Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences

Abstract

Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant’s improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.

Cluster Analysis to Distinguish Patients Most Likely to Benefit from Outpatient Cardiac Rehabilitation—A Prospective, Multicenter Study

“…Although cardiac rehabilitation was associated with a reduction in TG in previous reports [ 27 ], TG concentration did not change significantly in our study. Similarly, although cardiac rehabilitation can improve glycaemic control in patients with diabetes [ 28 ], we did not see any change in fasting plasma glucose. Likewise, uric acid concertation, which is associated with the risk of cardiovascular diseases, did not change after cardiac rehabilitation in our study [ 29 ].…”

Effects of Caffeine Intake on Cardiopulmonary Variables and QT Interval after a Moderate-Intensity Aerobic Exercise in Healthy Adults: A Randomized Controlled Trial

“…Exercise recovery is an important measure for investigating the possibility of cardiovascular problems, including abnormal blood pressure responses, heart rate disorders, and abnormal or irregular heart rhythms. Recovery after exercise is a crucial step in sudden cardiovascular disease, usually appearing about 30 minutes immediately after intensive exercises [ 10 ]. This is due to increased sympathetic nerve activity and decreased parasympathetic nerve activity.…”

Novel Therapeutics for Type 2 Diabetes, Obesity, and Heart Failure

“…Closely monitoring individuals, particularly when first starting an exercise program or when adjustments are made to medical therapy, provides critical information to increase safety and efficacy. Detailed recommendations of how to monitor and manage patients with DM in CR have been described elsewhere 45,46. Programs need to develop the policies and procedures of how to properly respond to adverse events during CR 49.…”