Influence of Complications of Diabetes Mellitus on Exercise Tolerance of Patients with Heart Failure: Focusing on autonomic nervous activity and heart rate response during cardiopulmonary exercise tests

Abstract

Purpose: The purpose of this study was to clarify the influence of complications of diabetes on the exercise tolerance of patients with heart failure. Methods: The subjects of this study were 69 patients (44 men; mean age: 62.2 ± 13.4 years) who were hospitalized and diagnosed with heart failure between November 2016 and November 2017. The subjects all took part in a cardiopulmonary exercise test. The patients' medical background, indexes obtained from lower-limb muscle strength and the cardiopulmonary exercise test, heart rate response indexes [Δ heart rate (ΔHR)], and autonomic nervous activities were measured, and these individual indexes were compared between the diabetic group and the non-diabetic group. Results: Compared with the non-diabetic group, the peak oxygen uptake (peak!O2) and ΔHR in the diabetic group were significantly lower (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min and 27.2 ± 11.7 vs. 36.7 ± 14.7 bpm, respectively) (p<0.05). Regarding the autonomic nervous activity during the cardiopulmonary exercise test in the diabetic group, there was a significant decrease of parasympathetic nerve activity and a significant lack of increase in sympathetic nerve activity (p<0.05). Conclusions: Patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications. It was suggested that the decrease in heart rate response was due to the decrease of autonomic nervous activity and that this may play a role in reduced exercise tolerance.

Study on Influencing Factors of Frailty in Elderly Patients with Type II Diabetes

“…Exercise tolerance is one of the important indexes that can reflect people's physique, and patients with frailty can easily suffer from exercise intolerance [ 12 ]. Ishihara et al [ 13 ] have found that compared with normal people, the patients with type II diabetes mostly lack lower limb strength during exercise and have significantly weakened activity in autonomic nerves, sympathetic nerves, and parasympathetic nerves. Nowadays, diabetes, mostly affecting middle-aged and elderly patients, is a metabolism-related disease, whose nosogenesis is complex and related to many factors, such as obesity, hypertension, hyperlipidemia, imbalanced diet, and lack of exercise, posing a great threat to peoples' physical health [ 3 , 4 ].…”

Skeletal muscle atrophy in heart failure with diabetes: from molecular mechanisms to clinical evidence

“…16,33 For example, peak pulmonary oxygen uptake (V O 2peak ), the gold-standard measure of exercise intolerance and a strong predictor of mortality, 27 is lower by around 15-20% in HFDM vs. HF or DM despite a similar degree of cardiac dysfunction. 27,34,35 The most commonly used scoring system for symptoms, the New York Heart Association functional class, which divides patients into four subjective points on the basis of functional capacity reveals that patients with HFDM are on average more symptomatic and also have higher diuretic requirements compared with patients suffering HF without DM. 36 Collectively, the poor relationship between LV systolic dysfunction and symptoms in HF with and without DM suggest an important role of peripheral mechanisms.…”

“…It should come as no surprise, therefore, that patients with HFDM have both worse outcomes and symptoms compared with those with HF or DM 16,33 . For example, peak pulmonary oxygen uptake (V̇O 2peak ), the gold‐standard measure of exercise intolerance and a strong predictor of mortality, 27 is lower by around 15–20% in HFDM vs. HF or DM despite a similar degree of cardiac dysfunction 27,34,35 . The most commonly used scoring system for symptoms, the New York Heart Association functional class, which divides patients into four subjective points on the basis of functional capacity reveals that patients with HFDM are on average more symptomatic and also have higher diuretic requirements compared with patients suffering HF without DM 36 .…”

Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial

“…In the hypothesis with skeletal myogenic determinants, reduced VO 2 peak and peripheral oxygen extraction are consequence of slower muscle blood flow adjustment and early stimulation of the muscle metaboreflex [ 28 ]. In study by Ishihara et al performed on group of 69 HF patients (with preserved or moderate EF) VO 2 peak was lower in 14 DM patients when compared to 55 patients without DM (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min, p < 0.05, respectively) [ 29 ].…”