Application of an Exercise Intervention on the Evolution of Diastolic Dysfunction in Patients With Diabetes Mellitus

Abstract

Background-Diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes. We studied the impact of an exercise-based lifestyle intervention on the evolution of DD in patients with type 2 diabetes mellitus (T2DM) and prospectively investigated the clinical correlates of DD progression. Methods and Results-A total of 223 outpatients with T2DM were randomized to supervised exercise-based lifestyle intervention (initial gym-based program and lifestyle and diet advice followed by telephone-guided supervision) or usual care. Patients underwent echocardiographic assessment of diastolic function and metabolic and clinical evaluation at baseline and 3 years. Changes in prevalence and evolution of DD were assessed and correlations sought with clinical and metabolic variables. DD was present in 50% of patients at baseline and 54% at 3 years, with no difference between the usual care and intervention groups (60% versus 48%, Pϭ0.10). Abnormal DD at the final visit was independently associated with older age and a decrease in peak oxygen consumption over time (PϽ0.05). There was no impact on glycemic control or exercise capacity. In a subanalysis restricted to patients who finished the full 3-year follow-up, control subjects were independently associated with DD at 3 years (␤ϭ0.90; odds ratio, 2.46; Pϭ0.034), with the only other independent correlate being older age (␤ϭ0.05; odds ratio, 1.06; Pϭ0.019). Conclusions-Despite

A six-month exercise intervention in subclinical diabetic heart disease: Effects on exercise capacity, autonomic and myocardial function

“…This is in contrast to a trial in unselected type 2 diabetic patients, in which baroreflex sensitivity, but not heart-rate variability, was shown to improve following exercise training [8]. We also found heart-rate recovery to remain unchanged with exercise training, which was surprising given its strong association with exercise capacity [13] [14], increases in tissue velocities in patients with worse function at baseline pointed to exercise being efficacious in patients with subclinical LV dysfunction [16]. In this context,…”

“…Autonomic and LV functional responses to training may be directly related to improvements in exercise capacity [13,14]. Clinically relevant increases in peak oxygen uptake (VO 2peak ; ~12%) are typical following exercise interventions in type 2 diabetes [15], though secondary changes in LV function may not necessarily be observed [16].…”

Insulin resistance and hyperinsulinaemia in diabetic cardiomyopathy

“…For example, long-term caloric restriction in patients with obesity and/or T2DM decreased myocardial triglyceride content and improved diastolic left ventricular dysfunction 79 . Following an exercise training program, an exercise-based lifestyle intervention prevented progression of diastolic left ventricular dysfunction 80 and raised left ventricular ejection fraction by 2–5% in both the patients with obesity and those with T2DM 81,82 .…”

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“…Hence, it is likely that prevalence of diabetic cardiomyopathy is much higher than that previously thought in both types of diabetes. Furthermore, latent LV dysfunction caused by diabetes does not appear to be a trivial problem since blunted increase in systolic blood pressure/end-systolic LV volume ratio (SP/ESV) by exercise is associated with poor prognosis [61]. …”