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1,2,3, ,12,13,17. for week, the advisable volume for the diabetic is from 15 to 60 minutos and the extolled intensity varies from 50% to

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Volume 76 - Specil Edition - ARTICLE II EFFECTS OF THE GLYCEMIA BEHAVIOR WITHIN PERSONS WITH TYPE 2 DIABETES MELLITUS (DM) ON A WALKING PROGRAM 1 1 CARMEM CRISTINA BECK DUMMEL ADAIR DA SILVA LOPES 1 2 ILCA MARIA SALDANHA DINIZ LUIZ SERAFIM DE MELLO LOI 1-Universidde Federl de Snt Ctrin/UFSC, Florinópolis, SC Brsil; 2 Universidde Regionl do Noroeste do Estdo do Rio Grnde do Sul/UNIJUI, Snt Ros, RS Brsil INTRODUCTION The incidence nd prevlence of type 2 dibetes mellitus (DM) is incresing considerbly in the lst yers, turning into serious problem for public helth in prcticlly ll countries, independently of socioeconomic development level. The epidemic nd demogrphic trnsition from lst century with modifictions of the everydy lifestyle determined risk profile for 1,2,3,4 the development of chronic diseses, like the dibetes. Type 2 DM is responsible for bout 90% of dibetes cses nd hs been pointed s one of the ten min cuses, direct or indirectly, of deth in the world. The increse of the overweight txes nd obesity ssocited to lifestyle ltertions (indequte feeding nd reduction of physicl ctivity) nd the ging popultion, re the min fctors tht explin the growth of 5 type 2 DM prevlence. The min gol of the type 2 DM tretment is the control of the blood glycemi, becuse this wy it is possible to void shrp nd chronic complictions of dibetes, such s dibetic ketocidosis, hyperglycemic nonketotic syndrome, 6 hypoglycemi, the ltertions in the microcircultion nd mcro circultion nd lso neuropthy ltertions. The tretment of type 2 DM consists of different stges, mong them stnds out the stge I tht includes the dietry 7 tretment, exercise progrm, lifestyle chnges nd self-monitoring trining. However, it is observed tht besides the physicl exercise is suggested to be in stge I of the dibetes tretment, sttistic dt demonstrted tht in Brzil, in the ge 8 group of 30-69, 23% of the dibetics didn't mke ny tretment; 29% only diet; 41% used orl glucgons nd 7% insulin. Mny yers physicl exercise is prt of the bsic tretment for dibetes, due to the gret dvntges presented on the metbolism of the disese, such s: glycemi fll, reduction of the ft percentile, increse in of insulin ction nd orl 9,10 11,12,13,14,15,16 glucgons. However, in the lst decdes, reserches hve been ccomplished to identify reltionship between exercise prescription with metbolic effects in dibetes. To minimize risks, to increse the benefits of exercise for dibetic individul, to void current chronic complictions of this disese nd to gurntee qulity of life for this popultion hs been the mjor purpose of these studies. In spite of the different proposls by modlity, frequency, volume nd intensity in the exercise prescription for the dibetics, there is unnimity bout the importnce of cres nd necessry precutions for the dibetic's sfety. In this wy, the glucose levels monitoring is constituted of essentil procedure, s well s the diet djustments. Although the indiction of locted musculr resistnce exercises, the erobic exercises re more extolled. As for the frequency minimum of 3-4 dys 17 11,12,13,17 for week, the dvisble volume for the dibetic is from 15 to 60 minutos nd the extolled intensity vries from 50% to % FC resting nd 50%-80% VO2máx.. In ssumption of these mtters, the importnce of the physicl exercise in the tretment of type 2 DM, The objective of this reserch ws to verify the effects of the glycemi behvior from persons with type 2 Dibetes Mellitus (DM) on wlking progrm. METHODOLOGICAL PROCEDURES Popultion nd Smple The popultion ws constituted of dibetics of type 2, tht didn't mke use of insulin nd frequented the Dibetics Assocition of Três de Mio - RS. The ssocition counted with 80 prticipnts, however there ws no frequency on the monthly meetings which ws more prestige by the retired. The smple, intentionlly selected, ws composed by 12 individuls (10 femle nd 2 mle), who greed in being prt of the reserch nd signed responsibility term. The ge group ws from 55 to 76 yers (medium ge of 64,6 yers old). All of the women of the smple (n=10) presented systemic rteril hypertension dignosis (SAH) nd used medicines for their control. And the men (n=2) presented norml blood pressure. Besides the SAH, they presented other chronic complictions: hert indequcy (n=2), hert rrhythmi (n=1), dibetic nefropthytic (n=1) nd dibetic nephropthy (n=1). MATERIAL AND METHODS After medicl evlution through clinicl exm nd lbortoril exms (ure, glucose nd hemoglobin glucose) n limentry nmnesis ws ccomplished by the nutritionist which tried to djust nd give generl orienttions for the development of the wlking progrm. A semi-structured questionnire ws pplied to identify the prticipnts' physicl ctivity hbits. It is pointed out, tht the involvement of multidisciplinry tem composed by doctor, nurse, nutritionist nd professionl of Physicl Eduction ws fundmentl for the development of this reserch. The evlution of the dependent vribles in this study were: cpillry glycemi (GC), hemoglobin glucose (Hb) nd Body Mss Index (IMC), the wlking progrm ws the independent vrible. For the verifiction of the cpillry glycemi (GC) it ws used glucometer Byer S.A., the glucometer elite, sticks nd ribbons comptible regents. For cutbck, GC ws verified in wlking sessions. The hemoglobin glucose (Hb) ws discovered by lbortoril test with the subject in period without eting, t lest, twelve hours in the beginning nd fter the end of the wlking progrm. This lbortoril method is excellent for evlution of the dibetic's metbolic control, becuse the life time from red globules is, pproximtely, 1 dys. The chromtogrphy method ws used in personl resin computer-columns nd the vlues used referred were 4,2% to 6,2% of the totl hemoglobin. 19 For BMI, the protocol of Alvrez & Pvn (corporl mss nd stture) ws used, with the individuls wering light clothes, through Filizol scle with intervl mesure of 100 grms with stdiometer. BMI (Quetelet formul) ws used considering prmeters suggested by the World Orgniztion of Helth. The evlution of the ptitude crdiorespirtory (VO2 mx) ws ccomplished through the wlking mile test 21 (ACSM). The exercise prescription obeyed the scientific beginnings of sport trining. With the medicl informtion it ws obtined dt bout the tretment nd the disese stge, used mediction nd chronic complictions were considered for the wlking progrm prescription. The wlking progrm ws prescribed with weekly frequency of three dys (Mondys, Wednesdys nd Fridys); initil durtion of 30 minutes, fter two weeks 35 minutes, nd when completing three weeks the volume pssed to 40 minutes; fter the fourth week it ws ltered to 45 minutes nd when completing six weeks it went to 50 minutes nd it ws mintined until the end of the three months of intervention; the intensity ws 40%-65% of FC resting, monitored through hert frequency 417 Volume 7 - Specil Edition - ARTICLE II two to three times during the wlking, through hering rdil rtery for 15 seconds. It ws lso used, the scle of Borg, for dibetics tht used medicines to reduce FC. The determintion of the intensity lwys respected the physicl limittions, tking cre of complictions of the dibetes nd the ge of the smple. The wlk sessions begn nd ended with prolongtions. In ech session individul records of control were filled out, contining the dt of cpillry glycemi, blood pressure (verified before nd fter the session by technicin nurse) nd other pertinent observtions from ech individul, seeking lrger sfety on the progrm. The intervention hppened during three months nd 36 wlking sessions were ccomplished. Sttisticl Tretment For the sttisticl tretment the Excel progrm 97 version ws used. The significnt level dopted ws 5%. Before choosing by prmetric or no-prmetric sttistics the normlity of dt ws verified. Therefore, the cpillry glycemi ws nlyzed through binomil distribution - Tests of Signs nd the hemoglobin glucose ws nlyzed eqully through binomil distribution- Tests of Signs nd Wilcoxon test. BMI ws nlyzed by Student t test for dependent smples. RESULTS AND DISCUSSIONS The prticipnts of the reserch were designted by letters from A to L to possibility the individul results comprehension. It ws ble to verify, ccording to tble 1, tht ech individul (except one) presented significnt sttisticl 11,18 reduction (p=0,05) of Cpillry Glycemi. This result is ccording with the literture confirming tht exercise progrm, including erobic ctivities (wlking) cn result in significnt reduction of the snguine glucose levels. Therefore, the levels of 22, 23 GC cn demonstrte the mjor effect of wlking on the decrese of glycemic levels fter ech session done. Tble 1 Comprinson of the results from Cpillry Glycemi. Subject Freq. Absol. Pre-test (+1) Freq.Absol. Aft-test (-1) Freq. Relt. Pre-test (+1) Freq. Relt. Aft-test (-1) N of p Session A ,0% 95% 0,000* B ,9% 94,1% 0,000* C % 60% 0,251 D % 90% 0,001* E ,7% 93,3% 0,004* F ,0% 95% 0,002* G ,3% 94,7% 0.004* H % 75% 0,0* I % 85% 0,001* J % 90% 0,000* K % 100% 0,000* L % 100% 0,000* *p=0,05, sign test. 36 wlking sessions were ccomplished, however the cpillry glycemi test ws ccomplished in sessions. For the presenttion of the temporry series of GC vlues, it ws opted to ccomplish drw mong the nlyzed individul nlyses, A nd C were ccomplished. Thus, in the illustrtions 1 nd 2 re presented to temporry series of the vlues from these individuls' cpillry glycemi. The nlysis of the Illustrtion 1 relted with GC shows tht the Individul A presented gret vrition in the vlues of the pre-test nd the fter-test, observing highly significnt reduction(p=0,001) between the vlues of GC before nd fter the wlking. The nlysis of the Illustrtion 2, relted to C subject demonstrtes tht when the vlues of GC of the pre-test were high the fter-test vlues were lower nd, when the vlues of the pre-test ws lower the fter-test vlues presented smller decrese. In n isolted point the vlue of the pre-test ws higher nd fter-test lso. It is lso observed through the vlues of 8 GC tht this Individul is with good glycemic control (=140 mg/dl), (MINISTÉRIO DA SAÚDE, 01). These results did not present significnt sttisticl differences (p=0,25) between the pre nd the fter-test vlores de GC Pré-teste Pós-teste sessões de cminhd Illustrtion 1 Temporry series from the vlues of GC pre-test nd fter-test from A subject. 16 The cpillry glycemi behvior on the exercise (illustrtions 1 nd 2) re in gree with Gordon verifictions, tht the width of the decline in the mount of glucose in the blood is relted with the vlue of the glycemi obtined before the exercise, therefore, s lrger the vlue of GC before the exercise lrger decline cn be expected. In other hnds, s smller the levels of GC before the exercise, smller will be the possible decrese. vlores degc sessões de cminhd Pré-teste Pós-teste Illustrtion 2 Temporry series of the vlues of GC do pre-test nd fter-test from C subject. The sttistics results through the Test of Signs (Tble 2) show evidences tht wlking improved hemoglobin glucose levels (Hb) in the subjects of the smple with significnce p=0,02. With these results it cn be inferred tht dibetics Type 2 418 Volume 76 - Specil Edition - ARTICLE II - 06 cn improve the Hb levels through regulr wlking. These results were confirmed by the Wilcoxon Test. Therefore, it cn stnd out tht the wlking progrm, ccomplished three times week, with intensity of 40%-65% of FC resting, with 30 minutes (initil) to 50 minutes volume cn 18 improved hemoglobin glucose levels (p=0,025). A met-nlysis ccomplished by Boulé et l., relted intensity nd erobic exercises volume with ltertions in the crdiorespirtory ptitude nd Hb evidenced tht significnt reductions in the Hb levels re more ssocited to the intensity dopted in the progrm prescription. However the frequency of the exercises re 9. considered prepondernt fctor for the glycemic levels control in dibetics type 2 Thus, in spite of the frequency to be indispensble, the increment of intensity cn mximize the decrese of Hb nd consequently the glycemic control. Tble 2 Vlues of pre-test nd fter-test from hemoglobin glucose(hb ), difference nd sign test. Subjects Pre-test After-test Different Sign A 6,86 5,80 1,06 + B 6,37 6,68-0,31 - C 5,90 5,78 0,12 + D 7,52 6,34 1,18 + E 10,32 8,89 1,43 + F 5,00 6,84-1,84 - G 6,25 5,88 0,37 + H 8,00 7,36 0,64 + I 7,70 6,91 0,79 + J 7,00 6,38 0,62 + K 11,70 6,11 5,59 + L 10,10 9,76 0,34 + x= 2 n=12 Binomil distribution use p = 0,02 The results regrding BMI (Tble 3) demonstrted through the Student t test for dependent smples tht the progrm ws not effective (p=0,87) to chnge BMI of the subjects. Tble 3 Vlues of pre-test nd fter-test of BMI, difference, verge, t Test nd significnce level. Subject A B C D E F G H I J K L Pre-test After-test Difference t p 32,7 25,9 28,2 38,9 30,1 27,2 31,2 24,9 25,0 25,6 21,7 22,2 32,6 25,2 27,7 33,9 28,6 27,5 31,0 23,4 24,5 25,4 22,1 23,7 Médi 27,8 27,1 According with the results from subjects BMI involved in the smple (OMS) it ws verified tht before the intervention 25% were in helthy weight; 41,7% presented overweight; 25% obesity I nd 8,3% obesity II. After the intervention, it went to 33,3% with helthy weight; 41,7% with overweight nd 25% with obesity I. CONCLUSIONS AND RECOMMENDATIONS After the nlysis of the dt, considering the limittions of this study s the size of the smple, it cn be concluded tht: 1 - the wlking progrm ccomplished 3 times week, in n intensity of 40%-65% of FC resting nd with 30 to 50 minutes durtion, for 3 months (36 sessions) it resulted in the decrese of the cpillry glycemi in individuls dibetic type 2. Although discoveries from this reserch contribute to demonstrte the depressive effect of regulr wlking on GC, dditionl investigtions re necessry to turn these conclusions more significnt; 2 - regulr wlking progrm cn improve the plsmtic levels of Hb. This suggests tht erobic exercise cn help the dibetic type 2 to improve glycemic control, voiding mjor nd chronic complictions; 3 - lthough in literture indictes generl need of higher levels of intensity in wlking, this reserch with some individuls obtined significnt results of glycemic control with 40% of FC resting levels; 4 - the prescribed wlking progrm ws not effective to reduce BMI from persons with type 2 DM. It is suggested the ccomplishment of other studies with lrger smple, group controls, bigger time of intervention nd diet control. REFERENCES 1. LESSA, I. Doençs Crônics Não-Trnsmissíveis: Bses Epidemiológics. In: ROUQUAYROL, M.Z. & FILHO, N.A.F. Epidemiologi & Súde. 5.ed. Rio de Jneiro: MEDSI, TOSCANO, C. M. As Cmpnhs Ncionis pr Detecção ds Doençs Crônics Não-trnsmissíveis: Dibetes e Hipertensão Arteril. Ciênci & Súde Coletiv, v.9, n. 4, p , SOCIEDADE BRASILEIRA DE DIABETES. Consenso Brsileiro sobre Dibetes 02: Dignóstico e Clssificção do Dibetes Melito e Trtmento do Dibetes Melito Tipo 2. Rio de Jneiro: Digrphic, KING, H., AUBERT R.E. & HERMAN W.H. Globl Burden of Dibetes, : prevlence, numericl estimtes, nd projections. Dibetes Cre, v. 21, p , SARTORELLI, D.S. & FRANCO, L.J. Tendêncis do Dibetes Mellitus no Brsil: o Ppel d Trnsição Nutricionl, Cderno de Súde Públic, v.19 (Sup 1), p. s29-s36, Rio de Jneiro, S O C I E D A D E B R A S I L E I R A D E D I A B E T E S. E s t t í s t i c d o D i b e t e s n o B r s i l. cesso em CHACRA, A. R. & LERÁRIO, D. D. G. Novos Avnços n Terpi do Dibetes do tipo 2. Revist d Sociedde de Crdiologi do Estdo de São Pulo, São Pulo, v. 8, n. 5, p , Diretori de Publicções d SOCESP, BRASIL, Ministério d Súde. Deprtmento de Atenção Básic: Áre Técnic de Dibetes e Hipertensão Arteril. Cderno 7. Brsíli, MARTINS, D. M. Exercício Físico no Controle do Dibetes Mellitus. Gurulhos, São Pulo: Phorte Editor, NIELS, J. & GOODYEAR, L.J. Contrction Signling to Glucose Trnsport in Skeletl Muscle. J Appl Physiol. V. 99, p , MARTINS, D. M. Efeito do Exercício Físico sobre o Comportmento d Glicemi em Indivíduos Dibéticos. Florinópolis: UFSC, Dissertção (Mestrdo em Educção Físic), Centro de Desportos, ,1 0,7 0,5 5,0 1,5-0,3 0,2 1,5 0,5 0,2-0,4-1,5 1,454 0,087 Volume 76 - Specil Edition - ARTICLE II UBELS, F.L. et l. Wlking Trining for Intermittent Cludiction in Dibetes. Dibetes Cre, V. 22, n. 2, Feb ANDREWS, R. & HOLLAD, J. Short Exercise Progrmmes Benefit People With Dibetes. Dibetes nd Primry Cre, v.5, n.1, CHURCH, T.S. et l. Exercise Cpcity nd Body Composition s Predictors of Mortlity Among Men With Dibetes. Dibetes Cre, v. 27, n. 1, jn IM, J.G., KANG, H.J., STEWART, K.J. Type 2 Dibetes in Singpore: The Role of Exercise Trining for its Prevention nd Mngement. Singpore Medicine Journl, v.42, n. 2, GORDON, N. F. Dibetes: Seu Mnul Completo de Exercícios. São Pulo: Physis, AMERICAN COLLEGE OF SPORTS MEDICINE. ACSM's Guidelines for Exercise Testing nd Prescription 7.ed., BOULÉ, N.G. et l. Effects of Exercise on Glycemic Control nd Body Mss in type 2 dibetes mellitus: Metnlysis of Control Clinicl Trils. JAMA, v. 286, p , ALVAREZ, B. R. & PAVAN, A.L. Alturs e Comprimentos. In: PETROSKI, E.L. Antropometri: técnics e pdronizções. Porto Alegre: E.L. Petroski, W H O. W o r l d H e l t h O r g n i z t i o n. O b e s i t y n d O v e r w e i g h t. cesso em COLÉGIO AMERICANO DE MEDICINA ESPORTIVA. Teste de Esforço e Prescrição de Exercício. 5.ed. Rio de Jneiro: Revinter, SILVA, C.A. & LIMA, W.C. O exercício físico e o pciente dibético tipo II. Dynmis, v. 9, n. 34, p , ILVA, C.A. & LIMA, W.C. Efeito Benéfico do Exercício Físico no Controle Metbólico do Dibetes Mellitus Tipo 2 à Curto Przo. Arq Brs Endocrinol Metb, v. 46, n. 5, outubro, 02. EFFECTS OF THE GLYCEMIA BEHAVIOR WITHIN PERSONS WITH TYPE 2 DIABETES MELLITUS (DM) ON A WALKING PROGRAM ABSTRACT The objective of this reserch ws to verify the effects of the glycemi behvior from persons with type 2 Dibetes Mellitus (DM) on wlking progrm, nd they didn't mke use of insulin nd prticipted in the Dibetics Assocition of Três de Mio, RS. The dt ws composed by 12 individuls (10 femle nd 2 mle), with ges between 55 nd 76 yers. The dependent vribles studied in this reserch were: cpillry glycemi (GC), hemoglobin glucose (Hb) nd Body Mss Index (BMI). GC ws verified in wlking sessions (before nd fter); Hb ws tested by lbortoril test in the beginning nd t the end of the intervention; for BMI it ws used OMS norms. The wlking progrm hppened during three months (36 sessions) nd hd frequency of three times week, with 30 minutes ( t the beginning of the progrm) to 50 minutes durtion nd between 40% to 65% of FC resting for intensity. The cpillry glycemi nd the hemoglobin glucose were nlyzed by binomil distribution - Tests of Signs nd Test of Wilcoxon. BMI ws nlyzed by Test t of Student for dependent smples. The level of significnce ws of 5%. The results demonstrted tht, by the wy the exercise progrm ws mde, such GC s Hb presented significnt reductions sttisticlly (p=0,05); lthough the progrm did not lter the BMI (p=0,87). Therefore, these results shows tht the wlking progrm proposed hd gret importnce to the glycemic control for individuls with type 2 dibetic, reducing Cpillry Glycemi (GC) nd the Hemoglobin Glucose (Hb). However, it ws not ble to chnge the Body Mss Index (IMC) of the dibetics. KEY-WORDS: wlking progrm, control glycemic, dibetes mellitus. EFFETS D'UN PROGRAMME DE MARCHE SUR LE COMPORTEMENT DE LA GLYCÉMIE EN PERSONNES ATTEINT DE DIABÈTE MELLITUS TYPE 2 RESUMÉ L'objectif de cette étude été de vérifier les effets d'un progrmme de mrche sur le comportement de l glycémie en personnes tteint de dibète Mellitus type 2 (DM) sns tritement pr l'insuline et qui prticipient à l'assocition des dibétiques de Três Mio, RS. Le groupe été formé pr 12 personnes (dix du sexe féminin et 2 du sexe msculin) âgés entre 55 et 76 ns. Les vribles dépendntes nlysées dns cette étude ont été : l glycémie cpillire (GC), l'hémoglobine glucosée (Hb) et l'indice de l msse corporelle (IMC). L GC été vérifié pendnt sessions de mrche (vnt et près) ; l Hb été vérifié à trvers des tests de lbortoire u début et à l fin de l'intervention ; pour l'imc on utilisé les norm
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