Efeitos do exercício físico resistido na melhora da sensibilidade à insulina em indivíduos com doença de Alzheimer: uma revisão sistemática de ensaios clínicos randomizados

Abstract

Background: Alzheimer’s Disease (AD) is a chronic neurodegenerative condition affecting millions of people worldwide and represents the leading cause of dementia in individuals over 60 years of age (ALZHEIMER’S ASSOCIATION, 2022). Recent evidence suggests a significant association between insulin metabolic dysregulation and the development of AD (BERLANGA-ACOSTA et al., 2020). Resistance exercise has emerged as a promising non-pharmacological intervention capable of improving insulin sensitivity, reducing neuroinflammation, and promoting beneficial neurobiological adaptations (AMERICAN COLLEGE OF SPORTS MEDICINE, 2019). However, the specific influence of exercise on insulin sensitivity in patients with AD requires further investigation. Objective: This study aimed to evaluate the impact of resistance exercise on insulin sensitivity in individuals with Alzheimer’s Disease through a systematic review of Randomized Controlled Trials (RCTs). Methods: The review followed the PRISMA 2020 guidelines and included searches in the Embase, MEDLine/PubMed, CENTRAL, SPORTDiscus, PEDro, and Cochrane Library databases. RCTs investigating resistance exercise programs in adults with AD or related conditions were included, comparing individuals who performed exercise with those who did not, and assessing insulin sensitivity outcomes. The methodological quality of the studies was evaluated using the TESTEX scale. Results: A total of 207 studies were identified, of which only four randomized controlled trials met the inclusion criteria. The interventions involved different resistance exercise modalities applied to older adults with Alzheimer’s disease, mild cognitive impairment, or Type 2 Diabetes Mellitus associated with AD. The studies reported improvements in neurotrophic biomarkers (BDNF, IGF-1), reductions in inflammatory markers (TNF-α and IL-15), enhanced glycemic control and insulin sensitivity (particularly in studies involving functional training), as well as improvements in physical performance and cognitive function. Methodological quality varied among studies, and there was considerable heterogeneity in the exercise protocols. Conclusion: Resistance exercise shows potential as a complementary intervention in the management of Alzheimer’s Disease, with possible benefits related to insulin sensitivity. However, there is still a lack of studies directly investigating this relationship, highlighting the need for more robust clinical trials with standardized protocols.

Background: Alzheimer’s Disease (AD) is a chronic neurodegenerative condition affecting millions of people worldwide and represents the leading cause of dementia in individuals over 60 years of age (ALZHEIMER’S ASSOCIATION, 2022). Recent evidence suggests a significant association between insulin metabolic dysregulation and the development of AD (BERLANGA-ACOSTA et al., 2020). Resistance exercise has emerged as a promising non-pharmacological intervention capable of improving insulin sensitivity, reducing neuroinflammation, and promoting beneficial neurobiological adaptations (AMERICAN COLLEGE OF SPORTS MEDICINE, 2019). However, the specific influence of exercise on insulin sensitivity in patients with AD requires further investigation. Objective: This study aimed to evaluate the impact of resistance exercise on insulin sensitivity in individuals with Alzheimer’s Disease through a systematic review of Randomized Controlled Trials (RCTs). Methods: The review followed the PRISMA 2020 guidelines and included searches in the Embase, MEDLine/PubMed, CENTRAL, SPORTDiscus, PEDro, and Cochrane Library databases. RCTs investigating resistance exercise programs in adults with AD or related conditions were included, comparing individuals who performed exercise with those who did not, and assessing insulin sensitivity outcomes. The methodological quality of the studies was evaluated using the TESTEX scale. Results: A total of 207 studies were identified, of which only four randomized controlled trials met the inclusion criteria. The interventions involved different resistance exercise modalities applied to older adults with Alzheimer’s disease, mild cognitive impairment, or Type 2 Diabetes Mellitus associated with AD. The studies reported improvements in neurotrophic biomarkers (BDNF, IGF-1), reductions in inflammatory markers (TNF-α and IL-15), enhanced glycemic control and insulin sensitivity (particularly in studies involving functional training), as well as improvements in physical performance and cognitive function. Methodological quality varied among studies, and there was considerable heterogeneity in the exercise protocols. Conclusion: Resistance exercise shows potential as a complementary intervention in the management of Alzheimer’s Disease, with possible benefits related to insulin sensitivity. However, there is still a lack of studies directly investigating this relationship, highlighting the need for more robust clinical trials with standardized protocols.