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

Abstract

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...

Physical Fitness and Hypertension in a Population at Risk for Cardiovascular Disease: The Henry Ford ExercIse Testing (FIT) Project

“…This is in contrast to studies showing a strong relationship between fitness and incident hypertension in persons with diabetes. 9 This may reflect the fact that the maximal level of METs achieved among participants with diabetes was lower than the METs achieved among those without diabetes. This would attenuate the relationship in participants with diabetes, since METs demonstrate the strongest inverse relationship with incident hypertension at higher levels.…”

“…4 Numerous cross-sectional studies have described a relationship between reduced fitness and blood pressure or hypertension. [5][6][7][8][9] Furthermore, large cohort studies have demonstrated that low fitness precedes new-onset hypertension [10][11][12][13][14][15][16][17][18] even in normotensive populations, 19,20 and among persons with an elevated risk for hypertension. 21 Nevertheless, few studies 13 have examined the effect of demographic factors (age, sex, race) or common comorbidities (obesity, diabetes) on the association between direct measures of fitness and risk for hypertension.…”

Usefulness of exercise for home blood pressure control in people with diabetes: A study protocol for a crossover randomized controlled trial

“…Patients assigned to the exercise preceding group will be instructed to walk 30 minutes twice each day or 60 minutes once each day for at least 3 days per week from day 1 to day 28. After the follow-up visits 1 month after enrolment, patients will be instructed to perform physical activity only up to the level of daily life (<4 metabolic equivalents of task [METs]) [10] from day 29 to day 56 until the followup visits 2 months after enrollment. Patients assigned to the exercise lagging group will be instructed to perform physical activity only up to the level of daily life (<4 METs) from day 1 to day 28.…”

Possible neurocognitive benefits of exercise in persons with heart failure

“…Exercise may improve cognitive function in HF patients through other mechanisms. For example levels of C-reactive protein (CRP), normally an inflammatory cytokine associated with acute injury [ 72 ], are inversely related to amount of physical activity ([ 28 ]; [ 25 , 59 ]). Exercise is thought to reduce activation of the sympathetic nervous system, which in turn inhibits the release of inflammatory markers, including CRP [ 28 ].…”