The Relationship of Physical Fitness to Lipid and Lipoprotein(a) Levels in Adolescents With IDDm

Abstract

OBJECTIVE--Increased physical activity and physical fitness are recommended therapeutic modalities in addition to insulin and diet in the management of children with IDDM. The aim of this study was to assess the fitness levels of adolescents with IDDM compared with healthy control subjects and to evaluate the relationship between physical fitness and metabolic control. RESEARCH DESIGN AND METHODS--We studied 59 patients with IDDM, 28 boys and 31 girls, age 15.6 +/- 2.5 yr, duration of diabetes 7.6 +/- 3.5 yr, HbA1 10.6 +/- 2.1% (mean +/- SD), and compared them with 18 healthy, nondiabetic control subjects, 9 boys and 9 girls, matched for age, BMI, and Tanner stage. Physical fitness was measured by VO2max during progressive bicycle ergometry. HbA1 was used to determine glycemic control. Lipid profile included fasting total cholesterol, HDL, LDL, Lp(a), and TG levels. RESULTS--Patients with IDDM had lower VO2max levels than control subjects (33.7 +/- 7.0 vs. 41.0 +/- 10.4 ml.kg-1.min-1, P = 0.001). Males with IDDM had lower VO2max than male control subjects, but diabetic and control females showed no difference. In IDDM patients, VO2max correlated inversely with HbA1, insulin dose, cholesterol, LDL, TGs, and Lp(a), but did not correlate with HDL, which correlated inversely with BMI. CONCLUSIONS--We conclude that the state of physical fitness is an important correlate of lipid levels and Lp(a) in adolescents with IDDM. We speculate that higher physical fitness levels in adolescents with IDDM may decrease the risk of CVD through modulating lipid levels.

Care of Children and Adolescents With Type 1 Diabetes

“…Clinical practice guidelines for exercise in adult patients have been published by the ADA (94). Benefits of exercise in type 1 diabetes are detailed in an ADA Technical Review (95) and include a greater sense of well-being, help with weight control, improved physical fitness, and improved cardiovascular fitness, with lower pulse and blood pressure and improved lipid profile (95,96). These advantages apply to children as well as to adults, as indicated by studies demonstrating the beneficial effect of physical fitness on lipid and lipoprotein levels in adolescents (96).…”

“…Benefits of exercise in type 1 diabetes are detailed in an ADA Technical Review (95) and include a greater sense of well-being, help with weight control, improved physical fitness, and improved cardiovascular fitness, with lower pulse and blood pressure and improved lipid profile (95,96). These advantages apply to children as well as to adults, as indicated by studies demonstrating the beneficial effect of physical fitness on lipid and lipoprotein levels in adolescents (96). The effects of improved metabolic control on cardiovascular fitness is controversial, with most recent studies showing no relationship between physical fitness and A1C levels (97,98).…”

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications

“…Intervention strategies for the entire family that promote lifelong physical activity may help children overcome these adverse effects. Physical activity may also provide a lipid-lowering effect in adolescents with diabetes (503). Type 2 diabetes in youth.…”

Benefícios da atividade física no perfil lipídico de pacientes com diabetes tipo 1

“…Nossos achados são concordantes com os benefícios de um programa de exercícios de três meses, que reduziu o LDL e elevou o HDL em 10%, quando comparado aos níveis basais, dentro da primeira semana de treinamento físico (26). Também estão de acordo com o Lipid Research Clinic Prevalence Study (27), no qual níveis mais elevados de atividade física se associaram a concentrações mais altas de HDL-colesterol e com Austin e cols., que encontraram correlação negativa entre o exercício, LDLcolesterol e lipoproteína (a) em adolescentes com diabetes tipo 1 (28). Considerando que não há suporte na literatura para justificar o uso de agentes redutores de lípides para prevenção primária de ND, a melhora no perfil lipídico por medidas não-farmacológicas pode representar uma alternativa atraente para pacientes de alto risco de doença renal.…”