Efeitos de um programa exercício físico associado à educação para mudança do estilo de vida em indivíduos com pré-diabetes ou diabetes: estudo multicêntrico

Abstract

The treatment and prevention of diabetes involve pharmacological and behavioral strategies. Lifestyle changes, such as adopting a healthy diet, smoking cessation, improved sleep, psychosocial care, increased physical activity levels, and regular physical exercise, are fundamental for adequate diabetes management and prevention of its development. Health education is a key element for promoting these lifestyle changes. Therefore, the present study aims to compare the effectiveness of the Exercise and Education for Lifestyle (ExEd) program developed for Brazilians with an exclusively Exercise (Ex) program for improving functional capacity, disease-related knowledge, exercise self-efficacy, health literacy, physical activity level, adherence to the Mediterranean diet pattern, medication adherence, anthropometric measurements, glycated hemoglobina, cardiac autonomic control, quality of life, depressive symptoms, diet quality, diabetes-related comorbidities, satisfaction and adherence to the program in individuals with prediabetes and diabetes. For this, a randomized, multicenter, doubleblind clinical trial was conducted, involving a 12-week intervention with two parallel groups: ExEd and Ex. Participants could receive the program interventions to which they were randomized and allocated either in-person or remotely, depending on internet access and digital literacy level. The Ex program included aerobic exercises, muscle resistance exercises, and guidance for participants to accumulate at least 150 minutes of moderateto-vigorous intensity aerobic exercise per week. Meanwhile, ExEd followed the same exercise program and incorporated structured education sessions. Two hundred and sixtyfour individuals (65.9% female; 52.1 ± 12.6 years) were randomized, and 165 completed the program to which they were allocated. Both programs promoted a significant increase in functional capacity, measured by the distance covered in the Incremental Shuttle Walking Test (ExEd: 413 to 420 meters; Ex: 380 to 399 meters), health literacy, physical activity levels, and adherence to the Mediterranean diet pattern. However, the ExEd program promoted an increase in disease-related knowledge, measured by the total DATE-Q score, to significantly higher levels compared to the Ex program (ExEd: 13.4 to 14.7 points; Ex: 13.6 to 14.1 points). No significant differences were observed in quality of life, depressive symptoms, or medication adherence in response to the programs. Adherence to the interventions was similar (Exercise (ExEd + Ex): 51%; Education (ExEd): 47%), regardless of the allocated program, and most participants (83%) reported high satisfaction with the received interventions. Thus, we can conclude that both programs were effective in promoting the improvement of most investigated outcomes. However, the ExEd program was more effective than the Ex program in promoting improved disease-related knowledge.