Over the last 30 years the combination of both a sedentary lifestyle and excessive food availability has led to a significant increase in the prevalence of obesity and aggravation of rates of metabolic syndrome and type 2 diabetes mellitus (T2DM). Several lines of scientific evidence have been demonstrating that a low level of physical activity and decreased daily energy expenditure leads to the accumulation of visceral fat and, consequently, the activation of the oxidative stress/inflammation cascade, which underlies the development of insulin resistant T2DM and evolution of micro, and macrovascular complications. This paper focuses on the pathophysiological pathways associated with the involvement of oxidative stress and inflammation in the development of T2DM and the impact of regular physical exercise (training) as a natural antioxidant and anti-inflammatory strategy to prevent evolution of T2DM and its serious complications.

Background: Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals’ independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. Objective: To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. Methods: A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. Results: This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. Conclusions: Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability.

This study compares the effects of a single bout of exercise (acute extenuating) with those promoted by an exercise training program (chronic), focusing on low-grade chronic inflammation profile and on oxidative stress status, using the obese ZDF rats as a model of type 2 diabetes mellitus (T2DM). Animals were sacrificed after 12 weeks of a swimming training program and after a single bout of acute extenuating exercise. Glycaemic, insulinemic, and lipidic profile (triglycerides, total-cholesterol) were evaluated, as well as inflammatory (serum CRPhs, TNF-α, adiponectin) and oxidative (lipidic peroxidation and uric acid) status. When compared to obese diabetic sedentary rats, the animals submitted to acute exercise presented significantly lower values of glycaemia and insulinaemia, with inflammatory profile and oxidative stress significantly aggravated. The trained animals showed amelioration of glycaemic and lipidic dysmetabolism, accompanied by remarkable reduction of inflammatory and oxidative markers. In conclusion, the results presented herein suggessted that exercise pathogenesis-oriented interventions should not exacerbate underlying inflammatory stress associated with T2DM.

Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. Prospective observational study. Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.