The aim of this study was to evaluate the level of physical activity and cardiorespiratory fitness in teenagers with type 1 diabetes mellitus (T1D) in comparison with healthy scholar participants. Total of 154 teenagers (T1D=45 and CON=109). Height, weight, cardiorespiratory fitness (VO2max), and the level of physical activity by the Bouchard's Physical Activity Record were measured, and glycated hemoglobin (HbA1c)
The management of type 1 diabetes mellitus (T1DM) is based on three pillars: insulin therapy, nutrition, and regular practice of physical activity. Physical exercises are associated with metabolic demands that depend on the individual's energy stores and level of physical conditioning, and vary according to environmental conditions and intensity, duration, and type of exercise. All these factors, added to eventual distress with competitions, exert influence on glucose metabolism. The athletic career of diabetic individuals is often hindered by a risk of hypoglycemia during and after the exercise, frequent hyperglycemia before, during, and after certain physical activities, occurrence of ketoacidosis, and presence of chronic microvascular and macrovascular complications. Aerobic exercises reduce the levels of blood glucose while anaerobic exercise may promote transient hyperglycemia. Although diabetic individuals may achieve excellence in sport, their physical performance should be maximized by strict blood glucose control, adequate modifications in insulin dose on the day of the exercise, and appropriate nutritional intake. This review discusses the impact of physical exercise on glucose metabolism, as well as nutritional considerations and strategies appropriate to the practice of physical exercises by patients with T1DM.
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 (VO 2max ) 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 %VO 2FATMAX (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 %VO 2FATMAX results were correlated with age (r=0.81), BMI z-scores (r=0.65), and VO 2max 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 VO 2max ). 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. RESUMOObjetivo: 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 (VO 2max ) 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 % VO 2FATMAX (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 %VO 2FATMAX correlacionaram-se diretamente com a idade (r = 0,81), z-score IMC (r = 0,65) e VO 2max (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 apti...
Artigo originAl Original article artículO Original RESUMOIntrodução: O exercício físico é um fator importante do tratamento do diabetes mellitus. Objetivo: Verificar o efeito agudo dos exercícios intermitentes sobre glicemia e oxidação de substratos energéticos em adolescentes com diabetes tipo 1. Métodos: Foram avaliados 10 adolescentes diabéticos com idade entre 10 e 15 anos. Foram avaliadas as medidas antropométricas, hemoglobina glicosilada (HbA1c), VO 2máx e o teste de exercício intermitente. Nesse teste, os indivíduos permaneceram pedalando por 30 minutos em cicloergômetro com carga de 60% do VO 2máx , intercalados com tiros de intensidades máximas de 10 segundos a cada 5 minutos. Os substratos energéticos foram avaliados durante o teste e a glicemia capilar foi medida antes, imediatamente após o exercício e 30 minutos depois. Foi observada redução média da glicemia de 39,2 ± 41,92 mg/dl, isto é, média de 21,61% da glicemia inicial. Ocorreu diferença significativa (0,0001) entre os substratos energéticos oxidados, com predominância da utilização de CHO. Há uma forte correlação direta entre a HbA1c e o escore z do IMC (r = 0,821, p = 0,004) e entre HbA1c e glicose observadas pós-exercício (r = 0,702, p = 0,024) e também há forte correlação entre os níveis de glicose pré-exercício e pós-exercício (r = 0,851, p = 0,002) e entre pós-exercício e 30 minutos depois do exercício (r = 0,874, p = 0,001). O teste de regressão linear mostrou que o escore z do IMC explica 67% dos valores de HbA1c (r² = 0,675). Resultados: De acordo com os resultados observados, 30 minutos de exercícios aeróbicos intermitentes intercalados com tiros curtos de 10 segundos promovem redução média de 21% da glicemia, com tendência de aumento na fase de recuperação. O substrato energético predominante na atividade são os carboidratos (CHO). Conclusão: Quanto melhor for o escore z do IMC do adolescente, espera-se melhor controle glicêmico em adolescentes com diabetes tipo 1.Descritores: metabolismo dos carboidratos; diabetes mellitus; oxidação. (r = 0.821, p = 0.024), and there is a strong correlation between pre-exercise and post-exercise glucose (r = 0.851, p = 0.002) and between post-exercise and 30 minutes after exercise (r = 0.874, p = 0.001 ABSTRACT
The purpose of the study was to investigate the acute effect of continuous and intermittent aerobic exercise on blood glucose of adolescents with type 1 diabetes. A cross-sectional analysis of eight adolescents with type 1 diabetes mellitus between 10 to 15 years . Variables such as body mass, height, body mass index z score, glycated hemoglobin and cardiorespiratory fitness were assessed. There were two tests on a cycle ergometer: 30 minutes of continuous exercise and 30 minutes of intermittent exercise. Blood glucose was measured before and after the exercises and lactate concentration was measured at the end of the exercise. Student's t test and Pearson's correlation were used, considering p<0.05. In the continuous exercise protocol, there was a significant difference in pre-and post-exercise blood glucose levels (p = 0.048), whereas the intermittent exercise protocol did not show statistically significant differences in blood glucose. Higher concentrations of lactate were found after the intermittent exercises (p = 0.036). There was a strong correlation between glycemic control and body mass index z score (r = 0.893 p = 0.041). Regarding the other variables, there were no significant correlations. The reduction in blood glucose was lower after intermittent aerobic exercises, compared with continuous exercises, which could be an interesting strategy to prevent acute exercise-induced hypoglycemia. KeywordsDiabetes; Exercise; Hypoglycemia. Resumo
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