Treinamento aquático e terrestre em desfechos funcionais e glicêmicos de pessoas com Diabetes Tipo 2: dados preliminares do Aquatic and Land Exercise for Diabetes - ensaio clínico randomizado
DOI:
https://doi.org/10.12820/rbafs.31e0429Palavras-chave:
Diabetes melittus tipo 2, Exercício físico, Desempenho físico funcional, Controle glicêmicoResumo
Introdução: Pessoas com diabetes tipo 2 (DM2) apresentam baixa aderência e desconforto associado às práticas de exercício tradicionais, por isso, modalidades alternativas como exercício em meio aquático devem ser investigadas. Objetivos: Verificar os efeitos de 11 semanas do treinamento combinado (aeróbio e força) em diferentes meios (aquático e terrestre) sobre desfechos funcionais e glicêmicos de pacientes com DM2. Métodos: Dados preliminares de um ensaio clínico randomizado comparador, com dois grupos em paralelo. Participaram adultos e idosos com DM2 de ambos os gêneros, com idade entre 45 e 80 anos. O programa de treinamento foi aplicado três vezes por semana, em dias alternados, sendo realizado treinamento combinado no meio aquático (AQUA) ou terrestre (LAND). Foram avaliados, na linha de base e na 12ª semana, o desempenho nos testes: caminhada de 6 minutos (TC6M), Sentar e Levantar (SL), Sentar e Alcançar pelo Banco de Wells (Flex), TUG em velocidade habitual (TUG-h) e máxima (TUG-m) e controle glicêmico (glicose e insulina em jejum, HOMA-IR e HbA1c). Resultados: Participaram 37 pessoas (18 mulheres, 60,45 ± 8,72 anos). A aderência ao treinamento foi de 87,1 ± 12,9% no AQUA e 81,8 ± 15,5% no LAND (p = 0,231). Ambos os grupos apresentaram melhoras no TC6M, TUG-h, TUG-m e Flex (p < 0,001), enquanto apenas o AQUA apresentou melhoras no SL (p < 0,001). Não houve diferença significativa no controle glicêmico. Conclusão: Os treinamentos, aquático e terrestre melhoraram a capacidade funcional de pacientes com DM2, com destaque para melhora apenas no no AQUA na força dos membros inferiores. Ainda, 11 semanas não modificaram
significativamente o controle glicêmico destes pacientes.
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Referências
1. Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med. 2020;10(4):174-88. doi: https://doi.org/10.4103/ajm.ajm_53_20 DOI: https://doi.org/10.4103/ajm.ajm_53_20
2. Riebe D, Ehrman JK, Liguori G, Magal M. ACSM’s guidelines for exercise testing and prescription. 10th ed. Philadelphia: Wolters Kluwer; 2018.
3. American Diabetes Association. Standards of medical care in diabetes—2023. Diabetes Care. 2023;44(Suppl 1):S1-S291.
4. Tokmakidis SP, Zois CE, Volaklis KA, Kotsa K, Touvra AM. The effects of a combined strength and aerobic exercise program on glucose control and insulin action in women with type 2 diabetes. Eur J Appl Physiol. 2004;92(4-5):437-42. doi: https://doi.org/10.1007/s00421-004-1174-6 DOI: https://doi.org/10.1007/s00421-004-1174-6
5. Evans P, McMillin S, Weyrauch L, Witczak C. Regulation of skeletal muscle glucose transport and glucose metabolism by exercise training. Nutrients. 2019;11(10):2432. doi: https://doi.org/10.3390/nu11102432 DOI: https://doi.org/10.3390/nu11102432
6. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-79. doi: https://doi.org/10.2337/dc16-1728
7. Maloney A, Rosenstock J, Fonseca V. A model-based meta-analysis of 24 antihyperglycemic drugs for type 2 diabetes: comparison of treatment effects at therapeutic doses. Clin Pharmacol Ther. 2019;105(5):1213-23. doi: https://doi.org/10.1002/cpt.1307 DOI: https://doi.org/10.1002/cpt.1307
8. Liguori G, American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 11th ed. Philadelphia: Wolters Kluwer; 2020.
9. Mannucci E, Bonifazi A, Monami M. Comparison between different types of exercise training in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2021;31(7):1985-92. doi: https://doi.org/10.1016/j.numecd.2021.02.030 DOI: https://doi.org/10.1016/j.numecd.2021.02.030
10. Pan B, Ge L, Xun Y, Chen C, Yang K, Guo Y, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act. 2018;15(1):72. doi: https://doi.org/10.1186/s12966-018-0703-3 DOI: https://doi.org/10.1186/s12966-018-0703-3
11. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790-9. doi: 10.1001/jama.2011.576 DOI: https://doi.org/10.1001/jama.2011.576
12. Ahmad E, Sargeant JA, Yates T, Webb DR, Davies MJ. Type 2 diabetes and impaired physical function: a growing problem. Diabetology. 2022;3(1):30-45. doi: https://doi.org/10.3390/diabetology3010003 DOI: https://doi.org/10.3390/diabetology3010003
13. Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14(8):585-92. doi: 10.1016/j.jamda.2013.02.006 DOI: https://doi.org/10.1016/j.jamda.2013.02.006
14. Volpato S, Bianchi L, Lauretani F, Bandinelli S, Guralnik JM, Zuliani G, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012;35(8):1672-9. doi: https://doi.org/10.2337/dc11-2202 DOI: https://doi.org/10.2337/dc11-2202
15. Alvares TS, Pires FO, Vieira DE, Umpierre D, Balducci S, Boule NG, et al. Cardiorespiratory fitness is impaired in type 1 and type 2 diabetes: a systematic review, meta-analysis, and meta-regression. Med Sci Sports Exerc. 2024;56(9):1553-62. doi: https://doi.org/10.1249/MSS.0000000000003451 DOI: https://doi.org/10.1249/MSS.0000000000003451
16. Macedo ACP, Silveira JS, de Almeida JC, Porto LGG. Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Arch Endocrinol Metab. 2023;67(5):e230040. doi: https://doi.org/10.20945/2359-4292-2023-0040 DOI: https://doi.org/10.20945/2359-4292-2023-0040
17. Bhatt PP, Sheth MS. Comparison of fatigue and functional status in elderly type 2 diabetes patients versus age and gender matched individuals. Aging Med (Milton). 2024;7(1):84-9. doi: https://doi.org/10.1002/agm2.12289 DOI: https://doi.org/10.1002/agm2.12289
18. Pfeifer LO, De Nardi AT, da Silva LXN, et al. Association between physical exercise interventions participation and functional capacity in individuals with type 2 diabetes: a systematic review and meta-analysis of controlled trials. Sports Med Open. 2022;8(1):34. doi: https://doi.org/10.1186/s40798-022-00422-1 DOI: https://doi.org/10.1186/s40798-022-00422-1
19. Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, et al. Effect of exercise on functional capacity and body weight for people with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. BMC Sports Sci Med Rehabil. 2024;16(1):38. doi: https://doi.org/10.1186/s13102-024-00829-1 DOI: https://doi.org/10.1186/s13102-024-00829-1
20. Pasanen T, Tolvanen S, Heinonen A, Kujala UM. Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials. Br J Sports Med. 2017;51(20):1459-65. doi: https://doi.org/10.1136/bjsports-2016-097132 DOI: https://doi.org/10.1136/bjsports-2016-097132
21. Delevatti RS, Kanitz AC, Alberton CL, Marson EC, Lisboa SC, Pinho CD, et al. Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: a randomized clinical trial. J Sci Med Sport. 2016;19(8):688-93. doi: https://doi.org/j.jsams.2015.10.008 DOI: https://doi.org/10.1016/j.jsams.2015.10.008
22. Delevatti RS, Dal Pupo J, Messias LP, Giacomini F, Kanitz AC, Alberton CL, et al. Vertical ground reaction force during land- and water-based exercise performed by patients with type 2 diabetes. Medicina Sportiva. 2015;8(4):2550-7.
23. Kruel LFM, Posser MS, Alberton CL, Pinto SS, Araujo CL. Alterações fisiológicas e biomecânicas em indivíduos praticando exercícios de hidroginástica dentro e fora d’água. Kinesis. 2001;25(1):33-47.
24. Pendergast DR, Moon RE, Krasney JJ, Held HE, Zamparo P. Human physiology in an aquatic environment. Compr Physiol. 2015;5(4):1705-50. doi: https://doi.org/10.1002/cphy.c140018 DOI: https://doi.org/10.1002/j.2040-4603.2015.tb00655.x
25. Leonel LDS, Fernandes PTA, Peres DS, Oliveira DS, Silva RA, Pontes JR, et al. Aquatic training improves HbA1c, blood pressure and functional outcomes of patients with type 2 diabetes: a systematic review with meta-analysis. Diabetes Res Clin Pract. 2023;197:110575. doi: 10.1016/j.diabres.2023.110575 DOI: https://doi.org/10.1016/j.diabres.2023.110575
26. Rees JL, Johnson ST, Boulé NG. Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta Diabetol. 2017;54(10):895-904. doi: https://doi.org/10.1007/s00592-017-1023-9 DOI: https://doi.org/10.1007/s00592-017-1023-9
27. Leonel LDS, Wolin IAV, Danielevicz A, Diesel M, Constantini MI, de Oliveira Junior JB, et al. Twenty-four weeks of combined training in different environments, aquatic and land, in the type 2 diabetes management (Aquatic and Land Exercise for Diabetes–ALED): protocol of a randomized clinical trial. Trials. 2025;26(1):12. doi: https://doi.org/10.1186/s13063-024-08660-2 DOI: https://doi.org/10.1186/s13063-024-08660-2
28. Wells KF, Dillon EK. The sit and reach—a test of back and leg flexibility. Res Q. 1952;23(1):115-8. DOI: https://doi.org/10.1080/10671188.1952.10761965 DOI: https://doi.org/10.1080/10671188.1952.10761965
29. Rikli RE, Jones CJ. Senior fitness test manual. Champaign: Human Kinetics; 2013.
30. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. doi: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
31. Sova R. Aquatics: the complete reference guide for aquatic fitness professionals. Boston: Jones & Bartlett; 1992.
32. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017;23(2):377-81. doi: https://doi.org/10.1111/jep.12629 DOI: https://doi.org/10.1111/jep.12629
33. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2016;39(11):2065-79. doi: https://doi.org/10.2337/dc16-1728 DOI: https://doi.org/10.2337/dc16-1728
34. Ishiguro H, Kodama S, Horikawa C, Fujihara K, Hirose AS, Hirasawa R, et al. In search of the ideal resistance training program to improve glycemic control and its indication for patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Sports Med. 2016;46(1):67-77. doi: https://doi.org/10.1007/s40279-015-0379-7 DOI: https://doi.org/10.1007/s40279-015-0379-7
35. Ribeiro AKPL, Carvalho JPR, Bento-Torres NVO. Physical exercise as treatment for adults with type 2 diabetes: a rapid review. Front Endocrinol (Lausanne). 2023;14:1233906. doi: https://doi.org/10.3389/fendo.2023.1233906 DOI: https://doi.org/10.3389/fendo.2023.1233906
36. Opazo-Díaz E, Montes-de-Oca-García A, Galán-Mercant A, Marín-Galindo A, Corral-Pérez J, Ponce-González JG. Characteristics of high-intensity interval training influence anthropometrics, glycemic control, and cardiorespiratory fitness in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2024;54(13):3127-49. doi: https://doi.org/10.1007/s40279-024-02114-0 DOI: https://doi.org/10.1007/s40279-024-02114-0
37. Wan Y, Su Z. The impact of resistance exercise training on glycemic control among adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Biol Res Nurs. 2024;26(4):597-623. doi: https://doi.org/10.1177/10998004241246 DOI: https://doi.org/10.1177/10998004241246272
38. Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kraus WE. Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol. 2004;96(1):101-6. doi: https://doi.org/10.1152/japplphysiol.00707.2003 DOI: https://doi.org/10.1152/japplphysiol.00707.2003
39. Silva FM, Duarte-Mendes P, Teixeira AM, Soares CM, Ferreira JP. The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: a systematic review and meta-analysis. Sci Rep. 2024;14(1):1936. doi: https://doi.org/10.1038/s41598-024-51832-y DOI: https://doi.org/10.1038/s41598-024-51832-y
40. Lu Y, Baker JS, Ying S, Lu Y. Effects of practical models of low-volume high-intensity interval training on glycemic control and insulin resistance in adults: a systematic review and meta-analysis of randomized controlled studies. Front Endocrinol (Lausanne). 2025;16:1234567. doi: https://doi.org/10.3389/fendo.2025.1481200 DOI: https://doi.org/10.3389/fendo.2025.1481200
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Copyright (c) 2026 Angelica Danielevicz, Larissa dos Santos Leonel, Ingrid Alessandra Victoria Wolin, Marina Isolde Constantini, Herber Orlando Benitez, Mabel Diesel, Cíntia de La Rocha Freitas, Rodrigo Sudatti Delevatti

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