Influência do exercício resistido sobre o controle glicêmico e índices hematimétricos em idosos residentes em instituições de longa permanência (ILPIs)

Abstract

Exercise is considered a recognized therapeutic strategy in improving carbohydrate metabolism, but there are uncertainties about optimal glycemic control maintained by non-pharmacological therapeutic programs for different age groups and adaptive situations.Longevity-related repercussions include sarcopenia, the body's vulnerability to stress, neuroendocrine dysregulation, and immune disorders.These situations facing exercise can influence glycemic levels in an unexpected way. Physiologically, glycemic control is carried out by the interaction, well orchestrated between three main factors: secretion, degradation and peripheral sensitivity to insulin, where the metabolic demand of skeletal muscle tissue has a fundamental effect on this control.Our work consists of two experimental articles and a review article, in which we understand the effects of light-intensity resistance exercise on glycemic control, and blood count in elderly people living in long-stay institutions for the elderly (LSIEs).We believe this study provides support for the development of non-pharmacological programs, differentiated and adapted for this population, with the aim of preventing or improving type 2 diabetes mellitus and its associated comorbidities.In the first article, our main finding was the greater peripheral resistance to insulin action, after the exercise program, in elderly people aged less than or equal to 74 years.Our hypothesis led us to think about stressors inherent to exercise, which may have activated the hypothalamic-pituitary-adrenal axis, secreting adrenocorticotropic hormone (ACTH) and later cortisol hormone, which influenced post-training insulin resistance by reducing compensatory insulin clearance in response to a reduction in peripheral sensitivity.In the second article, we also found a greater peripheral resistance to insulin action in the same age group after training program. A possible explanation for this result is the influence of erythrocyte size variability on viscosity and blood flow, influencing the arrival of insulin in the cell, which may have caused resistance to its action.A highlight of our work was the improvement in erythrocyte size variability after the exercise program.We understand that this positive modulation in the post-exercise Red cell distribution width (RDW) is due to an adaptation to the need to transport glucose and insulin in a more efficient way for muscle contraction, aiming at improving blood flow and insulin delivery to the skeletal muscle.Although this hypothesis is the most plausible, we emphasize that the chronic condition of the elderly population is a subclinical inflammatory process that, associated with exercise, can release pro inflammatory cytokines that influence the size of erythrocytes, causing an increase in osmotic pressure and activation of the hypothalamic-pituitary-adrenal axis, with greater secretion of hormone arginine vasopressin and adrenocorticotropic hormones and cortisol, which may also have influenced post-training program insulin resistance.Although our results directed us to the activation of the hypothalamic pituitary-adrenal axis, as being the cause of the lower peripheral insulin sensitivity after the exercise program, we must be cautious in this statement.Due to the limitation of our study, which did not quantify the serum level of cortisol hormone, we therefore suggest new studies to the academic community that correlate this variable with physical activity, glycemic control and insulin resistance in the elderly. In our third article, we verified the relationship between leptin production, obesity and insulin, and we understand that obesity is an unfavorable condition for insulin homeostasis, and a risk factor for the onset of type 2 diabetes mellitus in the elderly population.