Effects of resistance training on the glycemic control of people with type 1 diabetes: a systematic review and meta-analysis

ABSTRACT Resistance training has shown the potential to contribute to better glycemic control in people with Type 1 Diabetes (T1D), however, there are contradictory results in this regard and a need to clarify the effects of isolated resistance training on glycemic control in T1D. The aim was to verify the effects of resistance training on the glycemic control of people with T1D. Original articles were selected, randomized and non-randomized clinical trials that aimed to verify chronic responses, through the concentrations of glycated hemoglobin (HbA1c), to a structured program of resistance exercise in the glycemia of patients with T1D. The following databases were searched; MEDLINE, PubMed, Web of Science, Scopus, ScienceDirect, LILACS, and SciELO. Five studies were included in the review. A reduction in HbA1c was observed (SMD = -0.568 ± 0.165 [95% CI = -0.891 to -0.246]; p = 0.001; I² = 82%) in patients undergoing resistance training, when compared to the control group (SMD = 1.006 ± 0.181 [95% CI = 0.653 to 1.360]; p <0.001). Two studies, with children and adolescents and longer interventions, demonstrated a significant reduction in HbA1c, increased strength, and an improved lipid profile. Resistance training was efficient for assisting in glycemic control in people with T1D and should be incorporated in treatment plans.

Effects of resistance training on the glycemic control of people with type 1 diabetes: a systematic review and meta-analysis.

Resistance training has shown the potential to contribute to better glycemic control in people with Type 1 Diabetes (T1D), however, there are contradictory results in this regard and a need to clarify the effects of isolated resistance training on glycemic control in T1D. The aim was to verify the effects of resistance training on the glycemic control of people with T1D. Original articles were selected, randomized and non-randomized clinical trials that aimed to verify chronic responses, through the concentrations of glycated hemoglobin (HbA1c), to a structured program of resistance exercise in the glycemia of patients with T1D. The following databases were searched; MEDLINE, PubMed, Web of Science, Scopus, ScienceDirect, LILACS, and SciELO. Five studies were included in the review. A reduction in HbA1c was observed (SMD = -0.568 ± 0.165 [95% CI = -0.891 to -0.246]; p = 0.001; I2 = 82%) in patients undergoing resistance training, when compared to the control group (SMD = 1.006 ± 0.181 [95% CI = 0.653 to 1.360]; p <0.001). Two studies, with children and adolescents and longer interventions, demonstrated a significant reduction in HbA1c, increased strength, and an improved lipid profile. Resistance training was efficient for assisting in glycemic control in people with T1D and should be incorporated in treatment plans.

Acute changes in glucose induced by continuous or intermittent exercise in children and adolescents with type 1 diabetes

ABSTRACT Objective: To estimate the rate of change during exercise and during recovery in moderate-continuous exercise (MCE) and high-intensity intermittent exercise (HIIE) in children and adolescents with type 1 diabetes (T1D). Subjects and methods: Participants performed 2 sessions of exercise: thirty minutes of continuous activity on a cycle ergometer (60% of VO2max) and thirty minutes (60% VO2max) interspersed with five bouts of maximum intensity lasting ten seconds every five minutes. Capillary blood glucose was measured before and after each test. The glucose rate of change in exercise (RoCE) was calculated (final blood glucose - onset blood glucose/exercise time), and the glucose rate of change in recovery (RoCR) (blood glucose 30 minutes after exercise - end of exercise blood glucose/recovery time). Results: The study included thirty-one participants (aged 13 ± 1.88 years). A lower blood glucose reduction was observed in the HIIE group, as well as better recovery values before, after, and thirty minutes after the test, respectively (333.14 ± 69.53, 226.19 ± 68.05 and 201.77 ± 66.84 versus 211.36 ± 91.03, 155.98 ± 82,68 and 165.76 ± 72.94). Covariance analyses showed a significant difference in glycemic variation between continuous and intermittent protocols immediately after exercise (−2.90 versus −2.08) and during the recovery period (−0.677 versus −0.389). Conclusions: HIIE led to a lower glucose reduction rate per minute during exercise and better recovery in the first 30 minutes after exercise compared to MCE in children and adolescents with T1D.

Acute changes in glucose induced by continuous or intermittent exercise in children and adolescents with type 1 diabetes.

Objective: To estimate the rate of change during exercise and during recovery in moderate-continuous exercise (MCE) and high-intensity intermittent exercise (HIIE) in children and adolescents with type 1 diabetes (T1D). Methods: Participants performed 2 sessions of exercise: thirty minutes of continuous activity on a cycle ergometer (60% of VO2max) and thirty minutes (60% VO2max) interspersed with five bouts of maximum intensity lasting ten seconds every five minutes. Capillary blood glucose was measured before and after each test. The glucose rate of change in exercise (RoCE) was calculated (final blood glucose - onset blood glucose/exercise time), and the glucose rate of change in recovery (RoCR) (blood glucose 30 minutes after exercise - end of exercise blood glucose/recovery time). Results: The study included thirty-one participants (aged 13 ± 1.88 years). A lower blood glucose reduction was observed in the HIIE group, as well as better recovery values before, after, and thirty minutes after the test, respectively (333.14 ± 69.53, 226.19 ± 68.05 and 201.77 ± 66.84 versus 211.36 ± 91.03, 155.98 ± 82,68 and 165.76 ± 72.94). Covariance analyses showed a significant difference in glycemic variation between continuous and intermittent protocols immediately after exercise (-2.90 versus -2.08) and during the recovery period (-0.677 versus -0.389). Conclusion: HIIE led to a lower glucose reduction rate per minute during exercise and better recovery in the first 30 minutes after exercise compared to MCE in children and adolescents with T1D.

Influence of Insulin Application Time and High-Intensity Intermittent Exercise on Hypoglycemic Risk in Adolescents With Type 1 Diabetes.

PURPOSE: The study analyzed the influence of exercise on hypoglycemia episodes postexercise and in the subsequent 24 hours in children and adolescents with type 1 diabetes. METHODS: Thirty young people performed the same protocol of physical exercises for 1 hour (Ex1h) and 2 hours (Ex2h) after the administration of insulin. They performed 30 minutes of exercise on a cycle ergometer with a load of 60% of maximal oxygen uptake, interspersed with maximum intensity sprints lasting 10 seconds every 5 minutes. RESULTS: Regarding the occurrence of hypoglycemia, in the 8 hours following the exercises, there was no occurrence in Ex1h (χ2 = 0.001; P = .0001) and a greater proportion for Ex2h (n = 71 episodes, 53.8%), while Ex1h had a higher number of nocturnal hypoglycemic episodes (n = 60, 71.4%) compared with Ex2h (n = 31, 23.1%, χ2 = 49.521, P = .0001), Ex1h triggered a lower number of hypoglycemia (n = 84) than Ex2h (n = 134, χ2 = 11.504, P = .001). There was a greater reduction in the average amount of fast-acting insulin administered the day after Ex1h compared with Ex2h (P = .031). CONCLUSIONS: Intermittent exercise performed 1 hour after insulin administration shows a lower risk of hypoglycemia within 8 hours after exercise, as well as a reduction in insulin the following day.

Impacto da atividade física na qualidade de vida e sobrevida de idosos com câncer: uma revisão sistemática / Impact of physical activity on the quality of life of older adults with cancer: a systematic review

Objetivo: avaliar o impacto da atividade física (AF) em qualidade de vida (QV) e sobrevida (SV) de idosos com câncer. Método: revisão sistemática nas bases de dados Medline-Bireme, PubMed, Cochrane-Embase e SciELO. Os estudos passaram por critérios de seleção e análise, com base nas escalas de PRISMA e PEDro. Resultados:foram selecionados dez estudos ao final do processo, sete relacionados à QV e três relacionados à SV. Os resultados mostraram que intervenções realizadas após o diagnostico oncológico trazem benefícios para a QV, como aumento da funcionalidade, da força muscular, da densidade mineral óssea, da flexibilidade, do bem-estar e da massa magra. Houve também impacto positivo na SV. Conclusão: os resultados desta revisão sistemática ajudam a compreender que a prática de AF pode trazer benefícios tanto para a QV quanto para a SV de pessoas acima de 60 anos com diagnósticos oncológicos.(AU)

Objective: to evaluate the impact of physical activity (PA) on quality of life (QoL) and survival rate (SV) of the elderly with cancer. Method: systematic review in databases such as Medline-Bireme, PubMed, Cochrane-Embase, and SciELO. The studies underwent selection and analysis criteria, based on PRISMA and PEDro scales. Results: ten studies were selected at the end of the process, seven related to QoL and three related to SV. The results showed that interventions performed after cancer diagnosis bring benefits for QoL, such as increased functionality, muscle strength, bone mineral density, flexibility, well-being and lean mass. There was also a positive impact on SV. Conclusion: the results of this systematic review help to understand that PA can offer benefits for both QoL and SV of people over 60 years of age with cancer diagnosis.(AU)

Comparative Study of the Efficacy of L-Tryptophan Nanoparticles on Motor and Cognitive Behavior in an Alzheimer's Experimental Model

Abstract Alzheimer's disease is the most common neurodegenerative disorder, with cognitive as well as behavioral manifestations. Also related to this pathology, is the decreased production and activation of some neurotransmitters, such as Serotonin, which is derived from the Tryptophan. Different methods to improve the effect and performance of some drugs have been studied including the Nanoparticles. The objective was to analyze the efficacy of L-tryptophan and L-tryptophan Nanoparticles in the acute response of motor and cognitive behavior in an Alzheimer's experimental model. Methods: 15 Wistar rats, divided into 3 groups (n = 5): GC (Alzheimer's control group), GLt (L-tryptophan), and GN (Nanoparticles). They were treated for six consecutive days. Anxiety tests, spatial memory tests, aversive memory tests, and motor behavior tests were all performed during this study. In the analysis of anxiety, improvement was observed in both treatments, being that GN presented improvement in two variables: freezing (79±18.8; 74.6±14.2) and TBF (287.8±1.08; 268±40.8). GLt only presented improvement in freezing (103.8±44.4). In the spatial memory analysis, there were no significant differences in aversive memory and motor behavior during the treatments. During the Size Effect analysis treatments, it is possible to observe some differences both in anxiety and motor behavior, precisely where NG presented better results than GLt. Even in a short period of time, the nanoparticles demonstrated great benefits as a treatment method. Conclusion: the use of nanoparticles is an effective treatment against changes in motor and cognitive behavior caused by Alzheimer´s, as it lowers anxiety and improves motor behavior.

O tempo sentado está associado aos fatores de risco cardiometabólicos em adolescentes? / Is sitting time associated with cardiometabolic risk factors in adolescents?

O presente estudo teve como objetivo verificar a associação entre o tempo sentado e fatores de risco cardiometabólicos em adolescentes. A amostra foi composta por 454 adolescentes (50,6% masculino) com idades entre 12 a 18 anos. O tempo diário despendido sentado e a prática de atividade física moderada-vigorosa foram avaliados por meio do recordatório de três dias de Bouchard. Os fatores de risco cardiometabólicos analisados foram: circunferência de cintura; glicose; HDL-C; triglicerídeos; e pressão arterial. Foi utilizada a análise de variância com dois fatores (sexo e quartis) para comparar os fatores de risco cardiometabólicos entre os quartis de tempo sentado. Para verificar a associação entre o tempo sentado e os fatores de risco cardiometabólicos foi empregado a regressão linear múltipla. Foi observado que os meninos pertencentes ao 4º quartil (maior tempo sentado) apresentaram valores mais elevados de glicose e triglicerídeos em comparação com seus pares com menos tempo. No sexo feminino, verificou-se que as pertencentes ao 3º e 4º quartil apresentaram maiores valores de triglicerídeos e glicose em comparação ao 1º quartil. Associações positivas e significativas foram observadas entre o tempo sentado e os valores de circunferência da cintura (ß = 0,093; p < 0,05), glicose (ß = 0,111; p < 0,05) e pressão arterial diastólica (ß = -0,115; p < 0,05) mesmo após o ajuste para a prática de atividade física moderada-vigorosa. De acordo com os achados do presente estudo, conclui-se que os adolescentes que permaneceram maior tempo sentado apresentaram maiores valores de glicose, triglicerídeos e escore de risco cardiometabólico em comparação aos que despenderam menos tempo

This study aimed to verify if there is an association between sitting time and cardiometabolic risk factors in adolescents. The sample was composed of 454 adolescents (50.6% male) aged between 12 and 18 years. The time spent in sitting and physical activity were assessed through a record of three days by Bouchard. The following cardiometabolic risk factors were analyzed: waist circumference, glucose, HDL ­ cholesterol, tri-glycerides, and blood pressure. It was used the Two-way Analysis of Variance (sex and quartiles) to compare the cardiometabolic risk factors between the quartiles of sitting time. To verify the association between sitting time and cardiometabolic risk factors it was used the multivariate linear regression. Boys of the 4th quartile (higher sitting time) presented higher values of glucose and triglycerides compared to their peers with less time. Girls of the 3rd and 4th quartile presented higher triglycerides and glucose values, compared to the 1st quartile. Significant associations (p < 0.05) were observed between sitting time with waist circumference (ß = 0.093; p < 0.05), glucose (ß = 0.111; p < 0.05) and diastolic blood pressure (ß = 0.115; p < 0.05) even after the adjustment for the moderate to vigorous physical activity. According to the findings of this study, we concluded that adolescents who spent more sitting time had higher values of glucose, triglycerides and cardiometabolic risk score compared with who has less sitting time

Associação entre a qualidade de vida, qualidade do sono e desenvolvimento motor de crianças / Association between quality of life, sleep quality and children's motor development

Objetivo։ Associar a qualidade de vida, qualidade do sono com o desenvolvimento motor de crianças. Métodos։ Estudo correlacional realizado com 70 participantes (35 meninos e 35 meninas) com idade de 9 a 12 anos. Para analisar a qualidade de vida foi aplicado o WHOQOL-bref. A qualidade de sono foi analisada pelo Pittsburgh Sleep Quality Index. Para análise do desenvolvimento motor foi utilizada a Escala de Desenvolvimento Motor. A análise estatística foi composta por média e desvio padrão e frequência percentílica. Para comparação das variáveis paramétricas foi utilizado o teste t de Student. A correlação de Pearson foi empregada para associar as variáveis e foi estipulado um nível de confiança de p<0,05. Resultados։ As meninas apresentaram valores significativos em relação aos meninos nas variáveis de índice de massa corporal, relações sociais, motricidade global, organização espacial, idade motora geral e quociente motor geral. Nas demais variáveis não foram observados valores significativos. Foi encontrada associação fraca entre qualidade de vida e a qualidade de sono, qualidade vida e a idade cronológica e a idade cronológica com a idade motora geral. Entretanto, entre a idade motora geral e o quociente motor geral foi observada associação forte. Conclusão։ Foi possível observar que a qualidade de vida apresenta influência positiva na idade cronológica. Porém, nas variáveis de idade motora geral e o quociente motor geral demonstrou não inferir, o mesmo aconteceu na associação entre a qualidade de sono e as demais variáveis.

Objective։ The association of quality of life, quality of sleep and the motor development of children. Methods։ Correlational study carried out with 70 participants (35 boys and 35 girls) aged between 9 to 12 years. In order to analyze the quality of life, the WHOQOL-bref tool was applied. Sleep quality was analyzed using the Pittsburgh Sleep Quality Index. Motor Development Scale was used to analyze motor development. The statistical analysis consisted of mean and standard deviation, and percentile frequency. Student t test was used to compare the parametric variables. Pearson's correlation was used to associate the variables and a confidence level of p <0.05 was stipulated. Results։ The girls presented significant values in relation to the boys in the body mass index, social relations, global motor skills, spatial organization, general motor age and general motor quotient variables. In the other variables, no significant values were observed. A weak association was found between quality of life and quality of sleep, quality of life and chronological age, and chronological age and general motor age. However, a strong association was observed between general motor age and general motor quotient. Conclusion։ It was possible to observe that quality of life has a positive influence on chronological age. However, in the general motor age and the general motor quotient variables, it demonstrated no interference, the same happened in the association between sleep quality and other variables.

Different amounts of moderate to vigorous physical activity and change in glycemic variability in adolescents with type 1 diabetes: is there dose-response relationship?

OBJECTIVE: To identify the level of physical activity and glycemic variability of adolescents with type 1 diabetes mellitus and to compare glycemic variability on days with different amounts of moderate to vigorous physical activity (MVPA). SUBJECTS AND METHODS: A sample of 34 subjects aged 10 to 15 years, 18 (52.94%) female; age: 13.04 ± 1.94; HbA1c: 9.76 ± 1.51. Physical activity was measured by wGT3X accelerometer. The glucose data were obtained using continuous glucose monitoring, and the following glycemic variability measures were calculated: standard deviation (SD), low blood glucose index (LBGI), high blood glucose index (HBGI), mean amplitude of glycemic excursions (MAGE), glycemic risk assessment in diabetes equation (GRADE) and coefficient of variation (CV). The most and least active days (the days with greater and lesser time dedicated to physical activities of moderate to vigorous intensity, respectively) were identified. In addition, based on the whole period of accelerometer use, daily means of time spent in MVPA were identified among participants, who were then divided into three groups: up to 100 minutes; from 101 to 200 minutes and above 201 minutes. Then, the measures of glycemic variability were compared among the most and least active days and among the groups too. RESULTS: The amount of MVPA was significantly different between the days evaluated (237.49 ± 93.29 vs. 125.21 ± 58.10 minutes), but glycemic variability measures did not present a significant difference. CONCLUSION: Despite the significant differences in the amount of MVPA between the two days evaluated, the glycemic variability did not change significantly. Arch Endocrinol Metab. 2020;64(3):312-8.

Bone mass and dietary intake in children and adolescents with type 1 diabetes mellitus.

OBJECTIVES: To evaluate the bone mineral density (BMD) in children/adolescents with type 1 diabetes mellitus (T1DM) and its association with the nutritional intake, metabolic control, and physical activity level of this population. METHODS: Study including 34 patients with T1DM and 17 controls. Assessments included the participants disease history, intake of macronutrient, calcium, phosphorus and magnesium, physical activity level, total body and lumbar spine BMD and serum levels of glycated hemoglobin, vitamin D, calcium, phosphorus, magnesium, osteocalcin and C-terminal telopeptide. RESULTS: Total body and lumbar spine BMD z-scores were normal in all but two participants in the T1DM group. The T1DM group had significantly lower total body BMD z-score values (p < 0.001) and levels of osteocalcin, C-terminal telopeptide, calcium, phosphorus, and magnesium. Intake of macronutrients and calcium was inadequate in both groups. Participants in the T1DM group were more sedentary (88%) and had inadequate metabolic control (91%) and low vitamin D levels (82%). Bone mass in the T1DM group was influenced by body mass index (BMI), pubertal stage, disease duration, calcium intake, and physical activity level. CONCLUSIONS: Bone mass in patients with T1DM was adequate but lower than controls and was influenced by BMI, pubertal stage, disease duration, calcium consumption, and physical activity level.

Comparação da qualidade de vida e sono de adolescentes portadores e não portadores de diabetes mellitus tipo 1 / Comparison of quality of life and sleep of adolescents with and without type 1 diabetes mellitus

RESUMO A Diabetes Mellitus Tipo 1 (DM1) é uma doença autoimune que afeta milhares de pessoas atualmente, com maior concentração de casos na adolescência. O tratamento implica alterações no estilo de vida que podem apresentar influência negativa sobre a qualidade do sono (QS) e qualidade de vida (QV). O propósito do estudo foi comparar a QS e QV entre adolescentes portadores e não portadores de DM1. Participaram do estudo 74 adolescentes divididos por grupos e sexo: GDM1-F (n=19), GDM1-M (n=18), GC-F (n=21) e GC-M (n=16). Os instrumentos utilizados foram o Índice de Qualidade do Sono de Pittsburgh e WHOQOL-bref. Para comparar os grupos foi utilizado Análise de Covariância, ajustada pela idade, com Post Hoc de Bonferroni. Os resultados sinalizam que os participantes do GDM1-F e GDM1-M, portadores de DM1, apresentaram maiores escores em todas as avaliações, com diferença significativa com o CG-F nas variáveis: QS global, Domínios Físico, Psicológico e Relações Sociais e QV total. Portanto, foi possível observar que os adolescentes portadores de DM1 apresentaram melhor avaliação da QS e QV em comparação as meninas sem DM1, independentemente da idade.

ABSTRACT Type 1 Diabetes Mellitus (DM1) is an autoimmune disease that affects thousands of people today, with a higher concentration of cases in adolescence. Treatment involves lifestyle changes that can have a negative influence on quality of sleep (QS) and quality of life (QL). The purpose of the study was to compare QS and QL among adolescents with and without DM1. Seventy-four adolescents participated in the study divided by groups and sex: GDM1-F (n=19), GDM1-M (n=18), GC-F (n=21) and GC-M (n=16). The instruments used were the Pittsburgh Sleep Quality Index and WHOQOL-bref. Age-adjusted Covariance Analysis with Bonferroni Post Hoc was used to compare the groups. The results show that the participants of GDM1-F and GDM1-M, with DM1, had higher scores in all evaluations, with significant difference with CG-F in the variables: global QS, Physical, Psychological and Social Relationships and total QL. Therefore, it was possible to observe that adolescents with DM1 had better QS and QL evaluations than girls without DM1, regardless of age.

Maximal fat oxidation during aerobic exercise in adolescents with type 1 diabetes / Oxidação máxima de gorduras durante o exercício aeróbico em adolescentes com diabetes tipo 1 / Oxidación máxima de grasas durante el ejercicio aeróbico en adolescentes con diabetes tipo 1

ABSTRACT Objective: To compare maximal fat oxidation rates (FATMAX) and analyze their association with cardiorespiratory fitness in adolescents with type 1 diabetes mellitus (T1DM). Methods: Twenty-two male and female adolescents aged between 11 to 17 years, following clinical and anthropometric evaluations, were assigned to the diabetic group (DG; n = 10) or control group (CG; n = 12). Cardiorespiratory fitness was determined by maximal oxygen uptake (VO2max) during a maximal aerobic test on a cycle ergometer using the Balke protocol. Maximal fat oxidation (FATMAX) was determined by the respiratory exchange ratio proposed in the Lusk table. Results: Adolescents in the DG had lower mean FATMAX (p<0.01) and %VO2FATMAX (p=0.001) values when compared with those in the CG. FATMAX values were inversely correlated with serum glycosylated hemoglobin (HbA1c) levels (r= −0.77) and directly correlated with BMI z-scores (r=0.76), while %VO2FATMAX results were correlated with age (r=0.81), BMI z-scores (r=0.65), and VO2max values (r=0.81). On multiple linear regression, HbA1c values explained 54% (adjusted r²=0.54, p=0.009) and BMI z-scores explained 3.1% (adjusted r²=-0.031, p=0.009) of the variation in FATMAX in the DG. Adolescents with T1DM had similar cardiorespiratory fitness and lower FATMAX rates (35±11 VO2max) when compared with controls (60±12 VO2max). Conclusion: These results suggest lower fat oxidation rates and greater use of glucose as an energy substrate during exercise and worse control in T1DM. Therefore, results may contribute to appropriate exercise prescription in T1DM, after verifying exercise intensity to reduce hypoglycemia risk. Level of evidence III; Case-control study.

RESUMO Objetivo: Comparar as taxas máximas de oxidação da gordura (FATMAX) e analisar a sua associação com a aptidão cardiorrespiratória em adolescentes com diabetes mellitus tipo 1 (DM1). Métodos: Vinte e dois adolescentes de ambos os sexos, de 11 a 17 anos, após avaliações clínicas e antropométricas, foram alocados no grupo diabético (GD; n = 10) ou no grupo controle (GC; n = 12). A aptidão cardiorrespiratória foi determinada pelo consumo máximo de oxigênio (VO2max) durante um teste aeróbico máximo em um cicloergômetro utilizando o protocolo Balke. A oxidação máxima da gordura (FATMAX) foi determinada pela razão de troca ventilatória proposta na Tabela de Lusk. Resultados: Os adolescentes no GD apresentaram menores valores médios de FATMAX (p<0,01) e % VO2FATMAX (p=0,001) quando comparados com aqueles no GC. Os valores de FATMAX correlacionaram-se inversamente com os níveis de hemoglobina glicosilada sérica (HbA1c) (r = −0,77) e diretamente com o z-score IMC (r = 0,76), enquanto os resultados de %VO2FATMAX correlacionaram-se diretamente com a idade (r = 0,81), z-score IMC (r = 0,65) e VO2max (r = 0,81). Na regressão linear múltipla, os valores de HbA1c explicaram 54% (r² ajustado = 0,54, p = 0,009) e o z-score IMC explicou 3,1% (r² ajustado = −0,031, p = 0,009) da variação no FATMAX no GD. Os adolescentes com DM1 apresentaram aptidão cardiorespiratória similar e taxas de FATMAX menores (35±11 VO2max) quando comparados com os do grupo controle (60±12 VO2max). Conclusão: Esses resultados sugerem taxas menores de oxidação da gordura e maior uso da glicose como substrato de energia durante o exercício e pior controle no DM1. Portanto, os resultados podem contribuir com a prescrição de exercício apropriada no DM1, após verificar a intensidade do exercício, a fim de diminuir o risco de hipoglicemia. Nível de evidência III; Estudo de caso-controle.

RESUMEN Objetivo: Comparar las tasas máximas de oxidación de la grasa (FATMAX) y analizar su asociación con la aptitud cardiorrespiratoria en adolescentes con diabetes mellitus tipo 1 (DM1). Métodos: Veintidós adolescentes de ambos sexos, de 11 a 17 años, después de evaluaciones clínicas y antropométricas, fueron asignados en el grupo diabético (GD, n = 10) o en el grupo control (GC, n = 12). La aptitud cardiorrespiratoria fue determinada por el consumo máximo de oxígeno (VO2max) durante un test aeróbico máximo en un cicloergómetro utilizando el protocolo Balke. La oxidación máxima de la grasa (FATMAX) fue determinada por la razón de cambio ventilatorio propuesta en la Tabla de Lusk. Resultados: Los adolescentes en el GD presentaron menores valores promedio de FATMAX (p<0,01) y % VO2FATMAX (p=0,001) cuando comparados con aquellos en el GC. Los valores de FATMAX se correlacionaron inversamente con los niveles de hemoglobina glicosilada sérica (HbA1c) (r = −0,77) y directamente con el z-score IMC (r = 0,76), mientras que los resultados de %VO2FATMAX se correlacionaron directamente con la edad (r = 0,81), z-score IMC (r = 0,65) y VO2max (r = 0,81). En la regresión lineal múltiple, los valores de HbA1c explicaron 54% (r² ajustado = 0,54, p = 0,009) y el z-score IMC explicó 3,1% (r² ajustado = −0,031, p = 0,009) de la variación en el FATMAX en el GD. Los adolescentes con DM1 presentaron aptitud cardiorrespiratoria similar y tasas de FATMAX menores (35±11 VO2max) cuando comparados con los del grupo control (60±12 VO2max). Conclusión: Esos resultados sugieren tasas menores de oxidación de la grasa y mayor uso de la glucosa como substrato de energía durante el ejercicio y peor control en la DM1. Por lo tanto, los resultados pueden contribuir con la prescripción de ejercicio apropiada en la DM1, después de verificar la intensidad del ejercicio, a fin de disminuir el riesgo de hipoglucemia. Nivel de evidencia III; Estudio de caso-control.

[Association between physical activity levels and adolescents' self-perception of self-esteem]. / Associação entre nível de atividade física e autoconceito de autoestima de adolescentes.

Physical activity levels and the self-perception of self-esteem are kindred factors of the health status of the population. Therefore, the scope of this research was to analyze the association between physical activity levels and adolescents' self-perception of self-esteem. The sample consisted of 98 individuals with an average age of 16.7 ± 1.2. Two tools were used: The International Physical Activity Questionnaire - short version, and the Rosenberg Self-Esteem Scale. Binary logistic regression (Odds Ratio) with α of 5% was then applied. The theoretical evidence revolved around the contemporary approach to the definition of health; and the results were discussed in the light of the behavioral theory of the adolescent. There was a predominance of active adolescents (41.8%), as well as a smaller proportion of sedentary adolescents (4.1%). A total of 55.1% had high self-esteem, while 44.9% were found to have low self-esteem. The conclusion drawn is that there was no association (Wald F = 2.756; p = 0.600) between the level of physical activity and the self-perception of self-esteem. Lastly, the behavioral aspects of the adolescent that point to future potential areas of investigation related to the theme of this group were discussed.

O nível de atividade física e o autoconceito de autoestima são fatores adjacentes do status de saúde da população. Assim, o objetivo desta pesquisa foi analisar a associação entre nível de atividade física e autoconceito de autoestima de adolescentes. A amostra foi constituída por 98 sujeitos com média de 16,7 ± 1,2 anos. Utilizou-se dois instrumentos: Questionário Internacional de Atividade Física ­ versão curta e Escala de Autoestima de Rosenberg. A regressão logística binária (Odds Ratio) com α de 5% foi utilizada. As evidências teóricas giraram em torno da abordagem contemporânea do conceito de saúde e os resultados foram discutidos à luz da teoria comportamental do adolescente. Houve predominância de adolescentes ativos (41,8%), bem como menor proporção de sedentários (4,1%). Apresentaram autoestima elevada 55,1%, enquanto 44,9% revelaram a ter baixa. Conclui-se que não houve associação (Wald F = 2,756; p = 0,600) entre nível de atividade física e autoconceito de autoestima. Por fim, discutiu-se elementos comportamentais do adolescente que apontam lócus às futuras intervenções relativas ao tema com este público.

Associação entre nível de atividade física e autoconceito de autoestima de adolescentes / Association between physical activity levels and adolescents' self-perception of self-esteem

Resumo O nível de atividade física e o autoconceito de autoestima são fatores adjacentes do status de saúde da população. Assim, o objetivo desta pesquisa foi analisar a associação entre nível de atividade física e autoconceito de autoestima de adolescentes. A amostra foi constituída por 98 sujeitos com média de 16,7 ± 1,2 anos. Utilizou-se dois instrumentos: Questionário Internacional de Atividade Física - versão curta e Escala de Autoestima de Rosenberg. A regressão logística binária (Odds Ratio) com α de 5% foi utilizada. As evidências teóricas giraram em torno da abordagem contemporânea do conceito de saúde e os resultados foram discutidos à luz da teoria comportamental do adolescente. Houve predominância de adolescentes ativos (41,8%), bem como menor proporção de sedentários (4,1%). Apresentaram autoestima elevada 55,1%, enquanto 44,9% revelaram a ter baixa. Conclui-se que não houve associação (Wald F = 2,756; p = 0,600) entre nível de atividade física e autoconceito de autoestima. Por fim, discutiu-se elementos comportamentais do adolescente que apontam lócus às futuras intervenções relativas ao tema com este público.

Abstract Physical activity levels and the self-perception of self-esteem are kindred factors of the health status of the population. Therefore, the scope of this research was to analyze the association between physical activity levels and adolescents' self-perception of self-esteem. The sample consisted of 98 individuals with an average age of 16.7 ± 1.2. Two tools were used: The International Physical Activity Questionnaire - short version, and the Rosenberg Self-Esteem Scale. Binary logistic regression (Odds Ratio) with α of 5% was then applied. The theoretical evidence revolved around the contemporary approach to the definition of health; and the results were discussed in the light of the behavioral theory of the adolescent. There was a predominance of active adolescents (41.8%), as well as a smaller proportion of sedentary adolescents (4.1%). A total of 55.1% had high self-esteem, while 44.9% were found to have low self-esteem. The conclusion drawn is that there was no association (Wald F = 2.756; p = 0.600) between the level of physical activity and the self-perception of self-esteem. Lastly, the behavioral aspects of the adolescent that point to future potential areas of investigation related to the theme of this group were discussed.

CARDIORESPIRATORY FITNESS ASSOCIATED TO TEENAGERS' FAT: VO2MAX CUTOFF POINT.

OBJECTIVE: To associate the Maximal Oxygen Uptake (VO2max) with body fat percentage (%BF), and to establish the best VO2max cutoff point for predicting risk %BF in teenagers. METHODS: This study was carried out with 979 subjects aged 10 to 18.8 years, 556 (56.8%) girls. The 20 m shuttle run protocol determined the VO2max, which was analyzed in quintiles and in a numeric scale. Cutaneous fold equations determined the %BF, later classified as risk to health/obesity when >25 in girls and >20 in boys. Regression method was used - Odds Ratio (OR) and Receiver Operating Characteristics Curve (ROC curve) with α <5%. RESULTS: From the total number of valid cases, 341 (65.6%) girls and 202 (53.2%) boys presented %BF of risk, and a larger proportion of %BF of risk was observed in the 1st quintile of the VO2max for both genders. There was inverse association between VO2max and %BF of risk from the 4th quintile (OR 1.84, 95%CI 1.05-3.24) until the 1st quintile (OR 4.74, 95%CI 2.44-9.19) for girls, and from the 2nd quintile (OR 2.99, 95%CI 1.48-6.00) until the 1st quintile (OR 5.60, 95%CI 2.64-11.87) for boys. As analytic highlights, VO2max Cutoff points for prediction of %BF of risk were ≤40.9 mL/kg-1/min-1 (AUC: 0.65; p<0.001) for girls and ≤44.8 mL/kg-1/min-1 (AUC: 0.66; p<0.001)for boys. CONCLUSIONS: VO2max was inversely associated to the %BF, and VO2max cutoff points for prediction of %BF of risk are important results to generate action to fight early obesity.

Cardiorespiratory fitness associated to teenagers' fat: vo2max cutoff point / Aptidão cardiorrespiratória associada à gordura de adolescentes: ponto de corte do vo2máx

ABSTRACT Objective: To associate the Maximal Oxygen Uptake (VO2max) with body fat percentage (%BF), and to establish the best VO2max cutoff point for predicting risk %BF in teenagers. Methods: This study was carried out with 979 subjects aged 10 to 18.8 years, 556 (56.8%) girls. The 20 m shuttle run protocol determined the VO2max, which was analyzed in quintiles and in a numeric scale. Cutaneous fold equations determined the %BF, later classified as risk to health/obesity when >25 in girls and >20 in boys. Regression method was used - Odds Ratio (OR) and Receiver Operating Characteristics Curve (ROC curve) with α <5%. Results: From the total number of valid cases, 341 (65.6%) girls and 202 (53.2%) boys presented %BF of risk, and a larger proportion of %BF of risk was observed in the 1st quintile of the VO2max for both genders. There was inverse association between VO2max and %BF of risk from the 4th quintile (OR 1.84, 95%CI 1.05-3.24) until the 1st quintile (OR 4.74, 95%CI 2.44-9.19) for girls, and from the 2nd quintile (OR 2.99, 95%CI 1.48-6.00) until the 1st quintile (OR 5.60, 95%CI 2.64-11.87) for boys. As analytic highlights, VO2max Cutoff points for prediction of %BF of risk were ≤40.9 mL/kg-1/min-1 (AUC: 0.65; p<0.001) for girls and ≤44.8 mL/kg-1/min-1 (AUC: 0.66; p<0.001)for boys.. Conclusions: VO2max was inversely associated to the %BF, and VO2max cutoff points for prediction of %BF of risk are important results to generate action to fight early obesity.

RESUMO Objetivo: Associar o Consumo Máximo de Oxigênio (VO2máx) com o % de Gordura Corporal (%GC) e estabelecer o melhor ponto de corte do VO2máx para a previsão do %GC de risco em adolescentes. Métodos: Estudo realizado com uma amostra de 979 sujeitos entre 10 e 18,8 anos, sendo 556 (56,8%) meninas. O protocolo shuttle run de 20 m determinou o VO2máx, que foi analisado em quintil e escala numérica. Equações de dobras cutâneas determinaram o %GC, posteriormente classificado como risco à saúde/obesidade quando >25, para meninas, e >20, para meninos. Utilizou-se regressão - Odds Ratio (OR) e Curva Característica de Operação do Receptor (curva ROC) com α <5%. Resultados: Do total de casos válidos, 341 (65,6%) meninas e 202 (53,2%) meninos apresentaram %GC de risco, e constatou-se maior proporção do %GC de risco no 1º quintil do VO2máx para ambos os sexos. Houve associação inversa entre VO2máx e %GC de risco do 4º quintil (OR 1,84, IC95% 1,05-3,24) até o 1º quintil (OR 4,74, IC95% 2,44-9,19) para meninas, e do 2º quintil (OR 2,99, IC95% 1,48-6,00) até o 1º quintil (OR 5,60, IC95% 2,64-11,87) para meninos. Pontos de corte do VO2máx para previsão do %GC de risco ≤40,9 mL/kg-1/min-1 (Area Under the Curve (Área Sob a Curva) - AUC: 0,65; p<0,001) para meninas e ≤44,8 mL/kg-1/min-1 (AUC: 0,66; p<0,001) para meninos foram destaques analíticos. Conclusões: VO2máx esteve associado inversamente ao %GC­, e os pontos de corte do VO2máx para a previsão do %GC de risco são resultados importantes para ações de combate à obesidade precoce.

Comparison of metabolic parameters in children and adolescents with and without insulin resistance / Comparação de parâmetros metabólicos em crianças e adolescentes com e sem resistência à insulina

ABSTRACT The aim of the study was to compare the behavior of metabolic parameters, blood pressure, and obesity indicators in children and adolescents with and without insulin resistance. Sixty-one overweight children (6 to 18 years) underwent anthropometric measurements of body mass (BM), height and waist circumference (WC), blood pressure (BP), bioimpedance (relative (%F) and absolute fat (BF)), and blood collection for determination of glucose, insulin, and lipid profile (TG, CT, HDL-C, LDL-C). The BMI z-score was used to classify nutritional status and the HOMA-IR index (> 2.5) for insulin resistance. Participants were divided into two groups, insulin resistant (IR, n= 27) and non-insulin resistant (NIR, n= 33). Regardless of age, children and adolescents with excess weight and IR presented higher BM, WC, BMI, %F and BF (kg), TG, and plasma insulin than their NIR counterparts, who in turn presented higher LDL-C. The groups did not differ in nutritional status (BMI z-score); however, in the comparison between the undesired proportions of the metabolic components, only three presented alterations with significant differences between the groups (TC, LDL-C, and TG). It is concluded that IR influences the development of dyslipidemias in this age group, especially TG.

RESUMO O objetivo do estudo foi comparar o comportamento de parâmetros metabólicos, pressão arterial e indicadores de obesidade em crianças e adolescentes com e sem resistência à insulina. Participaram do estudo 60 crianças e adolescentes com excesso de peso (6 a 18 anos)que foram submetidos amedidas antropométricas de massa corporal (MC), estatura ecircunferência da cintura (CC), pressão arterial (PA), bioimpedância[gordura relativa (%G) e absoluta (GC)] e coleta sanguínea para determinação das concentrações de glicose, insulina e perfil lipídico (TG, CT, HDL-C, LDL-C). O IMC z-scorefoi empregado para classificação do estado nutricional e o índice HOMA-RI (>2,5) para resistência à insulina.Os participantes foram divididos em dois grupos, resistentes (RI, n=27) e não resistentes à insulina (NRI, n=33).Independente da idade, crianças e adolescentescom excesso de peso e RI, apresentaram maior MC, CC, IMC, %G e GC (kg), TG e insulina plasmática do que contraparesNRI, que por sua vez, apresentaram valores mais elevados de LDL-C. Os grupos não diferiram para oestado nutricional(IMC z-score)porém, na comparação entre as proporções indesejadas dos componentes metabólicos, apenas três apresentaram alterações com diferenças significativas entre os grupos (CT, LDL-C e TG). Conclui-se que a RI apresenta-se com influência para o desenvolvimento de dislipidemias nessa faixa etária em especial o TG.

Applicability of the body adiposity index to estimate body fat in adolescents with type-1 diabetes mellitus / Aplicabilidade do índice de adiposidade corporal na estimativa do percentual de gordura de adolescentes com diabetes mellitus tipo 1

ABSTRACT The aim of the present study was to verify the level of concordance between Body Adiposity Index (BAI) and Dual-energy X-ray Absorptiometry (DEXA) in the evaluation of body fat percentage in adolescents with type-1 diabetes mellitus (DM1). The sample consisted of 34 adolescents (16 boys and 18 girls) aged 10-15 years. Height and hip circumference data were collected for BAI calculation, and fat percentage was evaluated using DEXA. The Shapiro Wilk test was used to verify data normality. The Wilcoxon test was performed to compare age, anthropometric and BMI, BAI z score and DEXA between sexes. The correlation of variables (BAI vs DEXA) was evaluated by the Spearman correlation coefficient. For the analysis of residual scores, the Bland-Altman test was applied. The Kappa coefficient (k) was performed to assess the level of concordance between BAI and DEXA. Therefore, weak and non-significant correlation between BAI and DEXA in boys (r= 0.19, p= 0.46), and girls (r= 0.10, p= 0.73) was observed. Thus, weak concordance was observed (k= 0.09) for both sexes. It was concluded that BAI is not recommended to estimate fat percentage in adolescents with DM1.

Resumo O objetivo do presente estudo foi verificar o nível de concordância entre o Absortometria de Raio-x de Dupla Energia (DEXA) na avaliação do percentual de gordura de adolescentes com diabetes mellitus tipo 1 (DM1). A amostra foi constituída por 34 adolescentes (16 meninos e 18 meninas) com idades entre 10 e 15 anos. Coletaram-se os dados de estatura e circunferência do quadril para cálculo do IAC, bem como avaliação do percentual de gordura via DEXA. O teste de Shapiro Wilk foi utilizado para verificar a normalidade dos dados. O teste de Wilcoxon foi realizado para comparar as variáveis de idade, antropométricas e IMC score Z, IAC e DEXA entre sexos. A correlação das variáveis (IAC vs DEXA) foi avaliada pelo coeficiente de correlação de Spearman. Para análise dos escores residuais aplicou-se o teste de Bland-Altman. O coeficiente de Kappa (k) foi realizado para avaliar o nível de concordância entre o IAC e DEXA. Sendo assim, foi encontrada correlação fraca e não significante entre IAC e DEXA tanto nos meninos (r=0,19; p=0,46), quanto nas meninas (r=0,10; p=0,73). Dessa forma, foi possível perceber concordância fraca (k= 0,09) para ambos os sexos. Conclui-se que o IAC não é recomendado para estimar percentual de gordura em adolescentes com DM1.

Health-related quality of life in a cohort of youths with type 1 diabetes.

OBJECTIVE: Health-related quality of life (HRQOL) in type 1 diabetes mellitus (T1DM) has been widely studied. The objectives of this study were to evaluate and identify the factors influencing the HRQOL of children and adolescents with T1DM. MATERIAL AND METHODS: In total, 59 patients (9-16 years, T1DM for ≥1 year) responded to a version of the Diabetes Quality of Life Instrument for Youth (DQOLY) adapted to adapted to Brazilian patients, the Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD). This instrument comprises 50 items (domains satisfaction, impact, and concerns, with the lowest scores corresponding to better HRQOL) and a questionnaire gathering social, demographic, and clinical parameters. RESULTS: The mean age of the patients was 13.6 years, and 57.6% were girls. The median age at diagnosis was 7.16 years, 63% presented diabetic ketoacidosis (DKA) at diagnosis and 29% during follow-up. Mean glycated hemoglobin (HbA1c) in the previous year was 10%. All patients administered multiple insulin doses (mean 4.2 applications/day), 74.5% used rapid-acting and intermediate-acting insulin analogs, and 67.8% used pens for insulin application. The results of the DQOLY were within the cutoff limit for better HRQOL. An isolated analysis of each domain and the questionnaire results showed that the following factors were associated with better HRQOL: height Z-score, lower HbA1c, practice of physical activity, use of pen, fewer hospitalizations, and residence in a rural area. There was a high DKA rate at diagnosis, and the metabolic control was inappropriate in most patients. Despite coming from low-income households, most patients had access to the recommended treatment. CONCLUSION: Among T1DM patients, 71% had IQVJD scores compatible with better HRQOL.