Normalization of diastolic dysfunction in type 2 diabetics after exercise training.
ABSTRACT The purpose of this study was to evaluate the impact of aerobic exercise training on left ventricular diastolic dysfunction (LVDD) and exercise capacity in subjects with type 2 diabetes.
Twenty-three sedentary subjects with well-controlled type 2 diabetes, free of coronary disease and having different degrees of LVDD, participated in the study. Subjects were treated with oral hypoglycemic agents and/or diet. Eleven subjects (EX) (age: 58 +/- 5 yr; mean +/- SD) underwent a 3-month aerobic exercise training program using a cycle ergometer, whereas a control group (CONT) of 12 subjects (57 +/- 6 yr) maintained their activities of daily living. Exercise capacity and LVDD, using echocardiography, were evaluated before and after the 3-month exercise program.
At baseline, anthropometric data were similar between the groups, except for body mass index (BMI), which was higher in CONT (31 +/- 3 vs 28+/- 3 kg x m(-2); P < 0.05). There were no significant differences in glycemic control (HbA1c: 6.4 +/- 1.2 vs 5.8 +/- 1.3%; P = 0.2) or maximal oxygen uptake (26.7 +/- 5.9 vs 28.6 +/- 3.9 mL x kg(-1) x min(-1); P = 0.4) between groups. Normalization of LVDD was observed in 5 of 11 EX subjects, (P < 0.0001) of whom four had grade 1 LVDD before exercise training. No change in diastolic function was observed in the CONT group. After exercise training, maximal oxygen uptake increased in the EX group (28.6 +/- 3.9 vs 32.7 +/- 5.7 mL x kg(-1) x min(-1); P < 0.05), whereas there was no change in the CONT group (26.7 +/- 5.9 vs 27.3 +/- 6.2 mL x kg(-1) x min(-1); P = 0.58). In both groups, there was no significant change in BMI.
Along with an improvement in exercise capacity, aerobic exercise training has the potential to reverse LVDD in patients with well-controlled, uncomplicated type 2 diabetes.
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ABSTRACT: Background The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF.MethodsA total of n = 43 patients with asymptomatic DD (n = 19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n = 24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6 months (2–3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up.ResultsPatients were 62 ± 8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO2) differed at baseline (DD 29.2 ± 8.7 mL/min/kg vs. HFpEF 17.8 ± 4.6 mL/min/kg; P = 0.004). After 6 months, peak VO2 increased significantly (P < 0.044) to 19.7 ± 5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8 ± 8.5 mL/min/kg; P < 0.002) with no overall difference between the groups (P = 0.217). E/e′ ratio (left ventricular filling index) decreased from 12.2 ± 3.5 to 10.1 ± 3.0 (P < 0.002) in patients with HFpEF and also in patients with DD (10.7 ± 3.1 vs. 9.5 ± 2.3; P = 0.03; difference between groups P = 0.210). In contrast, left atrial volume index decreased in the HFpEF group (P < 0.001) but remained stable within the DD group (difference between groups P = 0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P < 0.05). In contrast, vitality improved in both groups (difference between groups P = 0.708).ConclusionA structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestyle modification with physical activity is effective both in DD and HFpEF.ESC Heart Failure. 09/2014; 1(1).
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ABSTRACT: Background The role of structured exercise in improving cardio-metabolic profile and quality of life in patients with type 2 diabetes mellitus (2DM) has been widely demonstrated. Little is known about the effects of an aquatic-based exercise program in patients with 2DM. Objective to evaluate the effects of a supervised aquatic-based exercise program on cardio-metabolic profile, quality of life and physical activity levels in 2DM patients. Design and Setting: Observational study, community pre-post aquatic-based exercise program, primary care intervention Patients Eighteen men diagnosed with 2DM (52.2±9.3 years) Methods and Main Outcome Measurements: Cardio-metabolic profile, quality of life and physical activity levels were assessed before and after 12-weeks of an aquatic-based exercise program Results The results show a significant improvement of cardio-metabolic assessments (VO₂Max:24.1 vs 21.1 ml/kg/min, p<.05; blood pressure:125.4/77 vs 130.7/82.5 mmHg, p<.05; fasting blood glucose:119.6 vs 132.5 mg/dl, p<.05; body mass index:29.9 vs 31.1 Kg/m², p<.005; LDL-Chol:95.2 vs 104.9 mg/dl, p<.05 and diastolic function:E/E’ 9.1 vs 10.1, <.005) and an increase in quality of life and physical activity levels (Sf-36 - Mental component summary:72.3 vs 67, p<.05; PAID:20.1 vs 33.2, p<.005 and energy expenditure in general physical activity (PA:3888.7 vs 1239.5 Kcal/week, p<.05). Conclusions These findings demonstrate that an aquatic-based exercise program produces benefits on the cardiovascular system, metabolic profile and appears to be safe and effective improving quality of life and increasing physical activity levels in 2DM patients.PM&R 09/2014; · 1.66 Impact Factor
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ABSTRACT: Objective: The aim of this study was to determine whether high fitness attenuates the defects in left ventricular (LV) structure, function and triglyceride (TG) content in patients with type 2 diabetes mellitus (T2DM). Materials and methods: Patients (n = 74) with T2DM and ⩾1 additional cardiac risk factor were recruited to participate in this cross-sectional study. Outcome measures of interest were LV structure and function by magnetic resonance imaging (MRI) and myocardial TG content by 1H-magnetic resonance spectroscopy (MRS). The primary exposure variable was cardiorespiratory fitness defined by peak oxygen consumption scaled to fat-free mass (FFM; VO2peak-FFM). Results: Mean age was 53.5 years; 42.9% were women and mean glycosylated haemoglobin (HbA1c) was 8.0% with the mean duration of T2DM 8.2 years. VO2peak-FFM was crudely associated with both LV end systolic (r = 0.35, p = 0.002) and diastolic volumes (r = 0.32, p = 0.004), but not with ejection fraction (r = −0.15, p = 0.206), myocardial TG (r = −0.04, p = 0.734) or early diastolic peak filling rate (PFR; r = −0.01, p = 0.887). In multiple linear regression analyses, among measures of LV structure/function, VO2peak-FFM was independently associated only with LV end-diastolic volume (EDV) (β = 1.037, p = 0.038). Conclusion: In individuals with T2DM at increased cardiovascular (CV) risk, cardiorespiratory fitness is not associated with LV morphology, function or myocardial TG content.Diabetes & Vascular Disease Research 08/2014; · 3.04 Impact Factor