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Previous issue date: 2016-02-29 / Diabetes is associated with endothelial dysfunction and several cardiovascular
disorders, such as systemic arterial hypertension. Moreover, hypertension and diabetes
coexist very frequently, as 60-65% of diabetics are hypertensive. The coexistence of
hypertension and diabetes can reduce endothelium-mediated vasodilatation, which can
be partially explained by a reduced production of nitric oxide (NO) or a decreased
response to NO in the vascular smooth muscle. On the other hand, it has been shown
that a single session of exercise can promote significant reductions in blood pressure
(BP). This occurrence is known as post-exercise hypotension (PEH) and appears to be
associated with the activity of the kallikrein-kinin system and release of NO. Although
studies have observed PEH in individuais with T2D the molecular mechanisms have not
been fully elucidated. ln addition, the prescription of exercise intensities based on
lactate threshold (L T) has been suggested for individuais with T2D.Moreover, in spite
of previous studies showing that individuais with T2D exhibit PEH when exercising at
intensities around LT , There is evidence that subjects with T2D exhibit lower plasma
kallikrein activity (PKA) compared to healthy individuais, suggesting that lower NO
release and reduced endothelium-dependent vasodilation would be occurring in
response to exercise for this population. However, no investigations were made on the
integrated responses of PKA, BK, dessArg9-BK and NO and its association to the
occurrence of PEH in individuais with or without T2D.Furthermore, to the best of our
Knowledge, there is only one study that has investigated the effects of exercise (aerobic
and / or resistance) on the 24-hour BP response in individuais with T2D. Not to
mention that it is not of our knowledge, studies that have investigated the effects of
different aerobic exercise intesities on BP 24 hours in subjects with T2D.Additionally,
Several studies have investigated the effects of different exercise modes ( e.g., aerobic
vs. resistance ), intensities, and durations on BP responses during the post-exercise
recovery period. Studies regarding the effects of different sports modalities, especially
martial arts, have also been performed, such as: Tai Chi Chuan, Jiu Jitsu, and Judo.
However, until now, no study has explored the BP responses after a single Contact
Karate (CK) session. It is worth mentioning that the scientific literature related to
combat sports has hardly been explored, especially regarding health-related variables
(i.e., post-exercise BP reduction). Most studies have investigated performance-related
parameters in athletes, making the evaluation of health-related variables (such as PEH)
a scientific gap. Therefore, investigations related to this issue have been strongly
encouraged. It should be noted that given the known complications of type 2 diabetes
and characteristics of sport (high physical contact of high impact), it is wise to initially
investigate the effects of a contact karate session on the blood pressure response after
exercise in apparently healthy subjects and then, if possible, in special populations as
diabetes and hypertension. With regard to chronic exercise, in particular the resistance
exercise, the available literature concerning their effects on the response of NO and, in
tum, on BP in individuais with T2D, it is still incipient. To the best of our knowledge,
there have been only two randomized clinical trials ofRT's effects on NO concentration
and BP levels in T2D patients, only one of which, verified the NO response (along with
BP) due to R T. Therefore, there is an apparent lack of evidence on R T' s effects on the
responses of NO and BP in T2D patients. Objectives: Study 1) to investigate and
compare the responses of PKA, BK, desArg9-BK, NO and BP after a single session of
moderate-intensity aerobic exercise in T2D and non-diabetic (ND) individuais; study 2)
To verify the effects of different intensities of aerobic exercise on 24-hour ambulatory
BP responses in individuais with T2D and prehypertension; study 3) to verify the effects
of a Contact Karate (CK) session on BP responses during a post-exercise recovery
period in young adults; study 4) to determine the effects of eight weeks RT on the
responses of NO and BP in T2D patients and their controls peers. Methods: study
l)Ten subjects with T2D and 10 Non-diabetics (ND) underwent three sessions: 1)
maximal incremental test on cycle ergometer to determine lactate threshold (L T); 2) 20-
min of constant-load exercise on cycle ergometer, at 90% LT and; 3) control session.
BP and oxygen uptake were measured at rest and at 15, 30 and 45 min post-exercise.
Venous blood samples were collected at 15 and 45 minutes of the recovery period for
further analysis of PKA, BK and desArg9-BK. NO was analyzed at 15 minutes post
exercise. Study 2) ten individuals with T2D and prehypertension completed three
sessions applied in random order: non-exercise control (CON) and exercise at moderate
(MOD) and maximal (MAX) intensities. Heart rate (HR), BP, blood lactate
concentrations ([Lac ]), oxygen uptake (VO2), and rate of perceived exertion (RPE) were
measured at rest, during the experimental sessions, and during the 60 min recovery
period. After this period, ambulatory blood pressure was monitored for 24 h. Study 2)
ten individuals with T2D and prehypertension completed three sessions applied in
random order: non-exercise control (CON) and exercise at moderate (MOD) and
maximal (MAX) intensities. Heart rate (HR), BP, blood lactate concentrations ([Lac ]),
oxygen uptake (VO2), and rate of perceived exertion (RPE) were measured at rest,
during the experimental sessions, and during the 60 min recovery period. After this
period, ambulatory blood pressure was monitored for 24 h. Study 3) Thirty-two male
CK athletes volunteered and underwent one CK session (50 min) anda control session.
BP was measured during rest (before sessions), as well as on the 15th, 30th, 45th, and 60th
min of the post-exercise recovery. Study 4) We performed eight-weeks of randomized
controlled trial in T2D patients and ND individuals. After initial screening, were
randomly allocated into four groups: (1) trained T2D (T2DTRAINED; n = 9), (2)
trained ND (NDTRAINED; n = 10), (3) control T2D (T2DCON; n = 8) and (4) control
ND (NDCON; n = 7). NO and BP were determined before and after the intervention.
Results: study 1) The ND group presented PEH of systolic blood pressure (SBP) and
mean arterial pressure (MAP) on the 90% L T session but T2D group did not. Plasma
NO increased ~24.4% for ND and ~13.8% for T2D group 15min after the exercise
session. Additionally, only ND individuais showed increases in PKA and BK in
response to exercise and only T2D group showed increased desArg9-BK production.
Study 2) Compared with CON, only MAX elicited post-exercise BP reduction that
lasted for 8 h after exercise and during sleep. Study 3) The SBP, diastolic blood
pressure, and MAP were significantly lower at the post-exercise period compared to
pre-exercise rest (p<.05), with the largest reductions being observed at the 60th min of
recovery and at the sarne periods of post-exercise recovery of the control session. Study
4) After eight weeks of RT (three times per week), the T2D and ND experimental
groups decreased systolic blood pressure (SBP) by 7.0 and 3.4 mmHg, respectively.
However, the control groups showed maintenance (0.24 mmHg for T2D) or elevation
(2.2 mmHg for ND) of systolic blood pressure. Although none of these changes were
significant (p > .05). As regards the absolute values of BP, T2D subjects who did not
undergo the training (T2DCON) tended (p = .057) to have increase SBP and
significantly (p = .05) increased MAP. Conclusions: studyl) it was concluded that T2D
individuals presented lower PKA, BK and NOx release as well as higher desArg9-BK
production and reduced PEH in relation to ND participants after a single exercise
session. Study 2) A single session of aerobic exercise resulted in 24 h BP reductions in
individuals with T2D, especially while sleeping, and this reduction seems to be
dependent on the intensity of the exercise performed. Study 3) a single CK session can
promote a decrease in BP for at least 60 min after performing this type of exercise in
young adults. Study 4) eight weeks of RT does not increase NO concentrations and, in
tum, does not reduce BP in T2D patients-though it prevented its increase. / Introdu????o: o diabetes est?? associado com disfun????o endotelial, bem como com
diversas desordens cardiovasculares, como hipertens??o arterial sist??mica (HAS). A
HAS e o diabetes coexistem muito frequentemente. Aproximadamente, 60-65% dos
diab??ticos s??o hipertensos. A coexist??ncia do diabetes e HAS pode reduzir a
vasodilata????o endot??lio-dependente, que pode ser parcialmente explicada por uma
reduzida produ????o ou resposta ao ??xido n??trico (ON) na nusculatura vascular lisa. Por
outro lado, estudos t??m demonstrado que uma ??nica sess??o de exerc??cio pode promover
redu????es significativas na press??o arterial (PA). Esta ocorr??ncia ?? conhecida como
hipotens??o p??s-exerc??cio (HPE) e parece estar associada com a atividade do sistema
calicre??na-cinina e libera????o do ON. Embora estudos tenham observado HPE em
indiv??duos com diabetes tipo 2 (DT2), os mecanismos moleculares relacionados ?? sua
ocorr??ncia n??o foram completamente elucidados. Adicionalmente, a prescri????o de
intensidades de exerc??cio baseada em cargas relativas ao limiar de lactato (LL) t??m sido
sugerida para indiv??duos com DT2. No entanto, apesar de estudos anteriores
demonstrarem que os indiv??duos com DT2 apresentam HPE quando submetidos a
exerc??cios em intensidades em torno LL . Existe evid??ncia que indiv??duos com DT2
apresentam menor atividade da calicre??na plasm??tica (ACP) em compara????o aos
indiv??duos n??o diab??ticos, sugerindo uma menor libera????o de ON e redu????o da
vasodilata????o endot??lio-dependente em resposta ao exerc??cio para essa popula????o.
Contudo, para o nosso melhor conhecimento, ainda n??o foram realizadas investiga????es
sobre as respostas integradas de ACP, bradicinina (BK), des-Arg9-bradicinina, ON e
sua associa????o com a ocorr??ncia de HPE em indiv??duos com ou sem DT2. Ademais,
salvo melhor ju??zo, existe apenas um estudo que tenha investigado os efeitos do
exerc??cio f??sico (aer??bio e/ou resistido) sobre a resposta da PA de 24 horas em
indiv??duos com DT2. Sem mencionar que tamb??m n??o ?? do nosso conhecimento,
estudos que tenham investigado os efeitos de diferentes intensidades de exerc??cio
aer??bio sobre a PA de 24 horas em indiv??duos com DT2. Somando a isso, diversos
estudos t??m investigado os efeitos de diferentes modos de exerc??cio (aer??bio vs.
resistido), intensidades, e dura????es, sobre as respostas da P A p??s-exerc??cio. Estudos
sobre os efeitos de diferentes modalidades esportivas, especialmente artes marciais,
tamb??m foram realizados, tais como: Tai Chi Chuan, Jiu Jitsu e Jud??. Contudo, at?? o
presente momento, nenhum estudo investigou a resposta da P A ap??s uma ??nica sess??o
de Carat?? de contato (CC). Vale ressaltar que a literatura cient??fica relacionada a
esportes de combate t??m sido pouco explorada, especialmente em rela????o ??s vari??veis
relacionadas com a sa??de ( ou seja, a redu????o da PA p??s-exerc??cio). A maioria dos
estudos investigaram os par??metros relacionados com o desempenho em atletas,
tornando a avalia????o de vari??veis relacionadas com a sa??de, uma evidente lacuna
cient??fica. Portanto, investiga????es relacionadas a este assunto t??m sido fortemente
encorajada. Cabe salientar que, dado as conhecidas complica????es do DT2 e as
caracter??sticas da modalidade em quest??o ( elevado contato f??sico de alto impacto),
torna-se prudente inicialmente investigar os efeitos de uma sess??o de CC sobre a
resposta da P A p??s-exerc??cio em indiv??duos aparentemente saud??veis e posteriormente,
se poss??vel, em popula????es especiais como diab??ticos e hipertensos. No que se refere ao
exerc??cio cr??nico, em particular sobre o exerc??cio de for??a, a literatura dispon??vel a
respeito dos seus efeitos sobre a resposta do ON e, por sua vez, sobre a PA em
indiv??duos com DT2, ainda ?? muito incipiente. Para o melhor do nosso conhecimento,
existem apenas dois ensaios cl??nicos randomizados sobre os efeitos do treinamento
resistido (TR) sobre a resposta do ON e P A em pacientes com DT2, dos quais apenas
um, verificou a resposta do ON juntamente com a P A frente ao TR. Portanto, h?? uma
aparente falta de evid??ncias a respeito dos efeitos do TR sobre as respostas do NO e PA
em pacientes com DT2. Objetivos: estudo 1) investigar e comparas as respostas de
ACP, BK, desArg9-bradicinina, ON e PA ap??s uma ??nica sess??o de exerc??cio aer??bio
realizada em intensidade moderada (90% da carga de LL) em indiv??duos com e sem
DT2; estudo 2) verificar e comparar os efeitos de uma ??nica sess??o de exerc??cio aer??bio
sobre a resposta da PA de 24 horas e verificar os efeitos da intensidade do exerc??cio
aer??bio sobre a resposta da PA 24 h em indiv??duos com DT2 e pr??-hipertensos; estudo
3) avaliar os efeitos de uma ??nica sess??o de CC sobre a resposta da PA p??s-exerc??cio
em adultos jovens; estudo 4) investigar os efeitos de oito semanas de TR sobre as
respostas de ON e P A em pacientes com DT2 e seus pares controles. M??todos: estudo
1) Dez indiv??duos com e DT2 e 10 n??o diab??ticos (ND) foram submetidos a tr??s
sess??es: 1) teste incremental m??ximo em bicicleta ergom??trica para determinar o limiar
de lactato (LL); 2) 20 min de exerc??cio de carga constante em cicloerg??metro, em 90%
L T e; 3) sess??o controle. PA e consumo de oxig??nio foram mensurados em repouso e
aos 15, 30 e 45 min p??s-exerc??cio. Amostras de sangue venoso foram coletadas em 15 e
45 minutos do per??odo de recupera????o para posterior an??lise de ACP, BK e desArg9-
bradicinina. ON foi analisado aos 15 minutos ap??s o exerc??cio. Estudo 2) Dez
indiv??duos com diabetes tipo 2 e pr??-hipertens??o foram submetidos a tr??s sess??es
aplicadas em ordem rand??mica: 1) controle ( CON), sem exerc??cio e exerc??cio em
intensidades moderadas (MOD) e m??xima (MAX). A frequ??ncia card??aca (FC), P A, as
concentra????es de lactato sangu??neo ([Lac ]), consumo de oxig??nio (V02) e taxa de
percep????o de esfor??o (TPE) foram coletados em repouso, durante as sess??es
experimentais e durante o per??odo de recupera????o de 60 min. Ap??s esse per??odo, a P A
de 24 h foi monitorada. Estudo 3) Trinta e dois atletas CC foram submetidos a uma
sess??o de CC (50 min) e uma sess??o CON. A PA foi medida durante o repouso, bem
como aos 15, 30, 45 e 60 min da recupera????o p??s-exerc??cio. Estudo 4) Foi realizada oito
semanas de estudo randomizado controlado em pacientes DT2 e ND). Ap??s a triagem
inicial, foram distribu??dos aleatoriamente em quatro grupos: (1) treinados com DT2
(TREINADODT2; n = 9), (2) treinados ND (TREINADOND; = n 1 O), ( 3) controle
DT2 (CON DT2; n = 8) e (4) controle ND (CONND; n = 7). NO e BP foram
determinadas antes e ap??s a interven????o. Resultados: estudo 1) somente o grupo n??o
diab??tico (ND) apresentou HPE para press??o arterial sist??lica e press??o arterial m??dia
na sess??o LT 90%. O ON plasm??tico aumentou ~ 24,4% no grupo ND e ~ 13,8% para o
DT2 15 min ap??s a sess??o de exerc??cios. Al??m disso, apenas os indiv??duos ND
mostraram aumentos de ACP e BK em resposta ao exerc??cio e somente os DT2
mostraram um aumento da produ????o desArg9-bradicinina. estudo 2) Ademais,
comparado com a sess??o CON, somente a sess??o de exerc??cio MAX apresentou HPE,
que durou at?? 8 h ap??s o exerc??cio e durante o sono. estudo 3) Em rela????o ao CC, a
press??o arterial sist??lica (PAS), diast??lica (PAD) e press??o arterial m??dia (MAP) foi
significativamente menor no per??odo p??s-exerc??cio em rela????o ao pr??-exerc??cio repouso,
bem como em rela????o a sess??o CON, com as maiores redu????es sendo observadas aos 60
min de recupera????o. estudo 4) Ap??s oito semanas de RT, ambos os grupos
experimentais (DT2 e ND), apresentaram diminui????o da PAS em 7,0 e 3,4 mmHg,
respectivamente. No entanto, os grupos controle (DT2 e ND) demonstrou manuten????o
(0,24 mmHg para DT2) ou eleva????o (2,2 mmHg para ND) da PAS. Embora nenhuma
das mudan??as foram significativas (p> 0,05). Conclus??es: estudol) concluiu-se que os
indiv??duos comDT2 apresentaram menor libera????o ACP, bradicinina e ON, bem como
maior produ????o desArg9-bradicinina e reduzida HPE em rela????o aos participantes do
grupo ND ap??s uma ??nica sess??o de exerc??cio. Estudo 2) uma ??nica sess??o de exerc??cio
aer??bio resultou em redu????o da PA de 24 h em indiv??duos com DT2, especialmente
durante o sono, e esta redu????o parece ser dependente da intensidade do exerc??cio
realizado. Estudo 3) uma ??nica sess??o CC pode promover uma diminui????o da PA
durante pelo menos 60 minutos depois de realizar este tipo de exerc??cio em adultos
jovens. Estudo 4) oito semanas de TR n??o aumenta as concentra????es de ON e, por sua
vez, n??o reduz a P A em indiv??duos com DT2, por??m parece impedir o seu aumento.
| Identifer | oai:union.ndltd.org:IBICT/oai:bdtd.ucb.br:tede/2076 |
| Date | 29 February 2016 |
| Creators | Sales, Marcelo Pereira Magalh??es de |
| Contributors | Sim??es, Herbert Gustavo |
| Publisher | Universidade Cat??lica de Bras??lia, Programa Strictu Sensu em Educa????o F??sica, UCB, Brasil, Escola de Sa??de e Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UCB, instname:Universidade Católica de Brasília, instacron:UCB |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 6095716513072507778, 500, 500, 600, 3870802503144686128, 5178284805913411594 |
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