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El ejercicio influye positivamente mejorando el control glucémico y el PL. Para los pacientes con diabetes y masa corporal inadecuada, se prefieren actividades de intensidad baja o moderada 3-5 veces a la semana (150-300 min/semana).35 La American Diabetes Association (ADA) destaca la importancia de alcanzar los objetivos de concentración de lípidos y valor glucémico. Muchos pacientes con DM2 y sobrepeso u obesidad necesitan perder el 5 % de la masa corporal.36 Además, según la ADA, la dieta mediterránea influye positivamente en los resultados lipídicos. El control del lipidograma, correlacionado con un aumento del ejercicio, también permite reducir los factores de riesgo de ECV en los pacientes con diabetes.37 Además, según la ESC, incluso un pequeño cambio como añadir 1000 pasos al día tiene consecuencias positivas para la salud de numerosos pacientes.38
Dado que la definición de ejercicio es muy laxa, han aparecido preguntas sobre qué tipo de actividad es preferible para generar cambios positivos en cuanto al PL y el riesgo de ECV. Las investigaciones han demostrado que hacer ejercicio ≥150 min/semana se asocia a unas concentraciones objetivo variables de TG y C-HDL.39 En el artículo se describieron ambos mecanismos del EA y el EAN. Se recomienda realizar ejercicios de intensidad moderada, intensidad alta o combinar ambos aeróbicos.40 Un metaanálisis de 2001 demostró que el efecto más común del EA es el aumento del C-HDL, mientras que la reducción de las concentraciones de C-LDL, CT y TG no es tan frecuente.41 También se ha demostrado que el EA influye más beneficiosamente en la concentración de HDL que el EAN.24 Por otro lado, se ha estudiado la influencia de los ejercicios de fuerza (resistencia) de distinta intensidad. Las conclusiones han sido que los ejercicios de intensidad baja y moderada (≤75 % del máximo de cada repetición) son más beneficiosos para el PL que los de intensidad alta, con un volumen total de ejercicios equilibrado (serie × repeticiones × carga) en los grupos estudiados.42 Otro estudio abordó los métodos de entrenamiento combinados, y demostró —que para reducir la concentración de C-LDL— son preferibles la integración y el EA.43
El EA preferido por el paciente, de intensidad baja o moderada, debería servir para reducir el riesgo de ECV y de mortalidad asociada a ella gracias a su influencia beneficiosa en el perfil lipídico. Esta afirmación concuerda con las recomendaciones de la OMS, según las cuales los adultos deben hacer ejercicio, por lo menos de intensidad moderada, durante 150 minutos a la semana.44
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