Rev Bras Fisiol Exerc 2020;19(2):80-81
EDITORIAL
Importance of
multidisciplinarity in exercise
prescription
Marvyn de Santana do
Sacramento1,2,3, Victor Barbosa dos Santos1,3, Jefferson
Petto1,2,3,4,5
1ACTUS CORDIOS
Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brazil
2Centro Universitário
Social da Bahia, Salvador, BA, Brazil
3Faculdade do Centro
Oeste Paulista, Bauru, SP, Brazil
4Faculdade Adventista da
Bahia, Capoeiruçu, BA, Brazil
5Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
Marvyn de Santana do Sacramento:
marvynsantana@gmail.com
Victor Barbosa dos Santos:
ftvictorbarbosa@hotmail.com
Jefferson Petto:gfpecba@bol.com.br
Physical exercise (PE) is an instrument for health promotion that has
the following outcomes: improvements in functional capacity, prevention and
correction of pathological problems, improvements in body perception, quality
of life and others. However, achieving these benefits involves knowledge about
multiple aspects, often not addressed in the training of professionals who work
with body movement [1].
Having knowledge about the nuances of PE is a key item for the correct
prescription, but the contribution of other areas defines the level of
assertiveness of the therapy. If we think about the metabolic rehabilitation
process, for example, the patient with central obesity, Type 2 Diabetes
Mellitus (T2DM) and Dyslipidemia has great chances of benefiting from PE.
However, the performance of a multidisciplinary follow-up would allow a broader
coverage of the clinical aspects of this patient, adding information about the
nutritional, endocrine and psychological condition [1].
Thinking about the nutritional aspect, one of the elements that could
influence the outcome of PE is the orientation towards a diet based on
nutrients capable of combating installed diseases or replacing missing
substances. Following this line, one of the possible guidelines would be the
consumption of phytosterol, whose supplementation in 2 g/day has been pointed
out as capable of reducing up to 15% of low-density lipoproteins (LDL). In
addition to reducing an independent risk factor for atherosclerotic disease,
other precautions can be taken to control oxidative stress and reduce fat mass
[2].
When considering T2DM as the underlying disease in this case and its
extensive connection with pancreatic and metabolic endocrine function, we need
to pay attention to the follow-up with the specialist doctor. The decisions
made by this professional make it possible to maintain biochemical variables at
an optimal level, with the addition or reduction of drugs for glycemic control
and lipid profile. However, the pharmacological therapeutic window must be understood
by the movement professional, in order to avoid complications such as
hypoglycemia during or after physical exercise. Second, we emphasize that
decision making in a team is not exempt from adjustments for any professional, and can be constantly modified depending on
the patient's development. Still on exercise and blood glucose, it can increase
glucose uptake, mediated by the translocation of glucose transporters (GLUT-4)
to the cytoplasm [3]. Thus, the application of new doses of hypoglycemic
medication amplifies this effect, so why not discuss the times of application,
dosages, change of drugs or perhaps its complete removal?
Not far from this reality, the patient of the hypothetical case can
still evade the rehabilitation program due to the lack of family support or
previous traumas related to motor practice. In this scenario, the permanence of
this patient depends almost exclusively on the accompaniment of the
psychologist. The study by Turner et al. [4] regarding the opinion of patients
and nurses on the participation of these professionals in the scope of cardiac
rehabilitation, shows a favorable position for their permanence. However, this
is not the reality in the care systems, and they are “justified” by the cost
and reduced time in hospitals.
This connection between the different professions makes it possible to
discuss the real needs for medications, exercise dosages, nutritional and
psychological deficiencies, which decreases the treatment time, risks of
complications and abandoning interventions, respectively [5]. Therefore, this
should be based on specialized service systems. We understand that
administrative factors may imply the smooth functioning of this system and even
make it more costly, but, considering all the implications of a poorly
structured program, wouldn't an effort in this direction be the best option? Be
it by implementation or professional indication.
In addition, the secret to good professional performance is not in
having full knowledge and qualification to work in different areas of health,
but in the ability to identify situations where joint therapy significantly
benefits the life of each patient.
References