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Bonn SE, Hummel M, Peveri G, Eke H, Alexandrou C, Bellocco R, Löf M, Trolle Lagerros Y. Effectiveness of a Smartphone App to Promote Physical Activity Among Persons With Type 2 Diabetes: Randomized Controlled Trial. Interact J Med Res 2024; 13:e53054. [PMID: 38512333 PMCID: PMC10995783 DOI: 10.2196/53054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Physical activity is well known to have beneficial effects on glycemic control and to reduce risk factors for cardiovascular disease in persons with type 2 diabetes. Yet, successful implementation of lifestyle interventions targeting physical activity in primary care has shown to be difficult. Smartphone apps may provide useful tools to support physical activity. The DiaCert app was specifically designed for integration into primary care and is an automated mobile health (mHealth) solution promoting daily walking. OBJECTIVE This study aimed to investigate the effect of a 3-month-long intervention promoting physical activity through the use of the DiaCert app among persons with type 2 diabetes in Sweden. Our primary objective was to assess the effect on moderate to vigorous physical activity (MVPA) at 3 months of follow-up. Our secondary objective was to assess the effect on MVPA at 6 months of follow-up and on BMI, waist circumference, hemoglobin A1c, blood lipids, and blood pressure at 3 and 6 months of follow-up. METHODS We recruited men and women with type 2 diabetes from 5 primary health care centers and 1 specialized center. Participants were randomized 1:1 to the intervention or control group. The intervention group was administered standard care and access to the DiaCert app at baseline and 3 months onward. The control group received standard care only. Outcomes of objectively measured physical activity using accelerometers, BMI, waist circumference, biomarkers, and blood pressure were assessed at baseline and follow-ups. Linear mixed models were used to assess differences in outcomes between the groups. RESULTS A total of 181 study participants, 65.7% (119/181) men and 34.3% (62/181) women, were recruited into the study and randomized to the intervention (n=93) or control group (n=88). The participants' mean age and BMI were 60.0 (SD 11.4) years and 30.4 (SD 5.3) kg/m2, respectively. We found no significant effect of the intervention (group by time interaction) on MVPA at either the 3-month (β=1.51, 95% CI -5.53 to 8.55) or the 6-month (β=-3.53, 95% CI -10.97 to 3.92) follow-up. We found no effect on any of the secondary outcomes at follow-ups, except for a significant effect on BMI at 6 months (β=0.52, 95% CI 0.20 to 0.84). However, mean BMI did not differ between the groups at the 6-month follow-up. CONCLUSIONS We found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months' follow-up compared with controls receiving standard care. The effect of the app on BMI was unclear, and we found nothing to support an effect on secondary outcomes. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT03053336; https://clinicaltrials.gov/study/NCT03053336.
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Affiliation(s)
- Stephanie E Bonn
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine Hummel
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Peveri
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Helén Eke
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Christina Alexandrou
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Yen YF, Wang CC, Chen YY, Hsu LF, Hung KC, Chen LJ, Ku PW, Chen CC, Lai YJ. Leisure-time physical activity and mortality risk in type 2 diabetes: A nationwide cohort study. DIABETES & METABOLISM 2022; 48:101378. [PMID: 35872122 DOI: 10.1016/j.diabet.2022.101378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
AIM Physical activity improves insulin resistance, inhibits inflammation, and decreases the incidence of cardiovascular disease. These are major causes of death in patients with diabetes. METHODS The Taiwan National Health Interview Survey collected baseline characteristics of socioeconomic level, education, marriage, and health behaviour, including leisure time physical activity in 2001, 2005, 2009, and 2013. The National Health Insurance research dataset 2000-2016 contained detailed information on medical conditions, including all comorbidities. All-cause and cardiovascular deaths were confirmed by the National Death Registry. RESULTS A total of 4859 adults with type 2 diabetes were included in the analysis; 2389 (49 %) were men and the mean±SD age was 60±13 years. Kaplan-Meier curve of all-cause (log-rank P<0.001) and cardiovascular death (log-rank P=0.038) categorized by leisure-time physical activity showed a significant difference. The multivariable Cox regression model showed that those who had more leisure time physical activity had a significantly lower risk of all-cause death than those with no physical activity (physical activity of 1-800 MET-min/week HR = 0.66, 95% CI: 0.54-0.81, physical activity of >800 MET-min/week HR = 0.67, 95% CI: 0.56-0.81). A significant trend was also observed (P <0.001). Similar results were also observed for cardiovascular mortality (physical activity of 1-800 MET-min/week HR = 0.54, 95% CI: 0.36-0.84, physical activity of >800 MET-min/week HR = 0.78, 95% CI: 0.55-1.13). CONCLUSION For those with diabetes, increased leisure-time physical activity significantly reduced risk of all-cause and cardiovascular death. Further research is warranted to determine the proper prescription for physical activity to prolong healthy life.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chun-Chieh Wang
- Division of Chest Medicine, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Eldercare, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Fei Hsu
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Chuan Hung
- Department of Anaesthesiology, Chi Mei medical center, Tainan, Taiwan
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, Taichung, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yun-Ju Lai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.
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Thorsen IK, Yang Y, Valentiner LS, Glümer C, Karstoft K, Brønd JC, Nielsen RO, Brøns C, Christensen R, Nielsen JS, Vaag AA, Pedersen BK, Langberg H, Ried-Larsen M. The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial. JMIR Mhealth Uhealth 2022; 10:e30602. [PMID: 36170002 PMCID: PMC9557767 DOI: 10.2196/30602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required. Objective The primary objective of this study was to investigate the effectiveness of including an app-based (InterWalk) approach in municipality-based rehabilitation to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D. Methods The study was designed as a parallel-group, randomized trial with 52 weeks’ intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app–based interval walking training (IWT; IWT group; n=140), or (2) standard care + the standard exercise program (StC group; n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app–based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (minutes/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health–related quality of life (HRQoL), physical fitness, weight, and waist circumference. Results Participants had a mean age of 59.6 (SD 10.6) years and 128/214 (59.8%) were men. No changes in MVPA time were observed from baseline to 52-week follow-up in the StC and IWT groups (least squares means [95% CI] 0.6 [–4.6 to 5.8] and –0.2 [–3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95% CI] –0.8 [–8.1 to 6.4] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of –2.3 (95% CI –4.1 to –0.4) cm more in the IWT group compared with the StC group but with a Benjamini-Hochberg adjusted P=.06. No between-group differences were observed among the remaining key secondary outcomes. Conclusions Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app–based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Trial Registration ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690
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Affiliation(s)
- Ida Kær Thorsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Yanxiang Yang
- Chair of Sport and Health Management, Technical University of Munich, Munich, Germany
| | | | - Charlotte Glümer
- Centre for Diabetes, Municipality of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rasmus Oestergaard Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Charlotte Brøns
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jens Steen Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | - Bente Klarlund Pedersen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Martiskainen TM, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Effectiveness of physical activity counselling provided for people with type 2 diabetes mellitus in primary healthcare in North Karelia, Finland: a register-based evaluation study. BMJ Open 2022; 12:e058546. [PMID: 35788078 PMCID: PMC9255411 DOI: 10.1136/bmjopen-2021-058546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls. SETTING The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016-2018. PARTICIPANTS The study population consisted of patients aged 19-87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention. INTERVENTIONS Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year. RESULTS Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096). CONCLUSIONS This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI.
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Affiliation(s)
- Tuula Marketta Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Abildgaard J, Johansen MY, Skov-Jeppesen K, Andersen LB, Karstoft K, Hansen KB, Hartmann B, Holst JJ, Pedersen BK, Ried-Larsen M. Effects of a Lifestyle Intervention on Bone Turnover in Persons with Type 2 Diabetes: A Post Hoc Analysis of the U-TURN Trial. Med Sci Sports Exerc 2022; 54:38-46. [PMID: 34431828 DOI: 10.1249/mss.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION/PURPOSE The increased risk of fractures with type 2 diabetes (T2D) is suggested to be caused by decreased bone turnover. Current international guidelines recommend lifestyle modifications, including exercise, as first-line treatment for T2D. The aim of this study was to investigate the effects of an exercise-based lifestyle intervention on bone turnover and bone mineral density (BMD) in persons with T2D. METHODS Persons with T2D were randomized to either a 12-month lifestyle intervention (n = 64) or standard care (n = 34). The lifestyle intervention included five to six weekly aerobic training sessions, half of them combined with resistance training. Serum markers of bone turnover (osteocalcin, N-terminal propeptide of type-I procollagen, reflecting bone formation, and carboxyterminal collagen I crosslinks, reflecting bone resorption) and BMD (by DXA) were measured before the intervention and at follow-up. RESULTS From baseline to follow-up, s-propeptide of type-I procollagen increased by 34% (95% confidence interval [CI], 17%-50%), serum-carboxyterminal collagen I crosslink by 36% (95% CI, 1%-71%), and s-osteocalcin by 31% (95% CI, 11-51%) more in the lifestyle intervention group compared with standard care. Loss of weight and fat mass were the strongest mediators of the increased bone turnover. Bone mineral density was unaffected by the intervention (ΔBMD, 0.1%; 95% CI, -1.1% to 1.2%). CONCLUSIONS A 12-month intensive exercise-based lifestyle intervention led to a substantial but balanced increase in bone turnover in persons with T2D. The increased bone turnover combined with a preserved BMD, despite a considerable weight loss, is likely to reflect improved bone health and warrants further studies addressing the impact of exercise on risk of fractures in persons with T2D.
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Affiliation(s)
| | - Mette Yun Johansen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | | | - Lars Bo Andersen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, Sogndal, NORWAY
| | | | | | | | | | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
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Nielsen SG, Danielsen JH, Jacobsen SS, Kristensen PL, Storgaard H, Molsted S, Vilsbøll T. Effectiveness and acceptability of a pragmatic exercise intervention for patients with type 2 diabetes in specialized care. Diabetes Res Clin Pract 2022; 183:109176. [PMID: 34923022 DOI: 10.1016/j.diabres.2021.109176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
Abstract
AIMS Physical activity improves glycaemic control in type 2 diabetes (T2D), but adherence is low, and diabetes complications are barriers towards adopting physical activity. We investigated adherence and effects of individualized supervised exercise. METHODS Patients with intermediate (level 2) to high (level 3) risk of complications to T2D (stratified by Danish risk stratification model) were offered 12 weeks of exercise. Primary outcomes were working capacity assessed with the Åstrand-Rhyming cycling test (Åstrand), functional capacity assessed with the 30-second chair-stand test(30 s-CST) and health-related quality of life assessed with EuroQoL-5D-5L (EQ-5D-5L). Associations between stratification levels (2vs3) and drop-out, changes in 30 s-CST and EQ-5D-5L were analysed using multiple regression. RESULTS In total 350 patients accepted participation and 254 (73%) completed with 26 patients experiencing an adverse event. Odds ratio (OR) for non-completion were 1.82 [1.02-3.23] (p = 0.043) for patients stratified level 3 vs 2.Improvements were seen in Åstrand 2.71 [1.59; 3.83] ml O2/kg/min (p < 0.001), in 30 s-CST2.34 [2.01; 2.67] repetitions (p < 0.001) andin EQ-5D-5L 0.01 (-0.05 to 0.11) (p = 0.002). There were no associations between changes and risk-stratification levels. CONCLUSIONS Clinically relevant changes were seen after exercising regardless of the stratification levels in patients with intermediate to high risk of complications to T2D.
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Affiliation(s)
| | | | | | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Stig Molsted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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MacDonald CS, Ried-Larsen M, Soleimani J, Alsawas M, Lieberman DE, Ismail AS, Serafim LP, Yang T, Prokop L, Joyner M, Murad MH, Barwise A. A systematic review of adherence to physical activity interventions in individuals with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3444. [PMID: 33769660 DOI: 10.1002/dmrr.3444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Lifestyle interventions are pivotal for successful management of type 2 diabetes (T2D), however, the proportion of people with T2D adhering to physical activity advice has not been thoroughly studied. The purpose of this systematic review was to summarise the evidence on adherence to exercise or physical activity components in lifestyle interventions in those with T2D. We searched MEDLINE EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus on 12 November 2019. Eligible studies enrolled adults with T2D and reported the proportion of adherence to lifestyle interventions as a primary or secondary outcome. We included 11 studies (nine randomised controlled trials (RCTs) enrolling 1717 patients and two nonrandomised studies enrolling 62 patients). Only one of the studies had low risk of bias. The proportion of participants adhering to physical activity varied from 32% to 100% with a median of 58%. Adherence was higher in interventions using supervised training and lowest in interventions using remote coaching and the adherence rate in observational studies was higher compared to RCTs (92% vs. 55%; p < 0.01). Study duration, risk of bias, or participants' sex, were not associated with adherence to physical activity. The proportion of those with T2D adhering to physical activity interventions for T2D varies widely and most of the included studies had a high risk of bias. These findings have important implications for planning and power analysis of future trials and when counselling patients about lifestyle interventions including physical activity or exercise components.
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Affiliation(s)
- Christopher S MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Abdalla S Ismail
- Canton Medical Education Foundation (CMEF), Aultman Hospital, Canton, Ohio, USA
| | - Laura P Serafim
- School of medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ting Yang
- Pulmonary and Critical Care Medicine Department, West China Hospital, Si Chuan University, China
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Cheng H, Zhu W, Zhu M, Sun Y, Sun X, Jia D, Yang C, Yu H, Zhang C. Susceptibility of six polymorphisms in the receptor for advanced glycation end products to type 2 diabetes: a systematic review and meta-analysis. Endocr J 2021; 68:993-1010. [PMID: 33840670 DOI: 10.1507/endocrj.ej21-0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We did a systematic review and meta-analysis, aiming to examine the association of available polymorphisms in the receptor for advanced glycation end products (AGER) gene with the risk of type 2 diabetes. Literature search, eligibility assessment, and data extraction were independently performed by two authors. Risk was expressed as by odds ratio (OR) and 95% confidence interval (CI) under the random-effects model. A total of 26 publications, involving 29 independent studies (8,318 patients with type 2 diabetes and 5,589 healthy or orthoglycemic controls) were included in this meta-analysis. Six polymorphisms in AGER gene, rs2070600, rs1800624, rs1800625, rs184003, rs3134940, and rs55640627, were eligible for inclusion. Overall analyses indicated that the mutations of rs1800624 (-374A) and rs55640627 (2245A) were associated with a significantly increased risk of type 2 diabetes (OR = 1.17 and 1.55, 95% CI: 1.00 to 1.38 and 1.21 to 1.98, respectively). Subsidiary analyses revealed that the mutation of rs2070600 was associated with 2.13-folded increased risk of type 2 diabetes in Caucasians (95% CI: 1.28 to 3.55), and the mutation of rs1800624 was associated with 1.57-folded increased risk in South Asians (95% CI: 1.09 to 2.25), with no evidence of heterogeneity (I2: 42.5% and 44.5%). There were low probabilities of publication bias for all studied polymorphisms. Taken together, our findings indicate an ethnicity-dependent contribution of AGER gene in the pathogenesis of type 2 diabetes, that is, rs2070600 was a susceptibility locus in Caucasians, yet rs1800624 in South Asians.
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Affiliation(s)
- Hao Cheng
- Department of Clinics, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Wenbin Zhu
- Department of Molecular Biology Laboratory, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Mou Zhu
- Department of Biochemistry and Molecular Biology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Yan Sun
- Department of Clinical Pathogen Microbiology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Xiaojie Sun
- Department of Clinical Biochemistry, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Di Jia
- Department of Biochemistry and Molecular Biology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Chao Yang
- Department of Biochemistry and Molecular Biology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Haitao Yu
- Department of Cell Biology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
| | - Chunjing Zhang
- Department of Biochemistry and Molecular Biology, Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, China
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9
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Dietary self-care and hospital readmission among individuals with diabetes mellitus. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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10
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Adams JA, Uryash A, Lopez JR, Sackner MA. The Endothelium as a Therapeutic Target in Diabetes: A Narrative Review and Perspective. Front Physiol 2021; 12:638491. [PMID: 33708143 PMCID: PMC7940370 DOI: 10.3389/fphys.2021.638491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
Diabetes has reached worldwide epidemic proportions, and threatens to be a significant economic burden to both patients and healthcare systems, and an important driver of cardiovascular mortality and morbidity. Improvement in lifestyle interventions (which includes increase in physical activity via exercise) can reduce diabetes and cardiovascular disease mortality and morbidity. Encouraging a population to increase physical activity and exercise is not a simple feat particularly in individuals with co-morbidities (obesity, heart disease, stroke, peripheral vascular disease, and those with cognitive and physical limitations). Translation of the physiological benefits of exercise within that vulnerable population would be an important step for improving physical activity goals and a stopgap measure to exercise. In large part many of the beneficial effects of exercise are due to the introduction of pulsatile shear stress (PSS) to the vascular endothelium. PSS is a well-known stimulus for endothelial homeostasis, and induction of a myriad of pathways which include vasoreactivity, paracrine/endocrine function, fibrinolysis, inflammation, barrier function, and vessel growth and formation. The endothelial cell mediates the balance between vasoconstriction and relaxation via the major vasodilator endothelial derived nitric oxide (eNO). eNO is critical for vasorelaxation, increasing blood flow, and an important signaling molecule that downregulates the inflammatory cascade. A salient feature of diabetes, is endothelial dysfunction which is characterized by a reduction of the bioavailability of vasodilators, particularly nitric oxide (NO). Cellular derangements in diabetes are also related to dysregulation in Ca2+ handling with increased intracellular Ca2+overload, and oxidative stress. PSS increases eNO bioavailability, reduces inflammatory phenotype, decreases intracellular Ca2+ overload, and increases antioxidant capacity. This narrative review and perspective will outline four methods to non-invasively increase PSS; Exercise (the prototype for increasing PSS), Enhanced External Counterpulsation (EECP), Whole Body Vibration (WBV), Passive Simulated Jogging and its predicate device Whole Body Periodic Acceleration, and will discuss current knowledge on their use in diabetes.
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Affiliation(s)
- Jose A Adams
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Arkady Uryash
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Jose R Lopez
- Department of Research, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Marvin A Sackner
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
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11
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Czosnek L, Rankin N, Zopf E, Richards J, Rosenbaum S, Cormie P. Implementing Exercise in Healthcare Settings: The Potential of Implementation Science. Sports Med 2020; 50:1-14. [PMID: 31749112 DOI: 10.1007/s40279-019-01228-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise is an efficacious therapy for many chronic diseases. Integrating efficacious evidence-based interventions (EBIs), such as exercise, into daily healthcare practice is a slow and complex pursuit. Implementation science seeks to understand and address this phenomenon by conducting studies about the methods used to promote the routine uptake of EBIs. The purpose of this article is to explore implementation science and a common conceptual framework in the discipline, the Consolidated Framework for Implementation Research (CFIR), as it applies to exercise EBI. We conclude by offering recommendations for future research that leverage implementation science priorities to highlight the potential of this research field for advancing the implementation of exercise EBI.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Nicole Rankin
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Eva Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.,School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
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12
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Pippi R, Di Blasio A, Aiello C, Fanelli C, Bullo V, Gobbo S, Cugusi L, Bergamin M. Effects of a Supervised Nordic Walking Program on Obese Adults with and without Type 2 Diabetes: The C.U.R.I.A.Mo. Centre Experience. J Funct Morphol Kinesiol 2020; 5:E62. [PMID: 33467277 PMCID: PMC7739339 DOI: 10.3390/jfmk5030062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Exercise is a convenient non-medical intervention, commonly recommended in metabolic syndrome and type 2 diabetes (DM2) managements. Aerobic exercise and aerobic circuit training have been shown to be able to reduce the risk of developing DM2-related complications. Growing literature proves the usefulness of Nordic walking as exercise therapy in different disease populations, therefore it has a conceivable use in DM2 management. Aims of this study were to analyze and report the effects of two different supervised exercises (gym-based exercise and Nordic walking) on anthropometric profile, blood pressure values, blood chemistry and fitness variables in obese individuals with and without DM2. In this study, 108 obese adults (aged 45-65 years), with or without DM2, were recruited and allocated into one of four subgroups: (1) Gym-based exercise program (n = 49) or (2) Nordic walking program (n = 37) for obese adults; (3) Gym-based exercise program (n = 10) or (4) Nordic walking program (n = 12) for obese adults with DM2. In all exercise subgroups, statistically significant improvements in body weight, body mass index, fat mass index, muscular flexibility and maximal oxygen uptake (VO2 max) were observed. Moreover, a higher percentage of adherence to the gym-based program compared to Nordic walking was recorded. Our findings showed that, notwithstanding the lower adherence, a supervised Nordic walk is effective as a conventional gym-based program to improve body weight control, body composition parameters, muscular flexibility and VO2 max levels in obese adults with and without type 2 diabetes.
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Affiliation(s)
- Roberto Pippi
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. d’Annunzio’ University of Chieti-Pescara, 66100 Chieti Scalo, Italy;
| | - Cristina Aiello
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Carmine Fanelli
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Valentina Bullo
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
| | - Stefano Gobbo
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Marco Bergamin
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
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13
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Ferrari M, Speight J, Beath A, Browne JL, Mosely K. The information-motivation-behavioral skills model explains physical activity levels for adults with type 2 diabetes across all weight classes. PSYCHOL HEALTH MED 2020; 26:381-394. [PMID: 32266821 DOI: 10.1080/13548506.2020.1749292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Physical activity is an evidence-based, effective treatment for type 2 diabetes mellitus (T2D), yet insufficient numbers of adults achieve recommended daily levels, particularly amongst higher weight classes. This cross-sectional study assessed whether the Information-Motivation-Behavioural Skills (IMB) Model explained physical activity levels in adults with T2D across different body mass index (BMI) levels (N = 381). Measures included the American Adults Knowledge of Exercise Recommendations (AAKER), Behavioural Regulation in Exercise Questionnaire (BREQ-2), Barriers Specific Self-Efficacy Scale (BARSE) and the outcome measure, International Physical Activity Questionnaire (IPAQ-short form). Analyses included structural equation modelling (SEM) and ordinal logistic regression models. SEM demonstrated a good fit of the IMB Model to the data, accounting for 44% of variance in physical activity levels. Both motivation and self-efficacy had a direct effect, and motivation indirectly predicted physical activity through self-efficacy. Further analyses found the effect of the IMB predictors did not vary according to BMI status. This study supports the application of the IMB Model in explaining physical activity behavior in adults with T2D. In particular, the contribution of motivation and self-efficacy as substantive and modifiable predictors of physical activity will facilitate the development of targeted and evidence-based interventions for individuals of all BMI classes.
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Affiliation(s)
- Madeleine Ferrari
- School of Psychology, Australian Catholic University, Strathfield, Australia.,School of Psychology, University of Sydney, Sydney, Australia
| | - Jane Speight
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Vic, Melbourne, VIC, Australia.,AHP Research, Hornchurch, UK
| | - Alissa Beath
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Jessica L Browne
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Vic, Melbourne, VIC, Australia.,Centre for Evidence and Implementation, Carlton, VIC, Australia
| | - Kylie Mosely
- BodyMatters Australasia, Sydney, NSW, Australia.,Graduate School of Health, University of Technology, Sydney, NSW, Australia
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14
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Pascual-Morena C, Martínez-Vizcaíno V, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Notario-Pacheco B, Saz-Lara A, Fernández-Rodriguez R, Cavero-Redondo I. Exercise vs metformin for gestational diabetes mellitus: Protocol for a network meta-analysis. Medicine (Baltimore) 2019; 98:e16038. [PMID: 31232936 PMCID: PMC6636956 DOI: 10.1097/md.0000000000016038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity. METHODS AND ANALYSIS This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn. DISCUSSION With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective. ETHICS AND DISSEMINATION The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy. STRENGTHS AND LIMITATIONS A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups. REGISTRATION NUMBER PROSPERO CRD42019121715.
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Affiliation(s)
- Carlos Pascual-Morena
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | | | - Alicia Saz-Lara
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | - Iván Cavero-Redondo
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
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15
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Li S, Liang M, Gao D, Su Q, Laher I. Changes in Titin and Collagen Modulate Effects of Aerobic and Resistance Exercise on Diabetic Cardiac Function. J Cardiovasc Transl Res 2019; 12:404-414. [PMID: 30820865 DOI: 10.1007/s12265-019-09875-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Diastolic dysfunction is a common complication that occurs early in diabetes mellitus. Titin and collagen are two important regulators of myocardial passive tension, which contributes to diabetic myocardial diastolic dysfunction. Exercise therapy significantly improves the impaired diabetic cardiac function, but its benefits appear to depend on the type of exercise used. We investigated the effect of aerobic and resistance exercise on cardiac diastolic function in diabetic rats induced by high-fat diet combined with low-dose streptozotocin injection. Interestingly, although resistance training had a more pronounced effect on blood glucose control than did aerobic training in type 2 diabetic rats, improvements in cardiac diastolic parameters benefited more from aerobic training. Moreover, aerobic exercise did significantly increase the expression levels of titin and decrease collagen I, TGFβ1 expression level. In summary, out data suggest that aerobic exercise may improve diabetic cardiac function through changes in titin-dependent myocardial stiffness rather than collagen-dependent interstitial fibrosis.
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Affiliation(s)
- Shunchang Li
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Min Liang
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Derun Gao
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Quansheng Su
- School of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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16
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Teich T, Zaharieva DP, Riddell MC. Advances in Exercise, Physical Activity, and Diabetes Mellitus. Diabetes Technol Ther 2019; 21:S112-S122. [PMID: 30785316 DOI: 10.1089/dia.2019.2509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Trevor Teich
- 1 School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Dessi P Zaharieva
- 1 School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Michael C Riddell
- 1 School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
- 2 LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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17
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Yaribeygi H, Butler AE, Sahebkar A. Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications. J Cell Physiol 2019; 234:12508-12515. [PMID: 30623433 DOI: 10.1002/jcp.28110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus is a highly prevalent metabolic disorder that affects many molecular pathways, causing a shift from a physiologic to a pathophysiologic state. Alterations in the molecular pathways promote diabetic complications and, thus, many medical and nonmedical therapies have been directed at preventing these complications. Despite the beneficial effects on moderating glycemic control, medical therapies may also have unfavorable side effects. This makes nonmedical therapeutic approaches more attractive due to lower pharmacological side effects of these strategies compared to medical agents. Aerobic exercise is now considered as a major nonmedical strategy that can promote beneficial and protective effects to counteract the development of diabetic complications via attenuation of the major molecular mechanisms involved in diabetes.
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Affiliation(s)
- Habib Yaribeygi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexandra E Butler
- Diabetes Research Center, Qatar Biomedical Research Institute, Doha, Qatar
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Pieralice S, Vigevano F, Del Toro R, Napoli N, Maddaloni E. Lifestyle Management of Diabetes: Implications for the Bone-Vascular Axis. Curr Diab Rep 2018; 18:84. [PMID: 30121859 DOI: 10.1007/s11892-018-1060-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To describe the main pathways involved in the interplay between bone and cardiovascular disease and to highlight the possible impact of physical activity and medical nutrition therapy on the bone-vascular axis. RECENT FINDINGS Diabetes increases the risk of both cardiovascular disease and bone fragility fractures, sharing common pathogenic pathways, including OPG/RANK/RANKL, the FGF23/Klotho axis, calciotropic hormones, and circulating osteogenic cells. This may offer new therapeutic targets for future treatment strategies. As lifestyle intervention is the cornerstone of diabetes treatment, there is potential for an impact on the bone-vascular axis. Evidence published suggests the bone-vascular axis encompasses key pathways for cardiovascular disease. This, along with studies showing physical activity plays a crucial role in the prevention of both bone fragility and cardiovascular disease, suggests that lifestyle intervention incorporating exercise and diet may be helpful in managing skeletal health decline in diabetes. Studies investigating the controversial role of high-fiber diet and dietary vitamin D/calcium on bone and cardiovascular health suggest an overall benefit, but further investigations are needed in this regard.
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Affiliation(s)
- Silvia Pieralice
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Francesca Vigevano
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Rossella Del Toro
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
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