Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Abstract

Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.

Physical activity and long-term prognosis in patients with stable coronary artery disease: How often, how intense, and how long?

“…2,7 Exercise training ameliorates body composition, blood pressure, plasma lipid profiles, insulin sensitivity, glucose intolerance, platelet activation, number of progenitor cells, endothelial dysfunction, atherosclerotic development, collateral formation, resting heart rate, myocardial perfusion, pathological remodeling of left ventricle, wall compliance, contraction-relaxation velocity and cardiac output. 2,[7][8][9] We have previously reported an association between the percent changes in coronary plaque volume assessed using intravascular volumetric ultrasonography and physical activity in patients who participated in phase II cardiac rehabilitation after acute coronary syndrome (ACS). 10 The percent change in the plaque volume was significantly and negatively correlated with daily physical activity evaluated using a pedometer.…”

Exercise training in diabetes

“…1,2 These metabolic parameters and endothelial dysfunction are important for the development of coronary artery disease and stroke. 3 Kemps et al 4 reviewed the literature on the role of different exercise modalities for different targets in cardiovascular prevention in patients with T2DM ( Figure 1).…”

“…For other target parameters, a strategy with only aerobic endurance training (AET) or a combination of AET and resistance training is more suited. 4 Obviously, T2DM is a disease with a combination of metabolic, structural and functional consequences. The European Society of Cardiology in collaboration with the European Association for the Study of Diabetes recommend combined AET and resistance training for all T2DM patients.…”

“…For example, patients with prominent dysfunction of the autonomic regulation, the combined exercise strategy can be more focused on AET because AET is most suited to improving autonomic regulation. 4 Hansen et al 9 developed the EXPERT tool, which is an interactive training and decision support tool to optimize exercise prescription for patients with cardiovascular disease. This tool takes the presence of TD2M into account and could be a user-friendly way to determine the appropriate amount of AET and/or resistance training.…”

“…Also, 15-20% of T2DM of patients who engage in regular exercise training fail to improve their metabolic profile. 4 It is crucial to detect these non-responders and to investigate which factors cause the non-responding of these patients. Research has suggested different predictors for non-response.…”