Avaliação da modulação autonômica cardíaca e efeitos de diferentes intensidades de treinamento físico em adultos com diabetes tipo 2
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2021-03-04
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Universidade Federal de Goiás
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INTRODUCTION: Diabetes mellitus is a metabolic disorder characterized by increased blood glucose concentration. The most common diabetes is type 2, about 95% of cases of diagnosis of the disease, resulting from genetic interaction and risk factors, especially inadequate nutrition and physical inactivity. Chronic hyperglycemia can lead to complications such as increased incidence of cardiovascular diseases, renal and ophthalmologic complications, and nerve fiber lesions. Among the treatment measures, the most widespread are pharmacological measures, however, physical exercise is seen as an effective non-pharmacological strategy.There is still no consensus on the best type of physical exercise program aimed at this audience. Although evidence indicates that moderate-intensity aerobic physical exercises that have been the most used in people with type 2 diabetes in recent years have increased the prescription of high intensity interval training. The protocols are not yet well defined and their effects on dm2 complications are not yet clarified, especially on cardiac autonomic modulation at rest and during physical exercise. OBJECTIVE: To evaluate cardiac autonomic modulation and the effects of different physical exercise protocols in adults diagnosed with type 2 diabetes. METHODS: This is an experimental study and has two articles shown in the "Publications" section. Article I, which had characteristics of a case-control study, involved ninety-three middle-aged adults stratified into two groups: control (CG, n = 34) and diabetics (GD, n = 59). All participants underwent biochemical tests to confirm the diagnosis of DM2, collection of R-R intervals for heart rate variability analysis, and cardiopulmonary effort test to quantify recovery heart rate (HRF). Finally, in study II 44 diabetic adults, diagnosis time > 5 years, were recruited and stratified into three groups, according to the intensity of physical exercise they performed, HIIT-30:30 (n=15, age 59.13 ±5.57), HIIT-2:2 (n=14, age 61.20 ± 2.88) and MCIT (n=15, age 58.50 ±5.26).All patients were submitted to anamnesis, evaluation of cardiorespiratory fitness and cardiac autonomic modulation, and were submitted to physical exercise programs for eight weeks. For statistical analysis, the Shapiro-Wilk test for normality and the Levene test for homogeneity were performed in the articles. In article I, for the comparison of variables, the T-Test for independent samples was used and simple Linear Regression was used to verify the prediction relationship between glycemic profile and cardiac autonomic modulation variables. Finally, in Article II, one-way ANOVA was used to verify the differences between the groups in the baseline. The two-way ANOVA in the 2x3 model was used to verify the differences between groups. When these differences were found, the post-hoc Ryan-Einot-Gabriel-Welsh (REGWQ) was used. (Statistical analysis was performed using the statistical program Statistical Package for the Social Sciences (SPSS); Armonk, NY; IBM Corp.), version 21. p < 0.05 was considered significant in all analyses. RESULTS: In Article 1, it was found that patients with DM2 presented impairment in cardiac autonomic modulation when compared to healthy individuals, evidencing a reduction in global HRV (SDNN= 19.31±11.72 VS CG 43.09±12.74, p < 0.0001), and also lower parasympathetic modulation (RMSSD= 20.49±14.68 VS 52.41±19.50, PNN50= 4.76±10.53 VS 31.24±19.24, 2VD%= 19.97±10.30 VS 28.81±9.77, p < 0.0001 for both indices), in addition, patients with DM2 showed slowing in heart rate response after interruption of physical exercise. Finally, in Article 2, we proposed the rehabilitation program for patients with DM2, group x time interactions were observed for HRR [F(2.82) = 3.641; p = 0.031] and SDNN [F(2.82) = 3.462; p = 0.036].Only the HIIT-30:30 group significantly increased the SDNN when compared to the other two groups (p = 0.002 and 0.025, respectively). FCrep decreased more in the HIIT-30:30 group compared to the TCMI group (p = 0.038). Group x time interactions were also observed for offTAU [F(2.82) = 3.146; p = 0.048] and offTMR [F(2.82) = 4.424; p = 0.015]. CONCLUSION: From the results found, it was possible to infer that high intensity interval training can be a safe and effective tool for patients with DM2 in different phases of a cardiac rehabilitation program, however, it is necessary that the team knows and knows how to work with the prescription of these exercises, since in this study the protocols HIIT-2:2 and HIIT-30:30 presented superior benefits than the MCITI protocol that will provide multidisciplinary teams plus a tool for improvement cardiovascular health of its patients.
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HIIT , Exercício físico , Diabetes , Saúde , Treinamento aeróbio , HIIT , Exercise , Diabetes , Health , Aerobic training
Citação
SILVA, L. R. B. Avaliação da modulação autonômica cardíaca e efeitos de diferentes intensidades de treinamento físico em adultos com diabetes tipo 2. 2021. 127 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2021.