Clinical profile and outcomes of diabetic and nondiabetic patients in cardiac rehabilitation

Hindman, Lisa; Falko, James M.; Lalonde, Michelle; Snow, Richard; Caulin–Glaser, Teresa

doi:10.1016/j.ahj.2005.04.002

Cited by 28 publications

(45 citation statements)

References 13 publications

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“…Moreover, the mean training volume and training response in exercise capacity in the current study did not differ between diabetic and nondiabetic patients during the exercise training program. Similar to our results, Banzer et al (30) and Hindman et al (31) showed that exercise capacity improved equally in patients with and without T2D after a cardiac rehabilitation that included supervised exercise training.…”

Section: Adherence To Exercise Trainingsupporting

confidence: 81%

“…Statistically significant but small improvements were seen in exercise capacity in CAD patients both with and without T2D. However, exercise capacity increased an average of ,5%, whereas in previous studies, the improvement in exercise capacity or CV fitness has varied from 14 to even 40% during exercise-based cardiac rehabilitation (29)(30)(31)(32). In our study, the patients had an average of about one MET higher exercise capacity at the baseline in comparison with the patients in previous studies.…”

Section: Effects Of Exercise Training On the CV Risk Profilecontrasting

confidence: 44%

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Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Karjalainen

Kiviniemi²,

Hautala³

et al. 2015

Diabetes Care

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OBJECTIVELeisure-time physical activity (LTPA) and exercise training are essential parts of current guidelines for patients with coronary artery disease (CAD). However, the contributions of LTPA and exercise training to cardiovascular (CV) risk in CAD patients with type 2 diabetes (T2D) are not well established. RESEARCH DESIGN AND METHODSWe examined the effects of LTPA (n = 539 and n = 507; with and without T2D, respectively) and 2-year controlled, home-based exercise training (n = 63 plus 64 control subjects with T2D and n = 72 plus 68 control subjects without T2D) on the CV risk profile and composite end point among CAD patients. RESULTSDuring the 2-year follow-up, patients with reduced LTPA at baseline had an increased risk of CV events (adjusted hazard ratio 2.3 [95% CI 1.1-5.1; P = 0.033], 2.1 [1.1-4.2; P = 0.027], and 2.0 [1.0-3.9; P = 0.044] for no LTPA, LTPA irregularly, and LTPA two to three times weekly, respectively) compared with those with LTPA more than three times weekly. Among patients who completed the 2-year exercise intervention, exercise training resulted in favorable changes in exercise capacity both in CAD patients with T2D (+0.2 6 0.8 vs. 20.1 6 0.8 MET, P = 0.030) and without T2D (+0.3 6 0.7 vs. 20.1 6 0.5 MET, P = 0.002) as compared with the control group but did not have any significant effects on major metabolic or autonomic nervous system risk factors in CAD patients with or without T2D. CONCLUSIONSThere is an inverse association between habitual LTPA and short-term CV outcome, but controlled, home-based exercise training has only minor effects on the CV risk profile in CAD patients with T2D.Physical activity and exercise training with well-known health benefits are key elements in the management of coronary artery disease (CAD) (1,2) and type 2 diabetes (T2D) (3). Although current guidelines for patients with CAD or T2D recommend physical activity daily, many patients do not become or remain regularly active (4-6). Almost half of patients with CAD do not attend recommended rehabilitation programs (7), and among attending patients, the dropout rate is even

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Section: Adherence To Exercise Trainingsupporting

confidence: 81%

Section: Effects Of Exercise Training On the CV Risk Profilecontrasting

confidence: 44%

Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Karjalainen

Kiviniemi²,

Hautala³

et al. 2015

Diabetes Care

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“…The effect of cardiac aerobic rehabilitation in DM patients was studied only in a few studies and with controversial results, depending on the duration of rehabilitation program and followed parameters (Milani and Lavie 1996;Verges et al 2004;Hindman et al 2005;Banzer et al 2007). Data similar to our results were reported by Milani and Lavie (1996): they observed significant improvement in exercise capacity after completion of 3 month of standard aerobic cardiac rehabilitation both in patients with type 2 DM (38% improvement degree) and those without type 2 DM (34%).…”

Section: Discussionmentioning

confidence: 99%

“…The study of Banzer et al (2004) confirmed previous results by Milani and Lavie (1996): the diabetic patients achieved nearly the same, significant improvement in exercise capacity (increase by 26%) as non-diabetic patients (27%); it is also in agreement with our results. Hindman et al (2005) assessed the effectiveness of cardiac rehabilitation program with aerobic exercise in diabetic and non-diabetic patients after myocardial infarction and/or revascularization therapy. After the completion of rehabilitation, the exercise capacity in DM patients improved by 26.3% without significant decrease in BMI.…”

Section: Discussionmentioning

confidence: 99%

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Benefit of Combined Cardiac Rehabilitation on Exercise Capacity and Cardiovascular Parameters in Patients with Type 2 Diabetes

Svačinová

Novàkovâ

Placheta

et al. 2008

Tohoku J. Exp. Med.

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Favorable effects of exercise training on cardiovascular prognosis have been reported repeatedly in patients with diabetes mellitus type 2 (DM2). However, little is known about the cardiovascular rehabilitation effects in diabetic patients with coronary artery disease (CAD). This study has evaluated the benefits of combined aerobic-resistance training in two groups of patients -diabetics and non-diabetics -after percutaneous coronary intervention (PCI). Changes in exercise capacity parameters, resting cardiovascular and anthropometrical parameters were evaluated in 77 patients who completed 12-weeks of combined aerobic-resistance training: 32 patients with DM2 (DM) and 45 patients without DM2 (NDM). Significant improvements in exercise capacity (total peak workload [W peak ], peak workload per kg of body weight [W peak /kg], total peak oxygen uptake [V O 2peak ], peak oxygen uptake per kg of body weight [V O 2peak /kg]) were found in both DM and NDM ( p < 0.01 and p < 0.001, respectively). The decrease in resting heart rate (HR rest ), resting systolic (SBP rest ) resting diastolic (DBP rest ) blood pressures, body weight (BW) and BMI in the DM group was not statistically significant. However, there was a statistically significant decrease in SBP rest , BW and BMI in the NDM group. In conclusion, this study demonstrated similar beneficial effects of combined cardiovascular training on exercise capacity in patients with or without type 2 diabetes mellitus. Our results suggest that the combined cardiac training is well tolerated and useful in secondary prevention in patients with DM2 and CAD. type 2 diabetes mellitus; cardiac rehabilitation; aerobic-resistance training; exercise capacity. Coronary artery disease (CAD) in patients with type 2 diabetes mellitus (DM2) is the major cause of mortality and morbidity (Donahue and Orchard 1992;Haffner et al. 1998;Laakso 1999;Hu et al. 2005) in Western countries. These patients have 2 to 4 times higher risk of cardiovascular diseases as compared with individuals without diabetes mellitus. Moreover, the progno-

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Effects of Cardiac Rehabilitation in Diabetic Patients: Both Cardiac and Noncardiac Factors Determine Improvement in Exercise Capacity

Clair

Mehta

Sacrinty

et al. 2014

Clinical Cardiology

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Background Diabetic patients have a worse prognosis than nondiabetic patients after myocardial infarction. Although exercise improves risk factors, exercise capacity, and mortality, it is still unclear if these benefits are the same as in nondiabetics. Furthermore, although exercise tolerance is predicted by systolic and diastolic dysfunction in nondiabetics, its role as a predictor of exercise capacity in diabetics remains unclear. Hypothesis Diabetics and nondiabetics see a similar improvement in their cardiac risk factors and exercise parameters from exercise‐based cardiac rehabilitation (CR). Methods A series of 370 diabetics and 942 nondiabetics entered a 36‐session outpatient CR program after interventions for coronary heart disease or after bypass or cardiac valve surgery. The program consisted of physical exercise, lifestyle modification, and pharmacotherapy. Results Quality of life, weight, blood pressure, and lipid profiles improved significantly in both groups during the 12‐week program. Baseline metabolic equivalents (METs) were lower in diabetics vs nondiabetics at the start of CR (2.4 vs 2.7, P < 0.001). Although both groups increased their exercise capacity, diabetics had less improvement (change in METs 1.7 vs 2.6, P < 0.001). Significant predictors for improvement after CR included age, sex, and weight, as well as both systolic and diastolic function. After adjustment for these, diabetes remained a significant predictor of reduced improvement in exercise capacity. Conclusions Diabetics saw a significant benefit in quality of life, weight, exercise tolerance, and cardiac risk factors, but to a lesser extent when compared with nondiabetics. The mechanisms for poorer improvement in diabetics following CR also include noncardiac factors and require further study.

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Clinical profile and outcomes of diabetic and nondiabetic patients in cardiac rehabilitation

Cited by 28 publications

References 13 publications

Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Benefit of Combined Cardiac Rehabilitation on Exercise Capacity and Cardiovascular Parameters in Patients with Type 2 Diabetes

Effects of Cardiac Rehabilitation in Diabetic Patients: Both Cardiac and Noncardiac Factors Determine Improvement in Exercise Capacity

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