Women with type 2 diabetes perceive harder effort during exercise than nondiabetic women

Abstract

Regular exercise is a cornerstone of diabetes treatment; however, people with type 2 diabetes (T2D) are commonly sedentary. It is possible that a harder rate of perceived exertion (RPE) during exercise for those with T2D as compared with nondiabetics may be a barrier to physical activity. This study examined RPE (Borg scale, ordinal range 6-20) during submaximal exercise at identical absolute work rates to test the hypothesis that women with T2D demonstrate harder RPE during exercise than nondiabetic controls. In a prespecified analysis of existing data from equivalently sedentary women, RPE during submaximal exercise was compared among women with uncomplicated T2D (n = 13, mean body mass index (BMI) 34.2, mean hemoglobin A1c 9%), overweight controls (OC, n = 13, mean BMI 30.7), and normal-weight controls (NWC, n = 13, mean BMI 23.1). Subjects performed three 7 min, constant-load exercise tests at 20 W and 30 W. Mixed-effects general linear modeling was used to test for differences in mean RPE estimates among groups with and without adjustment for relative work intensity, age, habitual physical activity, or BMI. Subjects with T2D perceived harder effort during bicycling exercise than controls, as measured by RPE at 20 W and 30 W (p < 0.05 for T2D vs. OC and for T2D vs. NWC). Adjusting for relative work intensity eliminated significant group RPE differences at 30 W, but group RPE differences at 20 W remained significant. Harder perceived effort during exercise may be a barrier to physical activity for those with T2D.

Similar level of impairment in exercise performance and oxygen uptake kinetics in middle-aged men and women with type 2 diabetes

“…Individuals with type 2 diabetes, who were younger (mean age ϭ 42 yr) than those studied in the present study, also perceive light to moderate exercise as more difficult than healthy controls (12), and this might contribute to their relatively lower levels of physical activity (32) and increased risk of cardiovascular outcomes and all-cause mortality in later life (6,39). The present study shows that middle-aged males and females with type 2 diabetes exhibit a similar degree of exercise intolerance and impairment in exercise V O 2 response, and that they were also more inactive than the healthy controls, despite the fact that individuals with type 2 diabetes and control groups were sedentary.…”

“…Each subject was tested on two occasions, separated by 72 h, and at the same time of day. Four female subjects were premenopausal (2 from each female group) and were tested during the midfollicular phase of their menstrual cycle (days [5][6][7][8][9][10][11][12]. Subjects refrained from consuming caffeine and alcohol in the 24 h before testing and limited their exercise to normal activities of daily living.…”

“…Additionally, the rate of adjustment of oxygen uptake (V O 2 kinetics) to steady-state exercise is slower in young and middle-aged women (8,21,32) and in a combined group of middle-aged men and women (4), although recent data suggests that V O 2 kinetics are not impaired in older men with type 2 diabetes compared with age-matched healthy controls (42). The slowing of the V O 2 kinetic response is associated with a faster onset of fatigue and lower exercise tolerance (28) and might help explain why individuals with type 2 diabetes perceive light/moderate exercise as more difficult than healthy controls (12). Ultimately this often leads to a sedentary behavior or physical inactivity, which is associated with worsening of cardiovascular outcomes and predicts mortality in people with type 2 diabetes (6,39).…”

Gymnasium-based unsupervised exercise maintains benefits in oxygen uptake kinetics obtained following supervised training in type 2 diabetes

“…In conclusion, type 2 diabetes slows the adjustment of _ VO 2 at the beginning of light to moderate exercise, and as a consequence, uncomplicated diabetic subjects perceive daily light routine activities as being more difficult (Huebschmann et al 2009). The present findings confirm that a supervised exercise programme results in the speeding of the _ VO 2 kinetic responses and that these benefits can be maintained with a follow-up gymnasium-based unsupervised programme.…”

“…This might help explain the lower exercise tolerance in individuals with type 2 diabetes (Kjaer et al 1990;Regensteiner et al 1995Regensteiner et al , 1998Regensteiner et al , 2009Baldi et al 2003. MacAnaney et al 2011a and their perception that routine daily activities are more difficult to perform when compared with healthy controls (Huebschmann et al 2009). Therefore, interventions aimed at accelerating the _ VO 2 kinetic response might be important to improve exercise tolerance in diabetic individuals and reduce the associated risk of mortality (Wei et al 2000).…”