Efeito agudo do exercício físico aeróbio e resistido sobre a glicemia em indivíduos com diabetes tipo 2: revisão sistemática e metanálise

Abstract

Introduction: Type 2 Diabetes Mellitus (DM2) is the most prevalent form of this health condition, accounting for 90 to 95% of DM cases worldwide. One of the pillars of DM2 treatment is regular physical exercise. The benefits of physical exercise are due to the cumulative acute effects over time since physical exercises promote increased tissue sensitivity to the action of insulin and stimulate glucose uptake independent of the action of this hormone, while resistance physical exercises promote an increase of muscle mass and improvement in the expression of glucose transporter type 4 and, consequently, improvement in tissue glucose uptake. This glycemic effect of physical exercise varies according to the moment of its practice, type, intensity, and duration of the exercise performed. Therefore, through a systematic review and meta-analysis, this study aimed to evaluate the acute effect of a single aerobic and/or resistance exercise session on blood glucose in people with DM2. Methods: The PRISMA scientific writing guidelines were followed, and the study protocol was registered in the PROSPERO database (CRD42022289985). The search strategies in the literature were elaborated from the acronym PICO (population: adults over 18 years old diagnosed with DM2; intervention: a single session of aerobic and/or resisted physical exercise; comparator: any control intervention that was performed in a group consisting of people with DM2 and who do not meet the characteristics described for the intervention; outcomes: glucose measured before and up to 24 hours after the session). The search for articles in the literature was carried out in the electronic databases CINAHL, Cochrane Library, EMBASE, Google Scholar, LILACS, MEDLINE/Ovid, SciELO, SPORTDiscus, and Web of Science. Randomized clinical studies in parallel or crossover design and non-randomized clinical studies, published from the origin of the databases and without language limitation, were included. Two independent reviewers and disagreements conducted at all stages of the review were resolved by a third reviewer. The results of all included studies were descriptively compared using a narrative synthesis. The risk of bias and certainty of evidence were assessed using the Cochrane Assessment tools “Risk of Bias” and GRADE, respectively. Statistical analyses were performed according to the Cochrane Handbook for Systematic Reviews of Interventions for the studies included in the meta-analysis. Data were reported as mean difference and 95% confidence intervals (CI), with a significant effect being considered when P < 0.05. Results: From the 6,237 studies found in the literature, 25 were included in this systematic review, and among these, 13 were grouped, allowing the use of meta-analysis techniques. The total sample included in this review consisted of 424 participants aged between 21 and 70 years, diagnosed with DM2 for at least 1.8 ± 1.0 years and at most 11.6 ± 1.9 years, most of them male (260 men, 119 women). The intensity of the physical exercises evaluated in a single session ranged from moderate to high, with 14 studies investigating the acute effect of continuous aerobic physical exercise, six studies investigating the acute effect of interval aerobic physical exercise, and five studies the acute effect of physical exercise resisted. Compared to the control condition, both continuous and interval aerobic physical exercise promoted a significant reduction in blood glucose in the first minute after the session (-1.51 mmol/L [-1.76, -1.26], P > 0.001, I² = 0.00% and - 2.65 mmol/L [-3.51, -1.80], P < 0.001, I² = 0.00%, respectively). This significant reduction in blood glucose lasted for up to 10 minutes after the continuous aerobic physical exercise session (-1.66 mmol/L [-2.56, -0.76] P <0.001, I² = 0.00%) and up to 30 minutes after the exercise session. interval aerobic physical exercise (-1.14 mmol/L [1.92, -0.36], P <0.001, I² = 0.00%). Resistance exercise did not promote a significant reduction in glucose in one minute (-1.03 mmol/L [-2.24, 0.18]; P = 0.09, I² = 0.00%), 30 minutes (- 0.22 [-1.55, 1.10]; P = 0.74, I² = 0.00%), 60 minutes (0.36 [-1.14, 1.87]; P = 0.63, I² = 0.00%), 90 minutes (1.55 [-0.20, 3.30]; P = 0.08, I² = 0.00%) or 120 minutes (0.54 [-1, 21, 2.30]; P =0.54, I² = 0.00%) after the session compared to the control condition. Conclusion: A single session of continuous or interval aerobic physical exercise promotes a significant improvement in glycemia for up to 10 or 30 minutes after its conclusion, respectively, in patients with DM2. On the other hand, a single resistance exercise session does not significantly change blood glucose in this population.