Mechanisms of Aerobic Exercise Impairment in Diabetes: A Narrative Review

Abstract

The prevalence of diabetes in the United States and globally has been rapidly increasing over the last several decades. There are now estimated to be 30.3 million people in the United States and 422 million people worldwide with diabetes. Diabetes is associated with a greatly increased risk of cardiovascular mortality, which is the leading cause of death in adults with diabetes. While exercise training is a cornerstone of diabetes treatment, people with diabetes have well-described aerobic exercise impairments that may create an additional diabetes-specific barrier to adding regular exercise to their lifestyle. Physiologic mechanisms linked to exercise impairment in diabetes include insulin resistance, cardiac abnormalities, mitochondrial function, and the ability of the body to supply oxygen. In this paper, we highlight the abnormalities of exercise in type 2 diabetes as well as potential therapeutic approaches.

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

“…Our 12-month follow-up assessment revealed that the further improvement after end of CR was reduced in diabetic patients when compared to non-diabetic patients. The poorer long-term development of VO 2 peak in our elderly diabetic patients was also found previously [37] and may reflect the natural disease progression that is associated with reduced cardiovascular fitness [38]. The previously reported relationship between glycemic control with gain in VO 2 peak [39] was not found in the present study, however, the assessment of HbA1c may not have allowed us to assess short term changes in glycemic control.…”

Alterations in glutathione, nitric oxide and 3‑nitrotyrosine levels following exercise and/or hyperbaric oxygen treatment in mice with diet‑induced diabetes

“…During a range of pathological processes and in all tissues and organs, NO was determined to be the primary molecule linked to the regulation of vascular endothelium tissue, and exercise may correct alterations in the bioavailability of this radical. Enzymatic production of NO by endothelial nitric oxide synthase has a regulatory role in endothelial dysfunction (54) and NO participates in vascular adaptation to exercise (55,56). Therefore, the association between NO and different nitric oxide synthases in diabetic tissues requires examination.…”

Effects of Physical Exercise on the Quality of Life of Type 2 Diabetes Patients

“…A recent study has characterized many individual impairments in key cardiac and vascular measures that are associated with CRF impairment in T2D, such as insulin resistance, endothelial dysfunction, decreased myocardial perfusion with exercise, abnormally increased pulmonary capillary wedge pressure (PCWP), decreased limb blood flow, and skeletal muscle mitochondrial dysfunction [27]. Some researchers highlight that being the reasons for which these abnormalities arise, caused by several factors, makes it unlikely that a single therapeutic approach will resolve the entire problem.…”

“…Diabetes patient usually has physiologic exercise limitations and decreased cardiorespiratory fitness (CRF). More exactly, when compared with people with and without diabetes, the first ones can present 20% lower maximal oxygen uptake (VO 2 max) [27]. This can be a problem for those patients once a reduced VO 2 max is linked to increased cardiovascular mortality [34].…”