diabetes were randomly assigned to aquatic aerobic training group (n=17) or dry-land aerobic training group (n=18). Exercise training interventions had duration of 12 weeks, performed in three weekly sessions (45min/session), with intensity progressing from 85% to 100% of heart rate of anaerobic threshold during interventions. All outcomes were evaluated at baseline and 12 weeks later. RESULTS: Patients were 56.7±7.9 years old. Decreases in glycated hemoglobin were observed in both groups (AT: -0.42±0.28%, DLT: -0.35±1.8%). Total cholesterol, high density lipoprotein, low density lipoprotein levels, plasma renin activity, angiotensin II concentrations, C-reactive protein, systolic blood pressure, resting heart rate, and timed up and go test performed at the usual speed also decreased in both groups in response to both interventions (p<0.05), without between-group differences. Both groups increased the ratio between oxygen uptake at the anaerobic threshold and oxygen uptake of peak (p=0.01). CONCLUSIONS: Aerobic training in an aquatic environment provides effects similar to aerobic training in a dry-land environment in patients with type 2 diabetes.

Punto de desviación de la frecuencia cardíaca es una alternativa de método para identificar el umbral anaeróbico en pacientes con diabetes tipo 2 / Heart rate deflection point as an alternative method to identify the anaerobic threshold in patients with type 2 diabetes

Objetivos: El propósito de este artículo fue evaluar la concordancia entre frecuencia cardíaca (FC) y velocidad en la cinta de correr correspondiente al umbral anaeróbico medido por el segundo umbral ventilatorio (VT2) y por el punto de deflexión de la FC (PDFC) en pacientes con diabetes tipo 2. Métodos: Se evaluaron treinta y dos pacientes sedentarios (56,1 ± 7,7 años) para determinar los valores de los umbrales, los pacientes realizaron una prueba de esfuerzo incremental a una velocidad inicial de 3 km h-1 durante 3 min, con incrementos de 1 km h-1 cada 2 min. Se analizó el grado de concordancia entre VT2 y PDFC mediante el test de Bland-Altman. Resultados: Los pacientes mostraron una FC de 133 ± 16 lpm en VT2 y 133 ± 18 lpm en PDFC. La velocidad media correspondiente a VT2 fue 6,3 ± 0,7 km h-1 y la correspondiente a PDFC fue 6,4 ± 1,1 km h-1. No hubo diferencias significativas entre los métodos evaluados (FC:p = 0,78; velocidad media: p = 0,57). Conclusión: Esta investigación concluye que existe correspondencia entre los métodos VT2 y PDFC en FC y la velocidad media en la cinta de correr, por lo tanto, cualquiera de estos dos métodos puede ser usado en estos pacientes

Aims: The purpose of this study was to evaluate the agreement between heart rate (HR) and treadmill velocity corresponding to the anaerobic threshold measured by second ventilatory threshold (VT2) and the HR deflection point (HRDP) in patients with type 2 diabetes. Materials and methods: Thirty-two sedentary patients (56.1 ± 7.7 years) were evaluated. To determine the threshold values, patients performed an incremental treadmill test, with an initial velocity of 3 km h-1 for 3 min, which was then increased by 1 km h-1 every 2 min. The degree of agreement between VT2 and HRDP was analyzed using the Bland–Altman test. Results: Patients had a HR of 133 ± 16 bpm at VT2 and 133 ± 18 bpm at HRDP. Mean velocity corresponding to VT2 was 6.3 ± 0.7 km h-1, and that corresponding to HRDP was 6.4 ± 1.1 km h-1. There were no significant differences between the methods evaluated (HR: p = 0.78; mean velocity: p = 0.57). Conclusions: The present investigation concludes that there is an agreement between VT2 and HRDP methods for HR and treadmill velocity, and thus, either method may be used for these patients