Exercício físico no diabetes mellitus tipo 1: quais as evidências para uma melhor prescrição?
DOI:
https://doi.org/10.33233/rbfe.v18i1.2878Palavras-chave:
diabetes tipo 1, exercício, atividade física, controle glicêmicoResumo
O exercício físico regular vem assumindo uma posição de destaque no tratamento do diabetes tipo 1, sendo-lhe atribuídas diversas adaptações orgânicas e benefícios extremamente relevantes no controle da doença. Sendo o diabetes associado largamente com doenças cardiovasculares, a importância do exercício em reverter os fatores de risco para tais doenças deve ser bastante valorizada. O exercício vem exercendo papel fundamental num melhor controle glicêmico, redução da pressão arterial e melhora do perfil lipídico. Entretanto, é importante ressaltar que alguns estudos não conseguiram correlacionar a prática do exercício com melhor controle glicêmico ou redução da HbA1c em indivíduos com DM1. Este estudo é uma revisão da literatura cujo objetivo foi analisar detalhadamente os efeitos benéficos – bem como as possíveis reações adversas – do exercício em sujeitos com DM1. Discutiram-se os seus efeitos metabólicos e fisiológicos, e os programas de atividade física que permitem a esses indivíduos se exercitar de forma agradável e segura. Apesar de todas as modalidades demonstrarem ganhos diretos sobre o controle glicêmico e/ou ligados a melhora de preditores de doenças cardiovasculares em população com DM1, observou-se que os melhores resultados foram nas sessões compostas por exercícios cíclicos e neuromusculares.
Referências
Guariguata L, Whiting D, Weil C, Unwin N, Unwin N. The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes Res Clin Pract 2011;94(3):322-32. https://doi.org/10.1016/j.diabres.2011.10.040
Campbell MD, Walker M, Bracken RM, Turner D, Stevenson EJ, Gonzalez JT et al. Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial. BMJ Open Diab Res Care 2015;3:e000085. https://doi.org/10.1136/bmjdrc-2015-000085
Mendes ABV, Fittipaldi JAS, Neves RCS, Chacra AR, Moreira Jr ED. Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol 2010;47:137-45. https://doi.org/10.1007/s00592-009-0138-z
Homma TK, Endo CM, Saruhashi T, Mori API, Noronha RM, Monte O et al. Dyslipidemia in young patients with type 1 diabetes mellitus. Arch Endocrinol Metab 2015;59(3):215-9. https://doi.org/10.1590/2359-3997000000040
Kannan U, Vasudevan K, Balasubramaniam K, Yerrabelli D, Shanmugavel K, John NA. Effect of exercise intensity on lipid profile in sedentary obese adults. J Clin Diagn Res 2014;8(7):BC08-10. https://doi.org/10.7860/jcdr/2014/8519.4611
Huang HH, Farmer K, Windscheffel J, Yost K, Power M, Wright DE et al. Exercise increases insulin content and basal secretion in pancreatic islets in type 1 diabetic mice. Exp Diabetes Res 2011:1-10. https://doi.org/10.1155/2011/481427
Mcdonald MW, Murray CR, Hall KE, Noble EG, Melling CWJ. Morphological assessment of pancreatic islet hormone content following aerobic exercise training in rats with poorly controlled Type 1 diabetes mellitus. Islets 2014;6(2):1-9. https://doi.org/10.4161/isl.29221
Mota MM, Silva TLTB, Fontes MT, Barreto AS, Araújo JES, Oliveira ACC et al. Resistance exercise restores endothelial function and reduces blood pressure in type 1 diabetic rats. Arq Bras Cardiol 2014;103(1):25-32. https://doi.org/10.5935/abc.20140087
Rocha REP, Coelho I, Pequito DCT, Yamagushi A, Borghetti G, Yamazaki RK et al. Interval training attenuates the metabolic disturbances in type 1 diabetes rat model. Arq Bras Endocrinol Metab 2013;57(8):594-602. https://doi.org/10.1590/s0004-27302013000800003
Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care 2006;29(3);601-6. https://doi.org/10.2337/diacare.29.03.06.dc05-1764
Davey RJ, Bussau VA, Paramalingam N, Ferreira LD, Lim EM, Davis EA et al. A 10-s sprint performed after moderate-intensity exercise neither increases nor decreases the glucose requirement to prevent late-onset hypoglycemia in individuals with type 1 diabetes. Diabetes Care 2013;36(12):4163-5. https://doi.org/10.2337/dc12-2198
Fuchsjäger-Mayrl G, Pleiner J, Wiesinger GF, Sieder AE, Quittan M, Nuhr MJ, Francesconi C et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care 2002;25(10):1795-801. https://doi.org/10.2337/diacare.25.10.1795
Galassetti PR, Iwanaga K, Pontello AM, Zaldivar FP, Flores RL, Larson JK. Effect of prior hyperglycemia on IL-6 responses to exercise in children with type 1 diabetes. Am J Physiol Endocrinol Metab 2006;290(5):833-9. https://doi.org/10.1152/ajpendo.00445.2005
Guelfi KJ, Jones TW, Fournier PA. Intermittent high-intensity exercise does not increase the risk of early postexercise hypoglycemia in individuals with type 1 diabetes. Diabetes Care 2005;28(2):416-8. https://doi.org/10.2337/diacare.28.2.416
Guelfi KJ, Ratnam N, Smythe GA, Jones PW, Fournier PA. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab 2007;292(3):865-70. https://doi.org/10.1152/ajpendo.00533.2006
Harmer AR, Ruell PA, McKenna MJ, Chisholm DJ, Hunter SK, Thom JM, Morris NR, et al. Effects of sprint training on extrarenal potassium regulation with intense exercise in Type 1 diabetes. J Appl Physiol (1985) 2006;100(1):26-34. https://doi.org/10.1152/japplphysiol.00240.2005
Khawali C, Andriolo A, Ferreira S. Benefits of physical activity on the lipid profile of type 1 diabetic subjects. Arq Bras Endocrinol Metabol 2003;47(1):49-54.
Landt KW, Campaingne BW, James FW, Sperling MA. Effects of exercise training on insulin sensitivity in adolescents with type I diabetes. Diabetes Care 1985;8(5):461-5. https://doi.org/10.2337/diacare.8.5.461
Makura CB, Nirantharakumar K, Girling AJ, Saravanan P, Narendran P. Effects of physical activity on the development and progression of microvascular complications in type 1 diabetes: retrospective analysis of the DCCT study. BMC Endocr Disord 2013;13(37):1-6. https://doi.org/10.1186/1472-6823-13-37
Manohar C, Levine JA, Nandy DK, Saad A, Dalla Man C, McCrady-Spitzer SK, Basu R et al. The effect of walking on postprandial glycemic excursion in patients with type 1 diabetes and healthy people. Diabetes Care 2012;35(12):2493-9. https://doi.org/10.2337/dc11-2381
Faulkner MS, Michaliszyn SF. Physical activity and sedentary behavior in adolescents with type 1 diabetes. Res Nurs Health 2010;33(5):441-9. https://doi.org/10.1002/nur.20393
Moser O, Tschakert G, Mueller A, Groeschl W, Pieber TR, Obermayer-Pietsch B, Koehler G et al. Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin. PLoS One 2015;10(8):1-17. https://doi.org/10.1371/journal.pone.0136489
Mosher PE, Nash NS, Perry AC, LaPerriere AR, Goldberg RB. Aerobic circuit exercise training: Effect on adolescents with well-controlled insulin-dependent diabetes mellitus. Arch Phys Med Rehabil 2018;79(6):652-7. https://doi.org/10.1016/s0003-9993(98)90039-9
Ramalho AC, Lima ML, Nunes F, Cambuí Z, Barbosa C, Andrade A, Viana A et al. The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Res Clin Pract 2006;72(3):271-6. https://doi.org/10.1016/j.diabres.2005.11.011
Salem MA, Abo MA, Elbarbary NS, ElHilal RA, Refaat YM. Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomized controlled trial. Diabetol Metab Syndr. 2010;2(47):1-10. https://doi.org/10.1186/1758-5996-2-47
Schaan BD, Waclawovsky G,Umpierre D, Figueira FR, Lima ES, Alegretti AP et al. A single session of aerobic or resistance exercise modifies the endothelial progenitor cell levels in healthy subjects, but not in individuals with type 1 diabetes. Diabetol Metab Syndr. 2015;7(supl 1):A251. https://doi.org/10.1186/1758-5996-7-S1-A251
Schweiger B, Klingensmith G, Snell-Bergeon JK. Physical activity in adolescent females with type 1 diabetes. International J Pediatr 2010;2010:1-6. https://doi.org/10.1155/2010/328318
Seeger JP, Thijssen DH, Noordam K, Cranen ME, Hopman MT, Nijhuis-van der Sanden MW. Exercise Training improves physical fitness and vascular function in children with type 1 diabetes. Diabetes. Diabetes Obes Metab 2011;13(4):382-4. https://doi.org/10.1111/j.1463-1326.2011.01361.x
Shin KO, Moritani T, Woo J, Jang KS, Bae JY, Yoo J et al. Exercise training improves cardiac autonomic nervous system activity in type 1 diabetic children. J Phys Ther Sci 2014;26(1):111-5. https://doi.org/10.1589/jpts.26.111
Sideraviciūte S, Gailiūniene A, Visagurskiene K, Vizbaraite D. The effect of long-term swimming program on glycemia control in 14-19-year aged healthy girls and girls with type 1 diabetes mellitus. Medicina (Kaunas) 2006:42(6):513-8.
Tsalikian, E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 2005;147(4):528-534. https://doi.org/10.1016/j.jpeds.2005.04.065
Wong CH, Chiang YC, Wai JP, Lo FS, Yeh CH, Chung SC et al. Effects of a home-based aerobic exercise programme in children with type 1 diabetes mellitus. J Clin Nurs 2011;20(5-6)681-91. https://doi.org/10.1111/j.1365-2702.2010.03533.x
Yardley JE, Kenny GP, Perkins BA, Riddell MC, Malcolm J, Boulay P et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care 2012;35:669-75. https://doi.org/10.1111/j.1365-2702.2010.03533.x
Yardley JE, Kenny GP, Perkins BA, Riddell MC, Balaa N, Malcolm J et al. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care 2013;36(3):537-42. https://doi.org/10.2337/dc12-0963
Lee SI, Patel M, Jones CM, Narendran P. Cardiovascular disease and type 1 diabetes: prevalence, prediction and management in an ageing population. Ther Adv Chronic Dis 2015;6(6)347-74.
Leroux C, Brazeau AS, Gingras V, Desjardins K, Strychar I, Rabasa-Lhoret R. Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review. Can J Diabetes 2014;38(1):62-9. https://doi.org/10.1016/j.jcjd.2013.08.268
Miculis CP, Campos W, Boquszweski MCS. Correlation between glycemic control and physical activity level in adolescents and children with type 1 diabetes. J Phys Act Health. 2015;12(2):232-7. https://doi.org/10.1123/jpah.2013-0024
Asano RY, Sales MM, Browne RAV, Moraes JFVN, Coelho Jr HJ, Moraes MR, Simões HG. Acute effects of physical exercise in type 2 diabetes: A review. World J Diabetes 2014;5(5):659-65. https://doi.org/10.4239/wjd.v5.i5.659
Kargarfard M, Rouzbehani R, Basati F. Effects of exercise rehabilitation on blood pressure of patients after myocardial infarction. Int J Prev Med 2010;1(2):124-30.
Nadeau KJ, Regensteiner JG, Bauer TA, Brown MS, Dorosz JL, Hull A, et al. Insulin resistance in adolescents with type 1 diabetes and its relationship to cardiovascular function. J Clin Endocrinol Metab 2010;95(2):513-21. https://doi.org/10.1210/jc.2009-1756
Rabasa-Lhoret R, Bourque J, Ducros f, Chiasson JL. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 2001;24(4)625-30. https://doi.org/10.2337/diacare.24.4.625
De Angelis K, Pureza DY, Flores LJF, Rodrigues B, Melo KFS, Schaan BD, et al. Efeitos fisiológicos do treinamento físico em pacientes portadores de diabetes tipo 1. Arq Bras Endocrinol Metab 2006;50(6):1005-13. https://doi.org/10.1590/s0004-27302006000600005
Hirsch IB, Marker JC, Smith LJ, Spina RJ, Parvin CA, Holloszy JO et al. Insulin and glucagon in prevention of hypoglycemia during exercise in humans. Am J Physiol Cell Physiol 1991;260(5):E695-704. https://doi.org/10.1152/ajpendo.1991.260.5.e695
Goodwin ML. Blood glucose regulation during prolonged, submaximal, continuous exercise: a guide for clinicians. J Diabetes Sci Technol 2010;4(3):694-705. https://doi.org/10.1177/193229681000400325
American Diabetes Association: diabetes mellitus and exercise (position statement). Diabetes Care 2002;25(Suplp1):S64-8.
Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes 2002;51(suppl1):S271-S283. https://doi.org/10.2337/diabetes.51.2007.s271
Jimenez CC, Corcoran MH, Crawley JT, Guyton Hornsby W, Peer KS, Philbin RD et al. National athletic trainers' association position statement: management of the athlete with type 1 diabetes mellitus. J Athl Train 2007;42(4):536-45. https://doi.org/10.4085/1062-6050-51.7.01
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