Análise do feedforward, eletromiografia e força muscular em voluntários do grupo de risco para covid-19 submetidos a um protocolo de exercícios domiciliares: ensaio clínico randomizado, controlado, cross over

Abstract

Introduction: Diabetes Mellitus (DM) is a serious metabolic disorder that leads to chronic hyperglycemia, a pathogenic condition that may include defects in insulin secretion and/or action. Type 2 DM (DM2) can induce neuropathy and a consequent reduction in muscle strength. This study was divided into four stages. In the first stage, the aim was to apply the Diabetes Self-Care Activities Questionnaire (QAD) to volunteers with DM2 during the Covid-19 pandemic; in the second stage, an instrument was proposed to measure the isometric strength of the flexor muscles of the toes individually using a specific isometric dynamometer that is easy to reproduce and has low cost; in the third stage, the objective was to compare the results of thermography, oximetry and baropodometry of the feet before and after an exercise program for the intrinsic muscles of the feet in volunteers with DM2; and in the fourth stage, the objective was to evaluate the effects of two home strengthening exercise protocols for the feet on neuropathic symptoms and self-care activities in DM2, evaluate the motor response time using PhysioPlay and evaluate the strength of the flexor muscle brevis of the fingers through electromyography and dynamometry of both feet of volunteers with DM2. Method: 109 volunteers with a previous diagnosis of DM2 were randomized into two groups: Control (CG) and Intervention (IG). Both performed two home exercise protocols for 30 minutes three times a week to strengthen the intrinsic muscles of the feet, being evaluated before and after each protocol. There was a twomonth washout period, after which the interventions were reallocated in a cross-over manner. Results: The QAD showed significant changes in the GI; in the proposed instrument, the results demonstrated excellent ICC in all fingers; there was a statistical difference in some thermography parameters, mainly in the GI; oximetry showed an increase in the left third and fourth fingers in the CG and a decrease in the right first and fourth fingers in the GI; in baropodometry, there was an increase in the mean pressure in both feet in both groups with eyes open, the maximum pressure with eyes closed decreased in the right foot in the GI, the stabilometric data showed a statistical difference in most parameters in both groups; the ESN showed mild symptoms that decreased after exercise in both groups; in the ECN there was an increase in the GI score; in the motor response time of the CG with eyes open there was a decrease in the time for abduction of the right hip at 10° and an increase at 20°, with eyes closed there was a decrease in the left hip at 10°, in the GI there was an increase in the hip directly at 10°; electromyography did not show significant results; in dynamometry, the strength of the finger flexor muscles increased in the CG in the right hallux and fourth toe and in the left second, third and fourth toes and in the IG it increased in the right second, fourth and fifth toes and in the left second, third and fourth toes. Conclusion: The findings meet the objective of the study, showing that exercises to strengthen the intrinsic muscles of the toes were a key factor in changing the parameters evaluated. We can see that small changes in the care routine of diabetic volunteers are essential for improving coping with the disease and preventing associated injuries.