Autonomic influence on cardiovascular performance in diabetic subjects

Roy, Thomas M.; Peterson, Hugh R.; Snider, Harvy L.; Cyrus, Jahangir; Broadstone, Vasti L.; Fell, R. D.; Rothchild, Armand H.; Samols, Elus; Pfeifer, Michael

doi:10.1016/s0002-9343(89)80818-6

Cited by 97 publications

(48 citation statements)

References 29 publications

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“…It has also been hypothesized that the lower VO 2max might be a consequence of a reduced rate of circulatory adjustments to an increased workload (i.e. cardiac output) [8,65], or poor diffusion and utilization of oxygen at the level of skeletal muscle [12]. Despite this, our present analysis suggests that people with Type 2 diabetes respond to exercise training with similar increases in VO 2max as those reported in older healthy adults [66].…”

Section: Discussionsupporting

confidence: 45%

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

et al. 2003

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Aims/hypothesis. Low cardiorespiratory fitness is a powerful and independent predictor of mortality in people with diabetes. Several studies have examined the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals. However, these studies had relatively small sample sizes and highly variable results. Therefore the aim of this study was to systematically review and quantify the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals. Methods. MEDLINE, EMBASE, and four other databases were searched up to March 2002 for randomized, controlled trials evaluating effects of structured aerobic exercise interventions of 8 weeks or more on cardiorespiratory fitness in adults with Type 2 diabetes. Cardiorespiratory fitness was defined as maximal oxygen uptake (VO 2max ) during a maximal exercise test.Results. Seven studies, presenting data for nine randomized trials comparing exercise and control groups (overall n=266), met the inclusion criteria. Mean exercise characteristics were as follows: 3.4 sessions per week, 49 min per session for 20 weeks. Exercise intensity ranged from 50% to 75% of VO 2max . There was an 11.8% increase in VO 2max in the exercise group and a 1.0% decrease in the control group (post intervention standardized mean difference =0.53, p<0.003). Studies with higher exercise intensities tended to produce larger improvements in VO 2max . Exercise intensity predicted post-intervention weighted mean difference in HbA 1c (r=−0.91, p=0.002 Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus N. G. Boulé 1 , G. P. Kenny 1 , E. Haddad 2 , G. A. Wells 3, 4 , R. J. Sigal 1, 3 1 School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada 2 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada 3 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada 4 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada pacities of athletes. In recent decades, VO 2max has had a growing importance in clinical settings and has become the gold standard measure of cardiovascular fitness and exercise capacity [1]. There is evidence from large cohort studies that low cardiorespiratory fitness is a powerful and independent predictor of long-term cardiac mortality in people with diabetes [2,3,4], even after controlling for traditional risk factors such as age, hypercholesterolaemia, smoking, and hypertension and excluding individuals with evidence of coronary ischaemia during testing. Furthermore, in non-diabetic subjects undergoing repeated maximalThe maximal amount of oxygen consumed during exercise (VO 2max ) has been used for decades by exercise physiologists to determine the maximum exercise ca-

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Section: Discussionsupporting

confidence: 45%

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

et al. 2003

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“…The association of heart rate recovery with vagal tone leads to T2DM being associated with poor heart rate recovery and chronotropic incompetence 30. Cardiac autonomic dysfunction is associated with reduced cardiac output response to functional capacity in diabetes, which is probably due to haemodynamic instability during exercise 31. Left atrial (LA) dysfunction is also common in patients with HF with preserved EF and asymptomatic T2DM and contributes to exercise intolerance.…”

Section: Discussionmentioning

confidence: 99%

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Wang¹,

Yang²,

Nolan³

et al. 2018

ESC Heart Failure

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AimsPatients with heart failure (HF) risk factors are described as being in Stage A of this condition (SAHF). Management is directed towards prevention of HF progression, but to date, no evidence has been described to align the intensity of this intervention to HF risk. We sought to what extent SAHF of Type 2 diabetes mellitus (T2DM) and other HF risks showed differences in subclinical left ventricular function, exercise capacity, and prognosis.Methods and resultsWe recruited 551 elder asymptomatic SAHF patients (age 71 ± 5 years, 49% men, 290 T2DM) with at least one risk factor from a community‐based population with preserved ejection fraction. All underwent a comprehensive echocardiogram including global longitudinal strain (GLS) and a 6 min walk test and were followed for 2 years. The primary endpoints were new‐onset HF and all‐cause mortality. The T2DM group was associated with reduced 6 min walk test distance (451 ± 111 vs. 493 ± 87 m, P < 0.001), worse diastolic function (E/e′ 9.2 ± 2.7 vs. 8.7 ± 2.4, P = 0.028), and impaired GLS (−17.7 ± 2.6% vs. −19.0 ± 2.6%, P < 0.001). Over a median follow‐up of 1.6 years, 49 T2DM‐SAHF and 27 other‐SAHF met the primary endpoint. T2DM‐SAHF had significantly worse outcome than other‐SAHF (P = 0.021). In Cox models, obesity [hazard ratio (HR) = 2.46; P = 0.007], atrial fibrillation (HR = 2.39; P = 0.028), 6 min walk distance (HR = 0.99; P = 0.034), and GLS (HR = 1.14; P = 0.033) were independently associated with the primary endpoint in T2DM‐SAHF, independent of age and glycaemic control.ConclusionsThe T2DM‐SAHF has worse subclinical left ventricular function, exercise capacity, and prognosis than other‐SAHF. Impaired GLS, atrial fibrillation, exercise capacity, and obesity are associated with a worse prognosis in T2DM‐SAHF but not in other‐SAHF.

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“…Patients with high parasympathetic activation usually have low resting heart rate and baseline oxygen consumption and may achieve high workload for a certain level of oxygen consumption. Abnormal cardiac autonomic function has been associated with poor cardiac output responses to exercise in diabetes (29), probably due to abnormal hemodynamic regulation during exercise. In addition, an indirect link between cardiac autonomic dysfunction and impaired exercise capacity is demonstrated by associations of cardiac autonomic dysfunction with insulin resistance (30) or poor glycemic control (as in the current study) and impaired resting left ventricular diastolic filling (31).…”

Section: Exercise Capacity and Autonomic Cardiac Functionmentioning

confidence: 99%

Determinants of Exercise Capacity in Patients With Type 2 Diabetes

et al. 2005

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OBJECTIVE -Type 2 diabetes is associated with reduced exercise capacity, but the cause of this association is unclear. We sought the associations of impaired exercise capacity in type 2 diabetes. RESEARCH DESIGN AND METHODS -Subclinical left ventricular (LV) dysfunctionwas sought from myocardial strain rate and the basal segmental diastolic velocity (Em) of each wall in 170 patients with type 2 diabetes (aged 56 Ϯ 10 years, 91 men), good quality echocardiographic images, and negative exercise echocardiograms. The same measurements were made in 56 control subjects (aged 53 Ϯ 10 years, 29 men). Exercise capacity was calculated in metabolic equivalents, and heart rate recovery (HRR) was measured as the heart rate difference between peak and 1 min after exercise. In subjects with type 2 diabetes, exercise capacity was correlated with clinical, therapeutic, biochemical, and echocardiographic variables, and significant independent associations were sought using a multiple linear regression model. RESULTS -Exercise capacity, strain rate, Em, and HRR were significantly reduced in type 2 diabetes. Exercise capacity was associated with age (r ϭ Ϫ0.37, P Ͻ 0.001), male sex (r ϭ 0.26, P ϭ 0.001), BMI (r ϭ Ϫ0.19, P ϭ 0.012), HbA 1c (A1C; r ϭ Ϫ0.22, P ϭ 0.009), Em (r ϭ 0.43, P Ͻ 0.001), HRR (r ϭ 0.42, P Ͻ 0.001), diabetes duration (r ϭ Ϫ0.18, P ϭ 0.021), and hypertension history (r ϭ Ϫ0.28, P Ͻ 0.001). Age (P Ͻ 0.001), male sex (P ϭ 0.007), BMI (P ϭ 0.001), Em (P ϭ 0.032), HRR (P ϭ 0.013), and A1C (P ϭ 0.0007) were independent predictors of exercise capacity.CONCLUSIONS -Reduced exercise capacity in patients with type 2 diabetes is associated with diabetes control, subclinical LV dysfunction, and impaired HRR. Diabetes Care 28:1643-1648, 2005C linical and observational studies have shown that exercise capacity is a strong predictor of cardiovascular and overall mortality (1). Patients with type 2 diabetes often complain of fatigue and reduced exercise capacity. Although these symptoms may be related to other disease conditions, such as hypertensive left ventricular (LV) hypertrophy or coronary artery disease, the presence of diabetes may independently contribute to the impaired exercise capacity (2).The causes of reduced exercise capacity in type 2 diabetes are unknown. Overt LV diastolic dysfunction, evidenced by abnormal transmitral flow, has been associated with impaired functional capacity in uncomplicated well-controlled type 2 diabetes (2). However, primary myocardial disease may be present in many patients with type 2 diabetes, without overt systolic or diastolic dysfunction, independent of LV hypertrophy and coronary artery disease (3). Cardiac autonomic dysfunction may play an important role in the development of diabetic heart disease (3). Reduced heart rate recovery (HRR) immediately after exercise is an important indicator of cardiac autonomic dysfunction and contributes to cardiovascular morbidity and mortality in other diseases (4,5). In this study, we sought the extent to which diabetes control, impaired HRR, a...

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Autonomic influence on cardiovascular performance in diabetic subjects

Cited by 97 publications

References 29 publications

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Determinants of Exercise Capacity in Patients With Type 2 Diabetes

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