Exercise intolerance in Type 2 diabetes: is there a cardiovascular contribution?

Poitras, Veronica J.; Hudson, Robert; Tschakovsky, Michael E.

doi:10.1152/japplphysiol.00070.2017

Cited by 36 publications

(24 citation statements)

References 123 publications

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“…Similar to what has been reported for T1DM, a reduction in blood volume has also been demonstrated for T2DM [110], and this, together with a systolic deficit, may impair cardiac preload and SV response to exercise in these patients [111].…”

Section: Cardiovascular Dysregulation In T2dmsupporting

confidence: 80%

Diabetic Cardiomyopathy and Ischemic Heart Disease: Prevention and Therapy by Exercise and Conditioning

Crisafulli

Pagliaro

Roberto

et al. 2020

IJMS

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Metabolic syndrome, diabetes, and ischemic heart disease are among the leading causes of death and disability in Western countries. Diabetic cardiomyopathy is responsible for the most severe signs and symptoms. An important strategy for reducing the incidence of cardiovascular disease is regular exercise. Remote ischemic conditioning has some similarity with exercise and can be induced by short periods of ischemia and reperfusion of a limb, and it can be performed in people who cannot exercise. There is abundant evidence that exercise is beneficial in diabetes and ischemic heart disease, but there is a need to elucidate the specific cardiovascular effects of emerging and unconventional forms of exercise in people with diabetes. In addition, remote ischemic conditioning may be considered among the options to induce beneficial effects in these patients. The characteristics and interactions of diabetes and ischemic heart disease, and the known effects of exercise and remote ischemic conditioning in the presence of metabolic syndrome and diabetes, are analyzed in this brief review.

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Section: Cardiovascular Dysregulation In T2dmsupporting

confidence: 80%

Diabetic Cardiomyopathy and Ischemic Heart Disease: Prevention and Therapy by Exercise and Conditioning

Crisafulli

Pagliaro

Roberto

et al. 2020

IJMS

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show abstract

“…This indicates that, in terms of aerobic capacity, half of the patients of the DM2 group could be already classified as in the mildmoderate stage of deterioration of functional capacity, and this supports the notion that some degree of exercise intolerance was present in patients with DM2 (46). This finding is not novel since altered exercise tolerance has been described sev-eral times in the recent past (46). We cannot provide any definitive explanation for the altered exercise capacity in patients with DM2, which was beyond the scope of the present investigation.…”

Section: Discussionmentioning

confidence: 61%

Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus

Roberto

Milia

Doneddu

et al. 2019

Journal of Applied Physiology

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Metaboreflex is a reflex triggered during exercise or postexercise muscle ischemia (PEMI) by metaboreceptor stimulation. Typical features of metaboreflex are increased cardiac output (CO) and blood pressure. Patients suffering from metabolic syndrome display hemodynamic abnormalities, with an exaggerated systemic vascular resistance (SVR) and reduced CO response during PEMI-induced metaboreflex. Whether patients with type 2 diabetes mellitus (DM2) have similar hemodynamic abnormalities is unknown. Here we contrast the hemodynamic response to PEMI in 14 patients suffering from DM2 (age 62.7 ± 8.3 yr) and in 15 age-matched controls (CTLs). All participants underwent a control exercise recovery reference test and a PEMI test to obtain the metaboreflex response. Central hemodynamics were evaluated by unbiased operator-independent impedance cardiography. Although the blood pressure response to PEMI was not significantly different between the groups, we found that the SVR and CO responses were reversed in patients with DM2 as compared with the CTLs (SVR: 392.5 ± 549.6 and −14.8 ± 258.9 dyn·s−1·cm−5; CO: −0.25 ± 0.63 and 0.46 ± 0.50 l/m, respectively, in DM2 and in CTL groups, respectively; P < 0.05 for both). Of note, stroke volume (SV) increased during PEMI in the CTL group only. Failure to increase SV and CO was the consequence of reduced venous return, impaired cardiac performance, and augmented afterload in patients with DM2. We conclude that patients with DM2 have an exaggerated vasoconstriction in response to metaboreflex activation not accompanied by a concomitant increase in heart performance. Therefore, in these patients, blood pressure response to the metaboreflex relies more on SVR increases rather than on increases in SV and CO. NEW & NOTEWORTHY The main new finding of the present investigation is that subjects with type 2 diabetes mellitus have an exaggerated vasoconstriction in response to metaboreflex activation. In these patients, blood pressure response to the metaboreflex relies more on systemic vascular resistance than on cardiac output increments.

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“…However, prior to prescribing all-extremity HIIT and MICT protocols for diabetes management, it is necessary to establish their feasibility/safety specifically in individuals with type 2 diabetes. This is essential given the known exercise intolerance (Colberg et al, 2016;Poitras et al, 2018) and increased risk of hypoglycemia in diabetes, particularly in older patients (Colberg et al, 2016;Poitras et al, 2018). Currently, there are no data on allextremity HIIT vs. MICT in type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Effect of all-extremity high-intensity interval training vs. moderate-intensity continuous training on aerobic fitness in middle-aged and older adults with type 2 diabetes: A randomized controlled trial

Hwang

Lim

Yoo

et al. 2019

Experimental Gerontology

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Aging and diabetes are associated with decreased aerobic fitness, an independent predictor of mortality. Aerobic exercise is prescribed to improve aerobic fitness; however, middle-aged/older diabetic patients often suffer from mobility limitations which restrict walking. Non-weightbearing/low-impact exercise is recommended but the optimal exercise prescription is uncertain. The goal of this randomized controlled trial was twofold: 1) to test if high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), implemented on a nonweight-bearing all-extremity ergometer, are feasible, well-tolerated and safe in middle-aged/older adults with type 2 diabetes; and 2) to test whether all-extremity HIIT is more effective in improving aerobic fitness than MICT. A total of 58 sedentary individuals with type 2 diabetes (46 to 78 years; 63±1) were randomized to all-extremity HIIT (n=23), MICT (n=19) or non-exercise control (CONT; n=16). All-extremity HIIT and MICT, performed 4×/week for 8 weeks under supervision, resulted in no adverse events requiring hospitalization or medical treatment. Aerobic fitness (VO 2peak) improved by 10% in HIIT and 8% in MICT and maximal exercise tolerance increased by 1.8 and 1.3 min, respectively (P≤0.002 vs. baseline; P≥0.9 for HIIT vs. MICT). In conclusion, all-extremity HIIT and MICT are feasible, well-tolerated and safe and result in similar improvements in aerobic fitness in middle-aged/older individuals with type 2 diabetes. These findings have important implications for exercise prescription for diabetic patients; they indicate

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Exercise intolerance in Type 2 diabetes: is there a cardiovascular contribution?

Cited by 36 publications

References 123 publications

Diabetic Cardiomyopathy and Ischemic Heart Disease: Prevention and Therapy by Exercise and Conditioning

Diabetic Cardiomyopathy and Ischemic Heart Disease: Prevention and Therapy by Exercise and Conditioning

Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus

Effect of all-extremity high-intensity interval training vs. moderate-intensity continuous training on aerobic fitness in middle-aged and older adults with type 2 diabetes: A randomized controlled trial

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