Glycemic Modulation Resulting from Different Orders of Physical Training in Type 2 Diabetics: A Case Study

Modulation Resulting from Different Orders of Physical Training in Type 2 Diabetics: A Case Study. Am J Biomed Sci Res. Abstract Aerobic training and strength training are recommended for the treatment of diabetes, but it is not clear the effect of the sequence of these trainings in the same session for glycemic modulation of type 2 diabetics. This study aimed to verify the glycemic modulation of type 2 diabetics submitted to different orders of training. It was characterized as a case study, approved by the Ethics and Research Committee 007/09. Five women with type 2 diabetes mellitus (DM2) participated in this study, attending a program of supervised physical exercise for diabetics of a public university in the Northeast/Brazil. They conducted 12 sessions of Combined Training (aerobic and strength in the same session). The program was divided in two moments: first moment: six sessions, where the order of exercises was Aerobic and Strength (AF); second moment: six sessions, where it was Strength and Aerobic (FA). The capillary blood glucose was collected before, during and immediately after each session. The non-parametric ANOVA test was performed for repeated measures and the significance level of p≤0,05 was adopted. The average of glycemic values was measured with the six days of collection of each training. The AF training presented significant reduction of capillary blood glucose values, when compared to the pre-intervention and post-intervention time (169mg/dL vs117.3mg/dL; ∆= -52.6mg/dL; p<0.001), in the AF session there was also significant reduction of these values (166.6mg/dL vs 118.4mg/dL; ∆= -48.2mg/dL; p<0.001). In the intragroup comparison, AF and FA did not show significant difference (p=0.68). It is concluded that AF and FA training are safe and efficient strategies, however, the intragroup analysis showed no difference in glycemic modulation in any of the orders.


Introduction
Type 2 diabetes mellitus (DM2) is a metabolic disease characterized by insulin resistance and deficiencies in insulin secretion, representing 90% to 95% of all cases of diabetes mellitus (DM) [1]. The DM2 treatment is aimed at maintaining glycemic rates as close as possible to the established standards of normality, through the association of oral and/or insulin medications, adequacy of diet and regular physical exercises [2]. Specifically, the practice of physical exercise (PE) is determinant in the prevention of DM2 and in the treatment of all forms of DM. When performed necessary for type 2 diabetics to be encouraged to participate in PE programs on a regular basis, increasing energy expenditure and consequently, obtaining better glucose control [4]. Diabetics who present a better glycemic control, due to adherence to PE, present a decline in the prevalence of chronic complications from diabetes, such as nephropathy, retinopathy, peripheral neuropathy, peripheral vascular disease and diabetic foot [5,6].
As an important part of the treatment, PE can be performed through different training methods, one of them is strength training that presents improvements in strength, bone mineral density, blood pressure, lipid profiles, cardiovascular health, insulin sensitivity and muscle mass [7]. The aerobic training, on the other hand, has effectiveness for metabolic control, anthropometry, glycemic control and blood pressure [8,9] oriented and supervised EF programs offers remarkable benefits to metabolic control [11], from glucose control to social interaction and knowledge about the disease itself, which helps control [12].
According to Yardley et al. [13], the training session should start with strength exercise, because aerobic training can generate a sharper decrease in glucose during exercise, requiring greater need for carbohydrate supplementation, however, this study was conducted in individuals with type 1 diabetes.
No previous studies were found that examined the acute effects related to the order of training types in the same EF session, and in individuals with DM2. Thus, this study aimed to determine whether the order of training in combined training, strength and aerobic, modulate differently the glycemic response in type 2 diabetics.

Materials and Methods
This study is characterized as a case study, is part of a larger in the left wrist, counted by the evaluator in ten seconds and multiplied by six [16].

Combined Training Protocol
It

Measurement of Capillary Blood Glucose
The measurement of capillary blood glucose was performed to identify its values and ensure the safety of the volunteers, preventing them from performing the protocols in the presence of hypoglycemia or hyperglycemia before them, during (after the 20 minutes of the first training) and immediately after each combined training session. For this measure, a glucometer and reagent strips of the Contour TS model, of the BAYER brand, respectively, were used. The collection was always performed on the minimum or ring fingers, discarding the first drop of blood and using the second drop [17]. The infectious material (gloves, lancets, tapes and paper towels) used for collection was deposited in a specific box of hospital material. All diabetics who participated in the program should be within the recommended blood glucose level <200 mg/ dL at the beginning of each session and >100 mg/dL at the end of each session [1].

Statistical Analysis
The non-parametric ANOVA test was performed for repeated measurements. The program used was SPSS 17.0. For this sample, a significance level of p≤0.05 was used. The average of 6 training sessions for each order was performed. And to calculate the delta variation the difference between moment 1 and moment 2 was considered.

Results
It was observed that the sessions of exercises in the order of training AF, presented significant reduction of the glycemic values in the moments: PRE/DURING and PRE/POST training, it was adopted significance level p < 0.001; (Table 1). When the volunteers performed the training sessions in the FA order, there was also a significant reduction in all moments: PRE/DURING; DURING/ POST and PRE/POST (p<0.001); (Table 1). However, no significant difference in glycemic values was observed when the intragroup analysis was performed: AF and FA (p=0.68).

Conclusion
It is concluded that the combined training, in the order of AF or