The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review

Abstract

Background: Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN. Methods: The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review. Results: Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes. Conclusions: Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.

Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II

“…It is a nonspecific predictor of mortality which reflects central-autonomic moment-to-moment adaption of somatic responses and emotional appraisal to maintain homeostasis and adapt to environmental stimuli [ 42 ]. In the context of diabetes, detection of a low HRV through measures such as MCR should prompt consideration of improved lifestyle factors including exercise [ 43 ].…”

Sympathetic Overactivity and Parasympathetic Impairment in Type 2 Diabetes: An Analysis of Cardiovascular Autonomic Functions

“…The autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. The sympathetic nervous system responds to stress by accelerating HR and raising BP, whereas the parasympathetic nervous system helps the body rest and digest, slowing down the HR [ 3 ]. Dysregulation in these systems can lead to various cardiovascular issues, including decreased heart rate variability (HRV) and orthostatic hypotension.…”

Exercise Effects on Autonomic Nervous System Activity in Type 2 Diabetes Mellitus Patients over Time: A Meta-Regression Study

“…A systematic review reported that T2DM was associated with a decrease in parasympathetic activity, as indicated by RMSSD, while findings regarding sympathetic activity, as indicated by the LF/HF ratio, were inconclusive [7]. A previous systematic review reported that exercise, encompassing aerobic exercise combined with resistance training, high-intensity interval training, and progressive resistance training, had a positive impact on cardiac autonomic function in individuals with T2DM [16]. Additionally, a previous systematic meta-analysis reported a lower RMSSD but no change in the LF/HF ratio in T2DM patients compared to healthy participants [7].…”