Short-term Aerobic Exercise Reduces Nitroglycerin-induced Orthostatic Intolerance in Older Adults With Type 2 Diabetes

Abstract

Aims/Hypothesis-Older adults are at a high risk for syncope due to orthostatic intolerance (OI), and this risk increases with comorbid type 2 diabetes and vasoactive medications. Despite many benefits, previous investigations have shown worsening OI with aerobic training. We examined whether aerobic exercise reduced OI in older adults with type 2 diabetes who were given a short-acting vasoactive agent (nitroglycerin).Methods-Forty older adults (25 males and 15 females, mean age 71.4 ± 0.7 years, ranging in age from 65 to 83 years) with type 2 diabetes were recruited. Subjects were randomized to each of 2 groups: an aerobic group (3 months of vigorous aerobic exercise) and a nonaerobic (no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week. After being given 400 μg of sublingual nitroglycerin, each subject was placed in a 70° head-up tilt for 30 minutes.Results-When the 2 groups were compared using a Cox proportional hazards model, tilt table tolerance was significantly better in the aerobic group as compared to in the nonaerobic group (χ 2 MC = 7.271, P = 0.007).Conclusions-Our findings indicate that a relatively short aerobic exercise intervention can improve postnitroglycerin orthostatic tolerance in older adults with type 2 diabetes.

Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

“…Fifteen articles showed unclear risk of bias [37–39, 41, 42, 47, 50, 55, 57, 58 63–65, 67, 68] and six showed high risk of bias [ 40 , 51 , 52 , 61 , 62 , 66 ] in adequate allocation concealment. Blinded outcome assessment was reported in 10 studies [ 39 , 44 – 47 , 49 , 53 , 59 , 60 , 69 ]. In terms of incomplete outcome data, four studies were judged as high risk [ 36 , 54 , 66 , 69 ] and three were unclear risk [ 35 , 43 , 48 , 67 ].…”

“…In terms of incomplete outcome data, four studies were judged as high risk [ 36 , 54 , 66 , 69 ] and three were unclear risk [ 35 , 43 , 48 , 67 ]. Eleven studies showed unclear risk of bias in selective reporting [ 34 , 35 , 40 , 41 , 45 , 47 , 50 , 53 , 59 , 60 , 66 ], and 16 showed unclear risks of other biases [ 38 , 42 , 44 , 45 , 47 , 48 , 50 , 55 , 57 , 59 , 60 , 62 , 63 , 65 , 67 , 69 ].…”

The Influence of Autonomic Dysfunction Associated with Aging and Type 2 Diabetes on Daily Life Activities

“…Aside from the obvious risk of falling in the elderly, orthostatic hypotension is associated with cardiovascular mortality and all-cause mortality [ 124 ]. Orthostatic tolerance decreases with both age and diabetes [ 125 – 128 ].…”

Aerobic training in older adults with type 2 diabetes and vasodepressive carotid sinus hypersensitivity

“…There are a number of different neuroautonomic etiologies for syncope in older adults, including orthostatic hypotension, vasovagal syncope, postprandial hypotension and carotid sinus syndrome (the focus of the current study). Aerobic exercise has been shown to be beneficial in young adults with orthostatic hypotension [19], and aerobic training improves tilt table tolerance in older adults [20]. Aerobic exercise has been shown to give some limited benefits in older adults with postprandial hypotension [21], but has shown no benefit in preventing vasovagal syncope during laboratory conditions [22].…”