Construção de um protocolo de exercícios físicos para o atendimento a pessoas com diabetes mellitus tipo 2: revisão rápida

Abstract

Type 2 Diabetes Mellitus (DM2) accounts for 90-95% of all diabetes cases. This form covers individuals with relative insulin deficiency and peripheral insulin resistance. Physical exercise is an efficient therapeutic strategy for the treatment of people with DM2 as it contributes to glycemic control, as well as reducing cardiovascular risk factors, increasing physical fitness, contributing to body weight control and improving people's quality of life. Objective: Formulate a physical exercise protocol aimed at health professionals for the treatment and maintenance of glycemic control of adults with type 2 Diabetes Mellitus. Methodology: The study consists in the elaboration of the protocol from a rapid review in search of studies who investigated the effects of physical exercise on the glycemic control of adults with type 2 Diabetes Mellitus (DM2) to analyze which exercise parameters (modality, frequency, volume, intensity, interval and progression) are recommended to achieve better glycemic control in the population of interest. The PICOT strategy was adopted for the elaboration of the inclusion criteria of the studies and the PRISMA protocol for the writing of the manuscript. PubMed and LILACS databases were used. The study selection process took place through 4 steps: identification, selection by title and abstract, eligibility assessment and inclusion. Two authors independently extracted data on population, intervention and outcome from each study, and the extracted information was organized into tables. The methodological quality of each study was analyzed based on the PEDro scale (PROSPERO - CRD 42021262614). Results: From a total of 1152 articles, 17 studies met the inclusion criteria and were analyzed. A total of 1,141 (745 in exercise groups and 396 in sedentary control groups) people with T2DM were included. Regarding the type of study, 15 (88.2%) were randomized clinical trials and 2 (11.8%) were non-randomized clinical trials. The age of patients ranged from 45.6 to 61.7 years. The mean intervention time was 17 weeks, ranging from 9 to 48 weeks. Six studies 35.3% reported that no adverse events occurred during the intervention, two (11.8%) reported some event and nine (52.9%) did not present any information. The theoretical basis obtained from the rapid review and other studies supported the construction of a guidance protocol for professionals about physical exercise as a treatment for DM2 and management of glycemic control. The following elements were elaborated: frameworks of concepts, flowcharts and explanatory texts constructed with objective and easy-to-understand language as didactic tools in order to assist in the outpatient routine of professionals responsible for prescribing exercises in the management of patients treated at all levels of care of the Unified Health System (SUS). Discussion: Aerobic, resistance and combined training are associated with decreases in HbA1c, fasting glucose or postprandial glucose. however, combined training should be prioritized as they appear to have greater effects on glycemic control than either method alone. Conclusion: The protocol created from this review aims to offer professionals working at the various levels of health care in the SUS, updated, objective information, presented in a didactic way about physical exercise as a form of treatment for DM2. It is recommended that physical exercise protocols include both resistance and aerobic exercise, as their effects are greater on glycemic control than either method alone.