Effect of Long-Term Endurance and Strength Training on Metabolic Control and Arterial Elasticity in Patients With Type 2 Diabetes Mellitus

Loimaala, Antti; Groundstroem, Kaj; Rinne, Marjo; Nenonen, Arja; Huhtala, Heini; Parkkari, Jari; Vuori, Ilkka

doi:10.1016/j.amjcard.2008.12.026

Cited by 73 publications

(92 citation statements)

References 28 publications

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“…15 We observed no reduction in aortic stiffness suggesting limited plasticity in diabetic vasculature. One study 16 reported no change in SBP or aortic stiffness among men with diabetes, but who were not necessarily hypertensive, after 2 years of exercise training. It is possible that adverse vascular changes in persons with diabetes 17 reflects end organ damage that cannot be reversed with exercise alone.…”

Section: Discussionmentioning

confidence: 99%

Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial

et al. 2012

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BACKGROUND: Increased blood pressure (BP) in type 2 diabetes (T2DM) markedly increases cardiovascular disease morbidity and mortality risk compared to having increased BP alone. OBJECTIVE: To investigate whether exercise reduces suboptimal levels of untreated suboptimal BP or treated hypertension. DESIGN: Prospective, randomized controlled trial for 6 months. SETTING: Single center in Baltimore, MD, USA. PATIENTS: 140 participants with T2DM not requiring insulin and untreated SBP of 120-159 or DBP of 85-99 mmHg, or, if being treated for hypertension, any SBP <159 mmHg or DBP<99 mmHg; 114 completed the study. INTERVENTION: Supervised exercise, 3 times per week for 6 months compared with general advice about physical activity. MEASUREMENTS: Resting SBP and DBP (primary outcome); diabetes status, arterial stiffness assessed as carotid-femoral pulse-wave velocity (PWV), body composition and fitness (secondary outcomes). RESULTS: Overall baseline BP was 126.8±13.5 / 71.7 ± 9.0 mmHg, with no group differences. At 6 months, BP was unchanged from baseline in either group, BP 125.8±13.2 / 70.7±8.8 mmHg in controls; and 126.0 ± 14.2 / 70.3 ± 9.0 mmHg in exercisers, despite attaining a training effects as evidenced by increased aerobic and strength fitness and lean mass and reduced fat mass (all p<0.05), Overall baseline PWV was 959.9±333.1 cm/s, with no group difference. At 6-months, PWV did not change and was not different between group; exercisers, 923.7±319.8 cm/s, 905.5± 344.7, controls. LIMITATIONS: A completion rate of 81 %. CONCLUSIONS: Though exercisers improve fitness and body composition, there were no reductions in BP. The lack of change in arterial stiffness suggests a resistance to exercise-induced BP reduction in persons with T2DM.KEY WORDS: exercise training; diabetes; high blood pressure; randomized trial.

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Section: Discussionmentioning

confidence: 99%

Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial

et al. 2012

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“…Ciolac et al reported that PWV in hypertensive patients decreased because of the reduction of SBP after aerobic interval training, whereas no significant reduction in PWV was observed after low-intensity continuous exercise training (Ciolac et al 2010). In addition, the effect of exercise training on PWV in the diabetic population is equivocal, and variously reported as being ameliorated (Madden et al 2009) or unchanged (Loimaala et al 2009). The different results among the studies may be explained by differences in exercise mode and status of the subjects.…”

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confidence: 99%

Duration of Exercise as a Key Determinant of Improvement in Insulin Sensitivity in Type 2 Diabetes Patients

Zhang

Guo

et al. 2012

Tohoku J. Exp. Med.

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Exercise duration and intensity are important parameters in exercise prescription and play a major role in improving insulin sensitivity (including transient and persistent improvement effects following cessation of training) in patients with type 2 diabetes mellitus (T2DM). However, whether duration or intensity of exercise is the more important factor has yet to be established. Therefore, we aimed to determine whether exercise prescriptions differing in duration and intensity differ in their ability to aid T2DM patients to retain insulin sensitivity following the conclusion of a period of training. Sedentary T2DM patients (age 51.2 ± 1.3 years) were assigned to either a low-intensity (50% V 4 O 2peak , n = 27) or a high-intensity exercise group (75% V 4 O 2peak , n = 28), and followed a 12-week exercise program of 5 sessions/week and 240 kcal/session. Insulin sensitivity (oral glucose tolerance test, ISI) was measured when subjects were sedentary and at 16-24 h and 15 days after the final training bout. The low-intensity group spent more training time to training per exercise session than the high-intensity group (56.1 ± 3.0 min/session vs. 34.3 ± 2.4 min/ session) (P < 0.01), but the total amount of energy expended was the same. ISI was increased in both groups 16-24 h after the final training session, but only the low-intensity group still had elevated ISI 15 days after the cessation of training. These findings suggest that in T2DM patients, the persistent traininginduced improvements in insulin sensitivity may be more dependent on exercise duration than exercise intensity in regimens with the same level of energy expenditure.

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“…A 3-month study with 36 elderly diabetic patients randomized to aerobic or anaerobic exercise showed a reduction in arterial stiffness in the aerobic group, 8 whereas another study with 50 patients randomized to exercise training or standard treatment did not show any change in aortic stiffness after a 24-month program. 7 The observed independent association between high fitness and a better ABPM profile, particularly during the nighttime period, identifies patients with a better cardiovascular risk profile. Nighttime BP levels and dipping pattern consistently have been demonstrated to predict better cardiovascular prognosis than office and daytime BPs in population-based studies 3 and in hypertensive individuals.…”

Section: Discussionmentioning

confidence: 98%

“…Besides, under debate is whether diabetic patients with lower fitness have increased aortic stiffness and, more importantly, whether physical activity can reduce arterial stiffness. 7,8 Regarding C-reactive protein, some studies on type 2 diabetes reported associations with exercise capacity 9,10 and a reduction in C-reactive protein levels after a program of physical training. 11,12 The aim of this study was to investigate the independent relationships between exercise capacity (evaluated by a self-reported questionnaire and, for a sub-sample of patients, by a standard treadmill test) and ambulatory BP monitoring data, aortic pulse wave velocity (PWV; which reflects arterial stiffness) and C-reactive protein, over and above other known conditions that negatively impact physical activity (such as the presence of chronic degenerative complications, obesity, arterial hypertension and left ventricular diastolic dysfunction).…”

Section: Introductionmentioning

confidence: 99%

High fitness is associated with a better cardiovascular risk profile in patients with type 2 diabetes mellitus

et al. 2011

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Novel cardiovascular risk markers, such as ambulatory blood pressure (BP) and aortic stiffness, have been proposed. The aim of this study was to investigate the relationship between physical fitness and some of these risk markers in 575 type 2 diabetic patients. In a cross-sectional design, clinical, laboratory, echocardiographic, aortic pulse wave velocity and 24-h ambulatory BP monitoring data were obtained. Fitness was self-reported using a standard questionnaire of daily activities, and then assessed as belonging to one of the three categories: low (o4 metabolic equivalents (METs)), moderate (X4 to o7 METs) and high fitness (X7 METs). In a random sub-sample of 265 patients, self-reported fitness was confirmed by a standard treadmill test. Statistical analysis was carried out, using tests including bivariate tests among the three categories and multivariate logistic regression. Agreement between self-reported and measured fitness was substantial (weighted j: 0.63). High fitness patients were younger, frequently male, had a decreased prevalence of degenerative complications, lower office and ambulatory BP levels, particularly during the night and had an increased prevalence of the normal nocturnal dipping pattern. High fitness patients also had lower hemoglobin A1c and C-reactive protein levels, a decreased prevalence of left ventricular hypertrophy and increased aortic stiffness. On multiple logistic regression, after adjustments for several confounders, high fitness was independently associated with a higher likelihood of having low C-reactive protein (odds ratio (OR): 2.3, 95% confidence interval (CI): 1.3-3.9), controlled nighttime BP (OR: 2.3, 95% CI: 1.4-3.8), normal dipping pattern (OR: 2.1, 95% CI: 1.2-3.5) and low aortic stiffness (OR: 2.5, 95% CI: 1.3-4.8). Patients with moderate fitness had intermediate OR. In conclusion, a moderate to high level of physical fitness was independently associated with several favorable intermediate cardiovascular risk markers, which may contribute to decreasing the burden of morbi-mortality in patients with type 2 diabetes. Hypertension Research (2011) 34, 856-861; doi:10.1038/hr.2011; published online 12 May 2011Keywords: ambulatory blood pressure; aortic stiffness; cardiorespiratory fitness; C-reactive protein; type 2 diabetes INTRODUCTION Studies in type 2 diabetic patients have found that high levels of aerobic fitness are associated with lower levels of overall mortality and mortality due to cardiovascular events, independent of traditional cardiovascular risk factors. 1,2 However, the relationship between cardiorespiratory fitness and some recently described non-traditional cardiovascular risk factors, such as ambulatory blood pressures (BPs), aortic stiffness and C-reactive protein, has not been as well characterized for type 2 diabetic patients. Whether these factors contribute independently to low fitness or merely reflect more advanced cardiovascular complications is unknown.Compared with office BPs, ambulatory BPs are stronger cardiovascular risk predictors...

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Effect of Long-Term Endurance and Strength Training on Metabolic Control and Arterial Elasticity in Patients With Type 2 Diabetes Mellitus

Cited by 73 publications

References 28 publications

Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial

Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial

Duration of Exercise as a Key Determinant of Improvement in Insulin Sensitivity in Type 2 Diabetes Patients

High fitness is associated with a better cardiovascular risk profile in patients with type 2 diabetes mellitus

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