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Abonie US, Addo RA, Kumah L, Ofori – Ampomah AK, Makinyi V. Effect of treadmill ambulatory training on glucose control and blood pressure in persons with type 2 diabetes: A pilot study. PLoS One 2024; 19:e0298179. [PMID: 38574086 PMCID: PMC10994293 DOI: 10.1371/journal.pone.0298179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/14/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Lack of time is often cited by persons with type 2 diabetes for non-participation in regular exercise. This highlights the need to explores ways to help persons with type 2 diabetes to engage in an active lifestyle. This study evaluated the effect of a short duration norm intensity exercise on blood glucose and blood pressure in persons with type 2 diabetes. METHODS Twenty persons with type 2 diabetes were randomly assigned to either training group (n = 10) or control group (n = 10). The training group received 4-weeks ambulatory training on a motor-driven treadmill (2 x 20 min per week at 60% target heart rate). The control group received no training. Blood glucose, and systolic and diastolic blood pressures were assessed before and after the 4-weeks training. Repeated measures ANOVA were used to examine training effect. RESULTS Training significantly improved blood glucose (mean difference = -2.73; p = 0.03). No effects were found for systolic blood pressure (mean difference = -0.30; p = 0.96) and diastolic blood pressure (mean difference = -0.90; p = 0.82). CONCLUSION Training improved blood glucose but not blood pressure. A short-duration ambulatory training is an appropriate exercise mode to elicit beneficial effect, and exercise adoption in persons with type 2 diabetes. TRIAL REGISTRATION This pilot trial is registered with the Pan African Clinical Trial Registry at pactr.samrc.ac.za (PACTR202306601940612).
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Affiliation(s)
- Ulric Sena Abonie
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Coach Lane Campus, Benton, Newcastle upon Tyne, United Kingdom
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region-Ghana
| | - Raphael Aseye Addo
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region-Ghana
| | - Laureen Kumah
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region-Ghana
| | - Ama Kissiwaa Ofori – Ampomah
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region-Ghana
| | - Vincent Makinyi
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Volta Region-Ghana
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Li X, Chattopadhyay K, Chen X, Li J, Xu M, Chen X, Li L. Association Between Physical Activity and Arterial Stiffness in Patients with Type 2 Diabetes in Ningbo, China: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:4133-4141. [PMID: 38145257 PMCID: PMC10740718 DOI: 10.2147/dmso.s438344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Aim The study aimed to investigate the association between physical activity and arterial stiffness in patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. Methods A cross-sectional study was conducted using the Metabolic Management Center (MMC) dataset of The First Affiliated Hospital of Ningbo University from 1st March 2018 to 28th February 2023. 4444 adults with T2DM were included in the study. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ)-Short and was categorized into high, moderate, and low. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1800cm/s or common carotid artery intima-media thickness (CCA IMT) ≥1mm. Multiple logistic regression analyses were performed to identify the association between physical activity and arterial stiffness. Results 6.5%, 47.0%, and 46.5% of patients with T2DM had high, moderate, and low physical activity, respectively. 18.8% and 17.5% of patients had arterial stiffness based on baPWV and CCA IMT, respectively. The odds of arterial stiffness (based on baPWV) were lower in patients having moderate to high physical activity (OR 0.82, 95% CI 0.68 to 0.98 and OR 0.58, 95% CI 0.39 to 0.87, respectively). The odds of arterial stiffness (based on CCA IMT) were found to be lower in patients having high physical activity (OR 0.49, 95% CI 0.33 to 0.74). Conclusion Higher physical activity was found to be associated with lower arterial stiffness in patients with T2DM in Ningbo, China. This was a cross-sectional study, and there is a need to conduct longitudinal studies on this topic.
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Affiliation(s)
- Xueyu Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Xiaoting Chen
- School of Medicine, Ningbo University, Ningbo, People’s Republic of China
| | - Jialin Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Miao Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xueqin Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Li Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Gao W, Lv M, Huang T. Effects of different types of exercise on hypertension in middle-aged and older adults: a network meta-analysis. Front Public Health 2023; 11:1194124. [PMID: 37799161 PMCID: PMC10549925 DOI: 10.3389/fpubh.2023.1194124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023] Open
Abstract
Objective This study mainly used network meta-analysis to explore the effect of different types of exercise on hypertension in middle-aged and older adults. Methods Several databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials on the effects of different types of exercise on hypertension in middle-aged and older adults. Results A total of 19 articles and 2,385 participants were included in the analysis. Aerobic exercise interventions [MD = -9.254, P < 0.05, 95% CI (-14.810, -3.698)] and static exercise interventions [MD = -10.465, P < 0.05, 95% CI (-18.135, -2.794)] had a significant effect on the improvement in systolic blood pressure (SBP). For diastolic blood pressure (DBP), aerobic exercise interventions [MD = -1.4096; P > 0.05, 95% CI (-8.2395, 5.4201)] and static exercise interventions [MD = -4.5206, P > 0.05, 95% CI (-14.0436, 5.0023)] were not statistically significant. The results of the surface under the cumulative ranking curve (SUCRA) showed that static exercise improved hypertension better than aerobic exercise. Conclusion Aerobic exercise and static exercise have been shown to have a good effect on the improvement of hypertension, but the effect on DBP is not significant.
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Affiliation(s)
- Wei Gao
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Moran Lv
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Tao Huang
- Institute of Physical Education, Huanggang Normal University, Huanggang, China
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Chen S, Zhou K, Shang H, Du M, Wu L, Chen Y. Effects of concurrent aerobic and resistance training on vascular health in type 2 diabetes: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1216962. [PMID: 37780628 PMCID: PMC10534066 DOI: 10.3389/fendo.2023.1216962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To determine the impacts of concurrent aerobic and resistance training on vascular structure (IMT) and function (PWV, FMD, NMD) in type 2 diabetes (T2D). Methods The electronic databases PubMed, Web of Science Core Collection, Cochrane Library, Embase, Scopus, CINAHL, and SPORTDiscus were systematically searched for articles on "type 2 diabetes" and "concurrent training" published from inception to August 2, 2022. We included randomized controlled trials that examined the effects of concurrent training versus passive controls on IMT, PWV, FMD and NMD in T2D. Results Ten studies were eligible, including a total of 361 participants. For IMT, concurrent training showed a slight decrease by 0.05 mm (95% CI -0.11 to 0.01, p > 0.05). concurrent training induced an overall significant improvement in FMD by 1.47% (95% CI 0.15 to 2.79, p < 0.05) and PWV by 0.66 m/s (95% CI -0.89 to -0.43, p < 0.01) in type 2 diabetics. However, concurrent training seemed to exaggerate the impaired NMD (WMD = -2.30%, 95% CI -4.02 to -0.58, p < 0.05). Conclusions Concurrent training is an effective method to improve endothelial function and artery stiffness in T2D. However, within 24 weeks concurrent training exacerbates vascular smooth muscle dysfunction. More research is needed to explore whether longer and/or higher-intensity concurrent training interventions could enhance the vascular structure and smooth muscle function in this population. Systematic review registration www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350604.
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Affiliation(s)
- Shengju Chen
- School of Physical Education, Liaoning Normal University, Dalian, China
| | - Kaixiang Zhou
- Sports Health College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huayu Shang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Mingyang Du
- College of Physical Education, Chongqing University, Chongqing, China
| | - Linfeng Wu
- College of Physical Education, Chongqing University, Chongqing, China
| | - Yu Chen
- College of Physical Education, Chongqing University, Chongqing, China
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do Nascimento Cândido G, Batalha APDB, da Silva Chaves GS, Pereira DS, Britto RR. Effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. J Diabetes Metab Disord 2023; 22:97-118. [PMID: 37255785 PMCID: PMC10225374 DOI: 10.1007/s40200-023-01205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/20/2023] [Indexed: 04/07/2023]
Abstract
Purpose To assess the effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus (T2DM). Methods This systematic review was registered on PROSPERO (CRD42020210470). Searches were performed on PubMed, PEDro EMBASE, MEDLINE (Ovid), LILACS, PsycINFO, SCIELO, CINAHL, and Cochrane Library. The primary outcome was cardiorespiratory fitness, defined as maximal oxygen uptake (VO2max) during a maximal or submaximal exercise test. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled using a random effects model and expressed as mean difference (MD) and 95% confidence interval (95%CI). Heterogeneity (I2) was assessed using Cochran's Q test. The risk of bias and quality of evidence was assessed using the Cochrane risk of bias tool and GRADE. Results Twenty-two studies comparing exercise and control groups were included. The risk of bias indicated some concerns in most studies, and the quality of evidence was rated very low. Interventions with moderate (MD = 1.91, 95%CI = .58 to 3.34) and progressive exercise intensity (MD = 2.70, 95%CI = 2.43 to 2.96) and volume (MD = 1.72, 95%CI = .59 to 2.85) showed greater improvements in VO2max. Conclusions Protocols that progressively increased exercise training parameters improved the cardiorespiratory fitness response. Progressive exercise might be more suitable for individuals with T2DM. Our conclusion may be limited due to the very low quality of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01205-5.
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Affiliation(s)
- Gabriela do Nascimento Cândido
- Graduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG CEP: 31270-901 Brazil
| | - Ana Paula Delgado Bomtempo Batalha
- Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Av. Eugênio Do Nascimento S/N, Juiz de Fora, MG CEP: 36038-330 Brazil
| | | | - Daniele Sirineu Pereira
- Department of Physical Therapy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG CEP: 31270-901 Brazil
| | - Raquel Rodrigues Britto
- Department of Physical Therapy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG CEP: 31270-901 Brazil
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Does Aerobic plus Machine-Assisted Resistance Training Improve Vascular Function in Type 2 Diabetes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis. J Clin Med 2022; 11:jcm11154257. [PMID: 35893348 PMCID: PMC9331013 DOI: 10.3390/jcm11154257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by hyperglycemia, insulin resistance, and pancreatic B cell dysfunction. Hyperglycemia can cause several complications, including nephrological, neurological, ophthalmological, and vascular complications. Many modalities, such as medication, physical therapies, and exercise, are developed against vascular disorders. Among all exercise forms, aerobic plus machine-assisted resistance training is widely applied. However, whether this intervention can significantly improve vascular conditions remains controversial. In this study, an electronic search was processed for the Pubmed, Embase, and Cochrane libraries for randomized controlled trials (RCTs) comparing the efficacy of aerobic plus machine-assisted resistance training with no exercise (control) on patients with T2DM. Pulse wave velocity (PWV), the index of arterial stiffness, was chosen as primary outcome. The reliability of the pooled outcome was tested by trial sequential analysis (TSA). Secondary outcomes included systolic blood pressure (SBP) and hemoglobin A1c (HbA1c). Finally, five RCTs with a total of 328 patients were included. Compared with control, aerobic plus machine-assisted resistance training failed to provide significant improvement on PWV (MD −0.54 m/s, 95% CI [−1.69, 0.60], p = 0.35). On the other hand, TSA indicated that this results till needs more verifications. Additionally, this training protocol did not significantly decrease SBP (MD −1.05 mmHg, 95% CI [−3.71, 1.61], p = 0.44), but significantly reduced the level of HbA1c (MD −0.55%, 95% CI [−0.88, −0.22], p = 0.001). In conclusion, this meta-analysis failed to detect a direct benefit of aerobic plus machine-assisted resistance training on vascular condition in T2DM population. Yet the improvement in HbA1c implied a potential of this training method in mitigating vascular damage. More studies are needed to verify the benefit.
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7
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Yang SY, Mirabal CS, Newcomb CE, Stewart KJ, Arking DE. Mitochondrial DNA copy number, metabolic syndrome, and insulin sensitivity: Insights from the Sugar, Hypertension, and Physical Exercise studies. PLoS One 2022; 17:e0270951. [PMID: 35849594 PMCID: PMC9292076 DOI: 10.1371/journal.pone.0270951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Mitochondrial DNA copy number (mtDNA-CN) measured in blood has been associated with many aging-related diseases, with higher mtDNA-CN typically associated with lower disease risk. Exercise training is an excellent preventative tool against aging-related disorders and has been shown to increase mitochondrial function in muscle. Using the Sugar, Hypertension, and Physical Exercise cohorts (N = 105), we evaluated the effect of 6-months of exercise intervention on mtDNA-CN measured in blood. Although there was no significant relationship between exercise intervention and mtDNA-CN change (P = 0.29), there was a nominally significant association between mtDNA-CN and metabolic syndrome (P = 0.04), which has been seen in previous literature. We also identified a nominally significant association between higher mtDNA-CN and higher insulin sensitivity (P = 0.02).
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Affiliation(s)
- Stephanie Y. Yang
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Caleb S. Mirabal
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Charles E. Newcomb
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Kerry J. Stewart
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Dan E. Arking
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Schneider VM, Frank P, Fuchs SC, Ferrari R. Effects of recreational sports and combined training on blood pressure and glycated hemoglobin in middle-aged and older adults: A systematic review with meta-analysis. Exp Gerontol 2021; 154:111549. [PMID: 34509590 DOI: 10.1016/j.exger.2021.111549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/21/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Combined resistance and aerobic training (CT) is the most suitable form of exercise training to simultaneously improve strength and cardiometabolic profile in middle-aged and older adults. Recreational sports (RS) emerge as an alternative to CT to improve these outcomes. We performed a meta-analysis on the effects of RS and CT on systolic blood pressure (SBP), diastolic blood pressure (DBP) and glycated hemoglobin (HbA1c) in middle-aged and older adults and to compare these exercise interventions to a non-exercising control group (CON). METHODS Search was conducted using the databases at PubMed, COCHRANE and SciELO between July and August 2020. Studies that included men and women aged ≥45 years, healthy or with values for SBP ≥130 mmHg or DBP ≥80 mmHg or with type 2 diabetes and performed RS or CT versus CON. RESULTS From 6017 records, 27 studies were included (9 RS and 18 CT). The analysis included 1411 participants with 55 ± 8 years. RS and CT were associated with reductions in SBP (RS: -7.2 mmHg, P = 0.03; CT: -3.6 mmHg, P < 0.001) and DBP (RS: -3.6 mmHg, P = 0.02; CT: -3.1 mmHg, P < 0.001) versus CON. Only CT was associated with a reduction in HbA1c versus CON (-0.47%; P < 0.001). CONCLUSIONS RS and CT are effective exercise interventions to improve BP in middle-aged and older adults. CT seems to be an excellent strategy to reduce HbA1c, and future studies are necessary to confirm the effectiveness of RS to improve HbA1c.
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Affiliation(s)
- Vinícius M Schneider
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Paula Frank
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Sandra C Fuchs
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Rodrigo Ferrari
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, RS, Brazil.
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Ooi TC, Mat Ludin AF, Loke SC, Fiatarone Singh MA, Wong TW, Vytialingam N, Anthony Abdullah MMJ, Ng OC, Bahar N, Zainudin N, Lew LC. A 16-Week Home-Based Progressive Resistance Tube Training Among Older Adults With Type-2 Diabetes Mellitus: Effect on Glycemic Control. Gerontol Geriatr Med 2021; 7:23337214211038789. [PMID: 34409130 PMCID: PMC8366135 DOI: 10.1177/23337214211038789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
Research has proven that aerobic exercise improves glucose homeostasis among patients with type 2 diabetes mellitus (T2DM). Elastic resistance (tube or band) is suggested as a good alternative for home-based strength training among older adults including those with T2DM due to its low cost, simplicity, portability, and versatility. This study aimed to measure the effects of 16-week home-based progressive resistance training (PRT), using a resistance tube on glucose homeostasis and cardiovascular risk factors among older adults with T2DM. A total of 70 participants aged 61.68 (5.50) years with T2DM were assigned to the intervention (n = 35) and control (n = 35) groups in this quasi-experimental trial. The intervention group underwent 16 weeks of home-based PRT using a resistance tube. Significant improvements in HbA1c (-1.34% point, p < 0.001), fasting blood glucose (-1.30 mmol/L, p < 0.001), and systolic blood pressure (-1.42 mmHg, p < 0.05) were observed after 16 weeks of intervention. However, no significant changes were observed in lipid profile, diastolic blood pressure, resting heart rate, and ankle-brachial index. The finding suggests that 16 weeks of home-based PRT using a resistance tube has the potential to improve glycemic control and reduce systolic blood pressure among older adults with T2DM and caused no adverse events.
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Affiliation(s)
- Theng Choon Ooi
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Program of Biomedical Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Seng Cheong Loke
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | | | | | - Ooi Chuan Ng
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Norhaniza Bahar
- Department of General Medicine, Serdang Hospital, Kajang, Malaysia
| | | | - Leong Chen Lew
- Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Program of Biomedical Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Saz-Lara A, Cavero-Redondo I, Álvarez-Bueno C, Notario-Pacheco B, Reina-Gutiérrez S, Sequí-Domínguez I, Ruiz JR, Martínez-Vizcaíno V. What type of physical exercise should be recommended for improving arterial stiffness on adult population? A network meta-analysis. Eur J Cardiovasc Nurs 2021; 20:696-716. [PMID: 33837399 DOI: 10.1093/eurjcn/zvab022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
AIMS Physical exercise has been associated with a reduction in arterial stiffness, a subclinical process underlying cardiovascular disease. However, the effect of different types of exercise (aerobic, resistance, combined, interval training, stretching, or mind-body modalities) on arterial stiffness is unclear. This network meta-analysis aimed to examine the effectiveness of different types of exercise on arterial stiffness as measured by pulse wave velocity in adults. METHODS AND RESULTS We searched Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE (via Pubmed), Embase, and Web of Science databases, for randomized clinical trials including at least a comparison group, from their inception to 30 June 2020. A frequentist network meta-analysis was performed to compare the effect of different types of physical exercise on arterial stiffness as measured by pulse wave velocity. Finally, 35 studies, with a total of 1125 participants for exercise intervention and 633 participants for the control group, were included. In the pairwise meta-analyses, the exercises that improved arterial stiffness were: interval training [effect size (ES) 0.37; 95% confidence interval (CI) 0.01-0.73], aerobic exercise (ES 0.30; 95% CI 0.13-0.48) and combined exercise (ES 0.22; 95% CI 0.04-0.40). Furthermore, the network meta-analysis showed that mind-body interventions were the most effective type of exercise to reduce the pulse wave velocity (ES 0.86; 95% CI 0.04-1.69). In addition, combined exercise (ES 0.35; 95% CI 0.08-0.62), aerobic exercise (ES 0.33; 95% CI 0.09-0.57), and interval training (ES 0.33; 95% CI 0.02-0.64) showed significant improvements. CONCLUSION Our findings showed that aerobic exercise, combined exercise, interval training, and mind-body exercises were the most effective exercise modalities for reducing arterial stiffness, assuming an important role in the prevention of cardiovascular diseases.
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Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain.,Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Av. República 71, Santiago, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Mayor Sebastián Bullo, 001518 Asunción, Paraguay
| | - Blanca Notario-Pacheco
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain
| | - Irene Sequí-Domínguez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain
| | - Jonatan R Ruiz
- PROmoting FITness and Health through physical activity Research Group (PROFITH), Department of Physical Activity and Sports Education, Sport and Health, University Research Institute (iMUDS), Faculty of Sports Science, University of Granada, Crta Alfacar s/n. 18011 Granada, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain.,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Av. Pedro de Valdivia 425, Talca, Chile
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Sabuncu T, Sonmez A, Eren MA, Sahin I, Çorapçioğlu D, Üçler R, Akin Ş, Haymana C, Demirci İ, Atmaca A, Ersöz HÖ, Satman I, Bayram F. Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study). Prim Care Diabetes 2021; 15:332-339. [PMID: 33277201 DOI: 10.1016/j.pcd.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey. METHODS Patients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg. RESULTS A total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04-1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05-1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01-1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15-1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively. CONCLUSION Our findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.
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Affiliation(s)
- Tevfik Sabuncu
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey
| | - Alper Sonmez
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mehmet Ali Eren
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey.
| | - Ibrahim Sahin
- Inonu University, Faculty of Medicine, Department of Endocrinology and Metabolism, Malatya, Turkey
| | - Demet Çorapçioğlu
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Rıfkı Üçler
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Endocrinology and Metabolism, Van, Turkey
| | - Şafak Akin
- Ankara Memorial Hospital, Ankara, Turkey
| | - Cem Haymana
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - İbrahim Demirci
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ayşegül Atmaca
- On Dokuz Mayıs University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Halil Önder Ersöz
- Karadeniz Teknik University, Faculty of Medicine, Department of Endocrinology and Metabolism, Trabzon, Turkey
| | - Ilhan Satman
- Istanbul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey
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12
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Cavero-Redondo I, Deeks JJ, Alvarez-Bueno C, Jolly K, Saz-Lara A, Price M, Pascual-Morena C, Martínez-Vizcaíno V. Comparative effect of physical exercise versus statins on improving arterial stiffness in patients with high cardiometabolic risk: A network meta-analysis. PLoS Med 2021; 18:e1003543. [PMID: 33591983 PMCID: PMC7924736 DOI: 10.1371/journal.pmed.1003543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 01/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The comparative analysis of the effect of several doses of statins against different intensities of physical exercise on arterial stiffness (a measure of cardiovascular risk) could shed light for clinicians on which method is most effective in preventing cardiovascular disease (CVD) and be used to inform shared decision-making between doctors and patients. This study was aimed at analyzing the effect, in high cardiometabolic risk patients, of different statins doses and exercise intensities on arterial stiffness (a measure of cardiovascular risk) by integrating all available direct and indirect evidence in network meta-analyses. METHODS AND FINDINGS We systematically searched MEDLINE, Embase, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to February 28, 2020; for unpublished trials, we also searched ClinicalTrials.gov. We searched for studies concerning the effect of statins or physical exercise on arterial stiffness, measured by pulse wave velocity (PWV). For methodological quality assessment, Cochrane Collaboration's tool for assessing risk of bias (RoB2) was used. A network geometry graph was used to assess the strength of the evidence. Comparative evaluation of the interventions effect was performed by conducting a standard pairwise meta-analysis and a network meta-analysis (NMA) for direct and indirect comparisons between interventions and control/nonintervention. A total of 22 studies were included in the analyses (18 randomized controlled trials (RCTs) and 4 nonrandomized experimental studies), including 1,307 patients with high cardiometabolic risk from Asia (3 studies), Oceania (2 studies), Europe (10 studies), North America (5 studies), and South America (2 studies). The overall risk of bias assessed with RoB2 was high in all included studies. For standard pairwise meta-analysis and NMA, high-intensity exercise versus control (mean difference (MD) -0.56; 95% CI: -1.01, -0.11; p = 0.015 and -0.62; 95% CI: -1.20, -0.04; p = 0.038, respectively) and moderate statin dose versus control (MD -0.80, 95% CI: -1.59, -0.01; p = 0.048 and -0.73, 95% CI: -1.30, -0.15; p = 0.014, respectively) showed significant MDs. When nonrandomized experimental studies were excluded, the effect on high-intensity exercise versus control and moderate statin dose versus was slightly modified. The main limitation of this study was that the magnitude of the effect of the exercise interventions could be underestimated due to regression toward the mean bias because the baseline cardiometabolic risk profile of patients in the physical exercise intervention trials was healthier than those in the statins ones; consequently, more modest improvements in physical exercise interventions compared to statins interventions can be expected. Additionally, we might consider as limitations the small study sizes, the heterogeneous patient groups, the focus on a proxy endpoint (PWV), and the high risk of bias. CONCLUSIONS In this NMA, we found that although many patients could benefit from statins for reducing CVD risk, our results support that, considering the beneficial effects of high-intensity exercise on arterial stiffness, it would be worthwhile to refocus our attention on this type of exercise as an effective tool for the prevention of CVD. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123120.
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Affiliation(s)
- Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - 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
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13
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Sanches A, Guzzoni V, Miranda VCDR, Peressim LB, Rocha S, de Lima PO, Marcondes FK, Tanno AP, Cunha TS. Recreational training improves cardiovascular adaptations, metabolic profile and mental health of elderly women with type-2 diabetes mellitus. Health Care Women Int 2020; 42:1279-1297. [DOI: 10.1080/07399332.2020.1821689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andrea Sanches
- Physiotherapy Course, Faculty of Americana, Santa Barbara d’Oeste, Sao Paulo, Brazil
| | - Vinicius Guzzoni
- Department of Cellular and Molecular Biology, Federal University of Paraíba, Paraíba, Brazil
| | | | | | - Suellen Rocha
- Physiotherapy Course, Faculty of Americana, Santa Barbara d’Oeste, Sao Paulo, Brazil
| | - Patrícia Oliveira de Lima
- Piracicaba Dental School, Department of Biosciences, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Fernanda Klein Marcondes
- Piracicaba Dental School, Department of Biosciences, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Ana Paula Tanno
- College of Health Sciences, Methodist University of Piracicaba, Piracicaba, Sao Paulo, Brazil
| | - Tatiana Sousa Cunha
- Science and Technology Institute, Federal University of São Paulo, São Paulo, Brazil
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14
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Melo KCB, Araújo FDS, Cordeiro Júnior CCM, de Andrade KTP, Moreira SR. Pilates Method Training: Functional and Blood Glucose Responses of Older Women With Type 2 Diabetes. J Strength Cond Res 2020; 34:1001-1007. [PMID: 29985228 DOI: 10.1519/jsc.0000000000002704] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Melo, KCB, Araújo, FdS, Cordeiro Júnior, CCM, de Andrade, KTP, and Moreira, SR. Pilates method training: Functional and blood glucose responses of older women with type 2 diabetes. J Strength Cond Res 34(4): 1001-1007, 2020-The objective of this study was to investigate the effect of 12 weeks of the Pilates method on the functional capacity (FC) and glycemic control of older women with type 2 diabetes (T2D). Twenty-two women with T2D were randomized into control (CONTROL: 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg) and Pilates (PILATES: 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg) groups, which held sessions of 60 minutes at a frequency of 3 times per week during 12 weeks. Blood glucose was measured before and after sessions in PILATES, as well as in moments of pre, rest, 4, 8, and 12 weeks of the PILATES and CONTROL interventions. The glycated hemoglobin (HbA1c) level before and after 12 weeks of the intervention was evaluated. The general index of the FC (GIFC) was obtained through a battery of tests for older patients with T2D. Analysis of variance detected differences in the GIFC for PILATES vs. CONTROL, respectively, in 4 weeks (30.3 ± 4.6 vs. 34.8 ± 4.9 seconds; p < 0.05), 8 weeks (29.2 ± 4.5 vs. 34.6 ± 4.9 seconds; p < 0.05), and 12 weeks (27.2 ± 4.0 vs. 35.3 ± 4.6 seconds; p < 0.05). PILATES presented a difference in postprandial glycemia pre- vs. 4 and 12 weeks (246.1 ± 58.5 vs. 219.9 ± 59.9 and 207.6 ± 49.1 mg·dl, respectively; p < 0.05), as well as in HbA1c pre- vs. 12 weeks (7.8 ± 1.0 vs. 6.7 ± 0.6%, respectively; p < 0.05). Differences in postprandial glycemia (p < 0.05) were found in PILATES before vs. after sessions, respectively, of 1st-12th (217.1 ± 49.1 vs. 157.9 ± 55.7 mg·dl), 13th-24th (204.5 ± 44.7 vs. 146.3 ± 44.5 mg·dl), and 25th-36th (214.3 ± 40.4 vs. 152.7 ± 52.0 mg·dl). A correlation between postprandial glycemia and GIFC after 12 weeks was detected (r = 0.37; p = 0.04). It is concluded that 12 weeks of the Pilates method induces improvement and relationship in the FC and glycemic control in older women with T2D.
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Affiliation(s)
- Karla Cinara Bezerra Melo
- Graduate Program of Physical Education, Federal University of Vale do São Francisco, UNIVASF, PE, Petrolina, Brazil
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15
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Exercise training reduces arterial stiffness in adults with hypertension: a systematic review and meta-analysis. J Hypertens 2020; 39:214-222. [PMID: 32833924 DOI: 10.1097/hjh.0000000000002619] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arterial stiffness, namely pulse wave velocity (PWV), is an emerging biomarker in the assessment of vascular health. This meta-analysis aims to determine the effects of exercise training on PWV in patients with hypertension, and to identify the possible moderator variables (e.g. type of exercise) of the effect of exercise on PWV. METHODS MEDLINE, EMBASE, Cochrane and Web of Science were searched up until July 2019 for randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in adults with hypertension. Random-effects modelling was used to compare changes from pre to postintervention in PWV between exercise and control groups. Data were reported as weighted mean difference (WMD) and 95% confidence interval (95% CI). Protocol registration: PROSPERO registration number CRD42019138658. RESULTS We included 14 trials (15 interventions), involving five aerobic, two dynamic resistance, six combined and two isometric resistance groups, totalling 642 participants with hypertension. PWV was significantly reduced by exercise training [(WMD (95% CI) = -0.76 m/s (-1.05 to -0.47)]. Analysis of moderator variables showed that aerobic exercise [WMD (95% CI) = -0.70 m/s (-1.20 to -0.19)], combined exercise [WMD (95% CI) = -0.74 m/s (-1.41 to -0.08)] and isometric resistance exercise [WMD (95% CI) = -0.98 m/s (-1.24 to -0.73)] reduced PWV. There was no significant reduction in PWV in participants undertaking dynamic resistance training [WMD (95% CI) = -0.58 (-1.58 to 0.42)]. CONCLUSION This meta-analysis supports that exercise interventions based on aerobic, combined or isometric exercise are suitable to improve PWV in adults with hypertension.
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16
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Brito LC, Azevêdo L, Peçanha T, Fecchio RY, Rezende RA, da Silva GV, Pio-Abreu A, Mion D, Halliwill JR, Forjaz CLM. Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men. Clin Exp Hypertens 2020; 42:722-727. [PMID: 32589058 DOI: 10.1080/10641963.2020.1783546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB). METHODS Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and considering P < .05 as significant. RESULTS In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 ± 8 vs -6 ± 6 and ACEi = -6 ± 7 vs. -8 ± 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014). CONCLUSIONS ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.
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Affiliation(s)
- Leandro C Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo , Brazil
| | - Luan Azevêdo
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo , Brazil
| | - Tiago Peçanha
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo , Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo , Brazil
| | | | | | - Andrea Pio-Abreu
- Hypertension Unit, General Hospital, Medical School, University of São Paulo , Brazil
| | - Décio Mion
- Hypertension Unit, General Hospital, Medical School, University of São Paulo , Brazil
| | - John R Halliwill
- Department of Human Physiology, University of Oregon , Eugene, USA
| | - Claudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo , Brazil
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Effects of Exercise Intervention on Adults With Both Hypertension and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. J Cardiovasc Nurs 2020; 36:23-33. [PMID: 32011348 DOI: 10.1097/jcn.0000000000000651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The positive effect of exercise on blood pressure has been reported in studies that investigated mostly patients with hypertension but without diabetes mellitus. However, the effect of exercise in adults with both hypertension and type 2 diabetes mellitus (T2DM) is unclear, and no systematic review and meta-analysis has been conducted to clarify this effect. OBJECTIVE This study was a systematic review and meta-analysis designed to investigate the effects of exercise on adults with both hypertension and T2DM. METHODS Studies were selected using electronic databases. Data were extracted using a standardized protocol. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, a meta-analysis of the studies was conducted. RESULTS Of 3207 publications identified, 8 trials were used to estimate the effect size of exercise. Effect sizes (weighted mean difference [WMD]) were heterogeneous, and random-effects models were used. Exercise was effective for systolic blood pressure (WMD, -5.25 mm Hg; 95% confidence interval [CI], -8.39 to -2.12), diastolic blood pressure (WMD, -3.16 mm Hg; 95% CI, -4.91 to -1.40), body mass index (WMD, -1.47 kg/m; 95% CI, -2.39 to -0.55), and waist circumference (WMD, -2.91 cm; 95% CI, -5.68 to -0.15). In subgroup analyses, aerobic exercise seemed to be the most effective intervention for lowering systolic (WMD, -9.43 mm Hg; 95% CI, -13.63 to -5.23) and diastolic (WMD, -5.90 mm Hg; 95% CI, -7.69 to -4.11) blood pressure. CONCLUSIONS Exercise seemed effective in reducing systolic and diastolic blood pressure, with subgroup analyses indicating that this effect was most profound with aerobic exercise.
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Gajanand T, Keating SE, Brown WJ, Hordern MD, Fassett RG, Coombes JS. Comparing the Efficacy of Supervised and Unsupervised Exercise Training on Glycaemic Control in Type 2 Diabetes: A Systematic Review. Curr Diabetes Rev 2020; 16:570-579. [PMID: 30747073 DOI: 10.2174/1573399815666190212120404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/19/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Exercise training is vital for glycaemic control in patients with type 2 diabetes mellitus (T2D). While the positive effects of supervised exercise training are well established, unsupervised training may offer an alternative and more sustainable means of realising the benefits of exercise away from a resource-heavy supervised setting. OBJECTIVE To evaluate the available literature and compare the efficacy of supervised and unsupervised exercise training programs on glycemic control in patients with T2D. METHODS CINAHL, MEDLINE, PubMed, and EMBASE, searched from inception to 20 July 2018. Only studies that included both supervised and unsupervised training were included. RESULTS Four studies, involving 115 participants, were included. One compared supervised with unsupervised exercise training and three investigated the efficacy of unsupervised training following supervised training. While supervised training is effective for improving glycaemic control in patients with T2D, unsupervised training may not maintain these changes. Included studies lacked detail relating to the supervised and unsupervised training programs. CONCLUSIONS Given that exercise is a critical component for maintenance of glycaemic control in patients with T2D, and because unsupervised training has been shown to be effective in improving clinical outcomes in other disease populations, further research is warranted to compare supervised and unsupervised exercise training in patients with T2D. It is important that future studies report standardised and detailed descriptions of key elements that form the basis of supervised and unsupervised exercise training groups.
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Affiliation(s)
- Trishan Gajanand
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew D Hordern
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Robert G Fassett
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 98:103-116. [PMID: 30020090 DOI: 10.1097/phm.0000000000001002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of -0.45% (P < 0.00001) and 0.03 (P = 0.002), respectively; the differences in within-group changes in glycated hemoglobin were synthesized, yielding mean differences of -0.19% (P = 0.1), -0.25% (P = 0.0006), and -0.64% (P = 0.006) for aerobic versus resistance, combined versus aerobic, and combined versus resistance exercise, respectively. Exercise has a significant effect on reducing glycated hemoglobin, whereas combined exercise is more effective compared with aerobic or resistance exercise alone. Exercise also improves ankle brachial index. However, evidence regarding the association between exercise and peripheral neuropathy and risks of diabetic foot ulcers in people with type 2 diabetes mellitus remains insufficient.
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Dos Santos Araujo JE, Nunes Macedo F, Sales Barreto A, Viana Dos Santos MR, Antoniolli AR, Quintans-Junior LJ. Effects of Resistance and Combined training on Vascular Function in Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials. Rev Diabet Stud 2019; 15:16-25. [PMID: 31132077 DOI: 10.1900/rds.2019.15.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes (T2D). Exercise can reduce the risk factors associated with CVD in T2D patients. However, research evaluating its beneficial effects in these patients has used different measurement protocols and types of exercise, complicating comparison. AIM To assess the effects of resistance training (RT) and combined training (CT) on the vascular function of T2D patients. METHODS A database search (MEDLINE, Scopus, and Web of Science) was performed to identify relevant articles that were published up to August 2017. Only original studies evaluating the effects of RT or CT interventions on vascular function in T2D patients were included. The articles were reviewed independently by at least three reviewers. The Cochrane guidelines were used to assess the methodological quality of the studies. Fourteen studies were finally included. Two studies only used RT and twelve studies used CT as intervention strategy. RESULTS AND CONCLUSIONS The results show that resistance training is a useful means for primary treatment of vascular diseases and maintenance of vascular function in T2D patients. However, more studies are necessary to gain full knowledge of the beneficial effects and to identify tailored exercise plans to optimize these benefits. The information provided in this review may help to improve current treatment of vascular diseases in T2D patients and to design future studies.
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Affiliation(s)
- João E Dos Santos Araujo
- Laboratory of Cardiovascular Pharmacology, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
| | - Fabrício Nunes Macedo
- Laboratory of Cardiovascular Pharmacology, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
| | - André Sales Barreto
- Laboratory of Cardiovascular Pharmacology, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
| | - Márcio R Viana Dos Santos
- Laboratory of Cardiovascular Pharmacology, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
| | - Angelo R Antoniolli
- Laboratory of Neurosciences and Pharmacological Trials, Department of Physiology, Federal University of Sergipe, Sergipe, Brazi
| | - Lucindo J Quintans-Junior
- Laboratory of Neurosciences and Pharmacological Trials, Department of Physiology, Federal University of Sergipe, Sergipe, Brazil
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Rao S, Pandey A, Garg S, Park B, Mayo H, Després JP, Kumbhani D, de Lemos JA, Neeland IJ. Effect of Exercise and Pharmacological Interventions on Visceral Adiposity: A Systematic Review and Meta-analysis of Long-term Randomized Controlled Trials. Mayo Clin Proc 2019; 94:211-224. [PMID: 30711119 PMCID: PMC6410710 DOI: 10.1016/j.mayocp.2018.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the effectiveness of exercise and pharmacotherapy interventions in reducing visceral adipose tissue (VAT). PATIENTS AND METHODS A systematic search of Ovid MEDLINE, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, New York Academy of Science Grey Literature Report, and OpenGrey was combined with hand searches of existing literature. A total of 2515 titles and abstracts were reviewed. Only randomized controlled trials evaluating the effectiveness of monitored exercise or pharmacological interventions in reducing VAT by using computed tomography or magnetic resonance imaging during a sustained intervention period (≥6 months) were included. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality and risk of bias. Separate analyses for each intervention were performed using random effect models, with pooled estimates of the change in VAT area (in centimeters squared) from baseline to follow-up reported as standardized mean difference (SMD; with 95% CI). RESULTS A total of 3602 participants from 17 randomized controlled trials were included in the final analysis. Both exercise and pharmacological interventions were associated with significant reductions in VAT: small reduction with pharmacological interventions (SMD, -0.27; 95% CI, -0.47 to -0.07; P=.02) and more substantial reductions with exercise interventions (SMD, -0.54; 95% CI, -0.63 to -0.46; P<.001). The mean absolute VAT reduction was greater in pharmacological trials than in exercise trials. Meta-regression exhibited a linear correlation between VAT and weight loss (R2=0.52 for exercise and R2=0.88 for pharmacological interventions), but VAT reduction relative to weight loss differed by intervention type. CONCLUSION Exercise interventions resulted in greater reduction in VAT relative to weight loss than did pharmacological interventions. A preferential reduction in VAT may be clinically meaningful when monitoring success of interventions because weight loss alone may underestimate benefits.
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Affiliation(s)
- Shreya Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sushil Garg
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis
| | - Bryan Park
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center, Dallas
| | | | - Dharam Kumbhani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ian J Neeland
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
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22
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Kemps H, Kränkel N, Dörr M, Moholdt T, Wilhelm M, Paneni F, Serratosa L, Ekker Solberg E, Hansen D, Halle M, Guazzi M. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:709-727. [PMID: 30642190 DOI: 10.1177/2047487318820420] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.
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Affiliation(s)
- Hareld Kemps
- 1 Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Nicolle Kränkel
- 2 Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Germany.,3 DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Marcus Dörr
- 4 University Medicine Greifswald, Department of Internal Medicine B, Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Trine Moholdt
- 6 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway.,7 St Olav's Hospital, Trondheim, Norway
| | - Matthias Wilhelm
- 8 Department of Cardiology, Bern University Hospital and University of Bern, Switzerland
| | - Francesco Paneni
- 9 Centre for Molecular Cardiology and Cardiology, Zurich University Hospital, University of Zurich, Switzerland
| | - Luis Serratosa
- 10 Hospital Universitario Quironsalud, Madrid, Spain.,11 Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Murcia, Spain
| | | | - Dominique Hansen
- 13 Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium.,14 Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Martin Halle
- 15 Technical University Munich, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,16 DZHK (German Centre for Cardiovascular Research), partner site Munich, Germany
| | - Marco Guazzi
- 17 University Cardiology Department and Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, I.R.C.C.S., Milan, Italy.,18 Policlinico San Donato University Hospital, Milan, Italy
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23
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Diets along with interval training regimes improves inflammatory & anti-inflammatory condition in obesity with type 2 diabetes subjects. J Diabetes Metab Disord 2018; 17:253-267. [PMID: 30918861 DOI: 10.1007/s40200-018-0368-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/01/2018] [Indexed: 12/11/2022]
Abstract
Background Different physical activities and diets change the regulation of inflammations in both type 2 diabetes (T2D) patients and obese individuals, but the effect of both (Physical activity and diet) on pro/anti-inflammations has remained unknown. We investigated pro/anti-inflammations control, cardiovascular function, and total physiological parameters before and after 24 weeks of low volume high intensity interval training (HIIT) on a cycle ergometer along with four dietary regimes in obesity with T2D patients. Methods 33 non-active obesity T2D patients (BMI ≥ 30) midges (47 yrs. ± 5) were volunteered to participate and randomly divided into three experimental(n = 11) [(1) LCD = low Carbohydrate Diet, (2) LFD = Low Fat Diet and (3) HFD = High Fat Diet)] and one control (n = 9) [ND = normal diet] groups. The whole groups performed underwent 8-week dietary regimes and then performed 3 days/weeks (3 set 10 × 60 s) HIIT on a cycle ergometer for 12 weeks, which followed by a 4-week diet period again. Also, prior to and after 8 weeks diet-12 weeks High Intensity Interval Training (HIIT) and 4 weeks diet 2-h oral glucose tolerance test (OGTT), resting blood pressure, incremental maximal oxygen uptake (VO2peak) cycle ergometer test and blood sample was collected from the subjects in order to measure pro/anti-inflammatory cytokines (IL-6, TNF-α, leptin, resistin, adiponectin, and FGF21). Results After 24 weeks of intervention, the results indicated that the highest improvement in the percentage of changes in glucose happened in LCD (-34.76), insulin in ND (+16.43), cholesterol in LCD (-33.35), LDL in LFD (-9.14), HDL in LCD (+41.81), TG in LCD (-40.71), weight in LCD (-12.49) and HOMA-IR in HFD (-6.82). The results also indicated that after 24 weeks of HIIT and diet interventions, highest benefit percentage change IL-6, resistin and leptin occurred in LCD (-32.10, -28.29 and - 53.92, respectively), TNF-α, FGF21 and adiponectin in LFD (-48.06, +55.30 and + 42.32, respectively). However, these changes were observed in other groups. Conclusions These results demonstrated that HIIT along with low carbohydrate regimes improves overall cardiovascular parameters and reduce pro-inflammatory markers and increase anti-inflammatory markers in type 2 diabetic patients. Additionally, as with HIIT along with low carbohydrate, HIIT coupled with low fat would improve inflammation markers, though these effects were less significant. These findings suggest that HIIT along with low carbohydrate is a beneficial exercise and dietary strategy in T2D patients.
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24
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Effects of Resistance Training on Arterial Stiffness in Persons at Risk for Cardiovascular Disease: A Meta-analysis. Sports Med 2018; 48:2785-2795. [DOI: 10.1007/s40279-018-1001-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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25
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McFarlane PA. Resistant Hypertension in Adults With Type 1 or 2 Diabetes: A Structured Diagnostic Approach. Can J Diabetes 2018; 42:173-178. [PMID: 29602405 DOI: 10.1016/j.jcjd.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
People with diabetes often have difficulty reaching their blood pressure targets and are labelled as having resistant hypertension. Clinicians often move quickly to screen such people for secondary causes of hypertension; however, such causes are rare, and resistant hypertension usually has other explanations that are significantly more common. By using a structured approach to resistant hypertension, clinicians can assist patients to reach their target blood pressure levels. Step 1 is to determine out-of-office blood pressure measurements using home or ambulatory blood pressure monitors. Step 2 is to determine the level of adherence to prescribed medications. Step 3 is to identify interfering substances. Step 4 is to check that the prescribed medications are synergistic and optimally dosed. Finally, if all other steps fail to get patients to their blood pressure targets, we consider possible secondary causes of hypertension. This approach is particularly useful in helping people with diabetes to reach their blood pressure targets.
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Affiliation(s)
- Philip A McFarlane
- Home Dialysis, Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
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26
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Støa EM, Meling S, Nyhus LK, Glenn Strømstad, Mangerud KM, Helgerud J, Bratland-Sanda S, Støren Ø. High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes. Eur J Appl Physiol 2017; 117:455-467. [PMID: 28160083 DOI: 10.1007/s00421-017-3540-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/09/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE It remains to be established how high-intensity aerobic interval training (HAIT) affects risk factors associated with type 2 diabetes (TD2). This study investigated effects of HAIT on maximal oxygen uptake (VO2max), glycated Hemoglobin type A1C (HbA1c), insulin resistance (IR), fat oxidation (FatOx), body weight (BW), percent body fat (%BF), lactate threshold (LT), blood pressure (BP), and blood lipid profile (BLP) among persons with T2D. Results were compared to the effects after a moderate-intensity training (MIT) program. METHODS Thirty-eight individuals with T2D completed 12 weeks of supervised training. HAIT consisted of 4 × 4 min of walking or running uphill at 85-95% of maximal heart rate, and MIT consisted of continuous walking at 70-75% of maximal heart rate. RESULTS A 21% increase in VO2max (from 25.6 to 30.9 ml kg-1 min-1, p < 0.001), and a reduction in HbA1c by -0.58% points (from 7.78 to 7.20%, p < 0.001) was found in HAIT. BW and body mass index (BMI) was reduced by 1.9% (p < 0.01). There was a tendency towards an improved FatOx at 60% VO2max (14%, p = 0.065). These improvements were significant different from MIT. Both HAIT and MIT increased velocity at LT, and reduced %BF, waist circumference, hip circumference, and BP, with no significant differences between the two groups. Correlations were found between change in VO2max and change in HbA1c when the two intervention groups were combined (R = -0.52, p < 0.01). CONCLUSION HAIT is an effective exercise strategy to improve aerobic fitness and reduce risk factors associated with T2D.
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Affiliation(s)
- Eva Maria Støa
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway.
| | - Sondre Meling
- Department of Endocrinology, Stavanger University Hospital, Former Hospital of Telemark, Stavanger, Norway
| | - Lill-Katrin Nyhus
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Glenn Strømstad
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Karl Magnus Mangerud
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Jan Helgerud
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Hokksund Medical Rehabilitation Center, Hokksund, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
| | - Øyvind Støren
- Department of Sports, Physical Education and Outdoor Life Studies, University College of Southeast Norway, Bø, Porsgrunn, Norway
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27
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Sabag A, Way KL, Keating SE, Sultana RN, O'Connor HT, Baker MK, Chuter VH, George J, Johnson NA. Exercise and ectopic fat in type 2 diabetes: A systematic review and meta-analysis. DIABETES & METABOLISM 2017; 43:195-210. [PMID: 28162956 DOI: 10.1016/j.diabet.2016.12.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/11/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
Abstract
Ectopic adipose tissue surrounding the intra-abdominal organs (visceral fat) and located in the liver, heart, pancreas and muscle, is linked to cardio-metabolic complications commonly experienced in type 2 diabetes. A systematic review and meta-analysis was performed to determine the effect of exercise on ectopic fat in adults with type 2 diabetes. Relevant databases were searched to February 2016. Included were randomised controlled studies, which implemented≥4 weeks of aerobic and/or resistance exercise and quantified ectopic fat via magnetic resonance imaging, computed tomography, proton magnetic resonance spectroscopy or muscle biopsy before and after intervention. Risk of bias and study quality was assessed using Egger's funnel plot test and modified Downs and Black checklist, respectively. Of the 10,750 studies retrieved, 24 were included involving 1383 participants. No studies were found assessing the interaction between exercise and cardiac or pancreas fat. One study assessed the effect of exercise on intramyocellular triglyceride concentration. There was a significant pooled effect size for the meta-analysis comparing exercise vs. control on visceral adiposity (ES=-0.21, 95% CI: -0.37 to -0.05; P=0.010) and a near-significant pooled effect size for liver steatosis reduction with exercise (ES=-0.28, 95% CI: -0.57 to 0.01; P=0.054). Aerobic exercise (ES=-0.23, 95% CI: -0.44 to -0.03; P=0.025) but not resistance training exercise (ES=-0.13, 95% CI: -0.37 to 0.12; P=0.307) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes. These data suggest that exercise effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aimed at reducing visceral fat in obesity-related type 2 diabetes. Further studies are required to assess the relative efficacy of exercise modality on liver fat reduction and the effect of exercise on pancreas, heart, and intramyocellular fat in type 2 diabetes and to clarify the effect of exercise on ectopic fat independent of weight loss.
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Affiliation(s)
- A Sabag
- Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia
| | - K L Way
- Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia
| | - S E Keating
- Faculty of Health Sciences, University of Sydney, NSW, Australia; Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, Australia
| | - R N Sultana
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; School of Exercise Science, Australian Catholic University, NSW, Australia
| | - H T O'Connor
- Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - M K Baker
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; School of Exercise Science, Australian Catholic University, NSW, Australia
| | - V H Chuter
- School of Health Sciences, University of Newcastle, NSW, Australia
| | - J George
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, NSW, Australia
| | - N A Johnson
- Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia.
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28
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Clark JE. The impact of duration on effectiveness of exercise, the implication for periodization of training and goal setting for individuals who are overfat, a meta-analysis. Biol Sport 2017; 33:309-333. [PMID: 28090136 PMCID: PMC5143767 DOI: 10.5604/20831862.1212974] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 04/14/2016] [Accepted: 06/19/2016] [Indexed: 01/28/2023] Open
Abstract
Given the assumption that all methods of exercise, e.g., endurance (ET), resistance (RT), or combination of both (E+R), can induce a beneficial effect size (ES) for changes in body composition and health status of individuals who are overfat. Thus the aim and purpose of this study is to evaluate the current body of knowledge to address the question as to the impact that the duration of exercise has on its relative effectiveness for inducing health and body compositional changes in individuals who are overfat to assist with developing periodized exercise protocols and establishing short and long term goals. A tiered meta-analysis of 92-studies and 200-exercise groupings were used for establishing pooled ES within and between groupings based on the increments of 4-week of duration and study designs of ≤8, 9-16, 17-23, 24-36, and ≥36 weeks. Analysis based on random-effect of response indicates a continuum of effectiveness within and between ET, RT and E+R based on duration. Where beneficial effectiveness is not indicated for any measures until after 8-weeks of continuous training with progressive effectiveness being noted in changes to cardiorespiratory fitness, inflammatory cytokines, and alteration of metabolic status from 12-weeks through 32-weeks of continuous training. Results indicate a greater ES for RT and E+R versus ET early in intervention that equalizes with longer durations. Supporting the use of RT and E+R within a periodized program. And secondarily, goals should be established first on performance gains and second body composition or health status modifications for the individual who is overfat.
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Affiliation(s)
- J E Clark
- Division of Mathematics, Science, and Health Careers; Department of Science, Manchester Community College, Manchester, CT, USA
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29
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Yalamanchi SV, Stewart KJ, Ji N, Golden SH, Dobs A, Becker DM, Vaidya D, Kral BG, Kalyani RR. The relationship of fasting hyperglycemia to changes in fat and muscle mass after exercise training in type 2 diabetes. Diabetes Res Clin Pract 2016; 122:154-161. [PMID: 27855341 PMCID: PMC5683408 DOI: 10.1016/j.diabres.2016.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 08/03/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022]
Abstract
AIMS Exercise training (ET) has been variably associated with body composition changes among persons with type 2 diabetes (T2DM). The degree to which these changes are related to hyperglycemia remains unclear. Our objective was to investigate the relationship of baseline fasting glucose (FG) to the magnitude of muscle gains and fat loss after ET in individuals with T2DM. METHODS Participants were enrolled in the SHAPE-2 trial, a six month supervised aerobic and resistance training intervention (three days/week), at Johns Hopkins. This was a post hoc single arm intervention study of participants who completed the exercise intervention (n=50). Participants were aged 40-65years and had T2DM that was not treated with insulin. Body composition was assessed by DEXA. RESULTS After 6months of ET, total fat mass decreased (-2.1±3.1kg) and total lean body mass (LBM) increased (0.5±2.0kg) overall, but there was variability among individual participants. There was an increase in % total LBM (1.4±1.9%) and decrease in % total body fat mass (-1.5±2.0%) after ET. Interestingly, each standard deviation (SD) increase in baseline FG (mean=135.5mg/dl; SD=39.0mg/dl) was related to a significant increase in % total LBM (0.54±0.26%, p=0.048) and decrease in % total body fat (-0.57±0.27%, p=0.04) after ET among individual participants. CONCLUSIONS Our data demonstrate that muscle gains and fat loss after ET are positively related to baseline hyperglycemia. Further studies are needed to characterize differences in metabolic response following ET among persons with diabetes.
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Affiliation(s)
- Swaytha V Yalamanchi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Kerry J Stewart
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Nan Ji
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Sherita H Golden
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Adrian Dobs
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Diane M Becker
- Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Brian G Kral
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
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30
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Funck KL, Laugesen E, Høyem P, Fleischer J, Cichosz SL, Christiansen JS, Hansen TK, Poulsen PL. Low Physical Activity Is Associated With Increased Arterial Stiffness in Patients Recently Diagnosed With Type 2 Diabetes. Am J Hypertens 2016; 29:882-8. [PMID: 26714500 DOI: 10.1093/ajh/hpv197] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/05/2015] [Indexed: 01/01/2023] Open
Abstract
AIMS Several studies have indicated that low physical activity is associated with increased risk of cardiovascular disease (CVD) and all-cause mortality among patients with diabetes. The association between physical activity and subclinical cardiovascular changes preceding clinical events remains to be elucidated. We investigated the relationship between physical activity and arterial stiffness, an independent predictor of CVD, in patients with type 2 diabetes and controls. METHODS We included 100 patients with type 2 diabetes and 100 sex- and age-matched controls in a cross-sectional study. Arterial stiffness (carotid-femoral pulse wave velocity, cfPWV) was measured using the SphygmoCor device (AtCor Medical, Sydney, Australia). Physical activity was assessed by an accelerometer (counts per minute (cpm), Actiheart (CamNtech, Cambridge, UK)) worn by the participants for up to 6 days. High vs. low levels of physical activity was defined according to the median level of activity (cpm = 31). RESULTS Sixty-five patients and 65 controls were included in the final analysis (median age 59 years, 55% men, median diabetes duration 1.9 years). Participants with low physical activity had higher cfPWV compared to participants with high physical activity: (i) Patients and controls combined: 9.3±1.7 m/s vs. 7.8±1.5 m/s, P < 0.001; (ii) Patients with diabetes: 9.5±1.8 m/s vs. 8.3±1.6 m/s, P = 0.02 and C) Controls: 9.0±1.4 m/s vs. 7.7±1.4 m/s, P < 0.01). The difference remained significant after adjustment for other determinants of cfPWV including whole body fat percentage (P < 0.01). No significant interaction between diabetes and the effect of low activity was seen. CONCLUSIONS Low physical activity is associated with increased arterial stiffness in patients recently diagnosed with type 2 diabetes and in healthy controls. CLINICAL TRIALS REGISTRATION Trial Number NCT00674271.
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Affiliation(s)
- Kristian L Funck
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark;
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Pernille Høyem
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Fleischer
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Simon L Cichosz
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Jens S Christiansen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Troels K Hansen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Per L Poulsen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
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Jiménez-Trujillo I, González-Pascual M, Jiménez-García R, Hernández-Barrera V, de Miguel-Yanes JM, Méndez-Bailón M, de Miguel-Diez J, Salinero-Fort MÁ, Perez-Farinos N, Carrasco-Garrido P, López-de-Andrés A. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection: An Observational Population-Based Study in Spain From 2001 to 2012. Medicine (Baltimore) 2016; 95:e3618. [PMID: 27149499 PMCID: PMC4863816 DOI: 10.1097/md.0000000000003618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To describe trends in the rates of discharge due to thoracic aortic aneurysm and dissection (TAAD) among patients with and without type 2 diabetes in Spain (2001-2012).We used national hospital discharge data to select all of the patients who were discharged from the hospital after TAAD. We focused our analysis on patients with TAAD in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or nondiabetic). Incidence was calculated overall and stratified by diabetes status. We divided the study period into 4 periods of 3 years each. We analyzed diagnostic and surgical procedures, length of stay, and in-hospital mortality.We identified 48,746 patients who were discharged with TAAD. The rates of discharge due to TAAD increased significantly in both diabetic patients (12.65 cases per 100,000 in 2001/2003 to 23.92 cases per 100,000 in 2010/2012) and nondiabetic patients (17.39 to 21.75, respectively). The incidence was higher among nondiabetic patients than diabetic patients in 3 of the 4 time periods.The percentage of patients who underwent thoracic endovascular aortic repair increased in both groups, whereas the percentage of patients who underwent open repair decreased. The frequency of hospitalization increased at a higher rate among diabetic patients (incidence rate ratio 1.14, 95% confidence interval [CI] 1.07-1.20) than among nondiabetic patients (incidence rate ratio 1.08, 95% CI 1.07-1.11). The in-hospital mortality was lower in diabetic patients than in nondiabetic patients (odds ratio 0.83, 95% CI 0.69-0.99).The incidence rates were higher in nondiabetic patients. Hospitalizations seemed to increase at a higher rate among diabetic patients. Diabetic patients had a significantly lower mortality, possibly because of earlier diagnoses, and improved and more readily available treatments.
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Affiliation(s)
- Isabel Jiménez-Trujillo
- From the Preventive Medicine and Public Health Teaching and Research Unit (IJ-T, MG-P, RJ-G, VH-B, PC-G, AL-D-A), Health Sciences Faculty, Rey Juan Carlos University, Alcorcon; Medicine Department (JMM-Y, MM-B), Hospital Gregorio Marañon; Pneumology Department (JDM-D), Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid; Dirección Técnica de Docencia e Investigación(MÁS-F), Gerencia Atención Primaria, Madrid; and Health Security Agency (NP-F), Ministry of Health. Madrid, Comunidad de Madrid, Spain
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Huang XL, Pan JH, Chen D, Chen J, Chen F, Hu TT. Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis. Eur J Intern Med 2016; 27:37-47. [PMID: 26655787 DOI: 10.1016/j.ejim.2015.11.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current meta-analysis evaluated the outcomes of various lifestyle interventions, including diet modifications (DIET), physical activity (PA), and patient education (EDU) in reducing the risk of cardiovascular disease in patients with type 2 diabetes. METHODS Randomized clinical trials comparing lifestyle intervention with "usual care" (control) in type 2 diabetes patients were hand-searched from medical databases by two independent reviewers using the terms "diabetes, cardiovascular risk, lifestyle, health education, dietary, exercise/physical activities, and behavior intervention". RESULTS Of the 235 studies identified, 17 were chosen for the meta-analysis. The average age of patients ranged from 50-67.3 years. Results reveal no significant difference between the groups, with respect to BMI, while PA and DIET yielded a greater reduction in HbA1c. Significant reduction in both systolic and diastolic pressures in the DIET group, and diastolic pressure in the PA group, was observed. HDL-c in the DIET group was significantly higher than the control group, while no change in LDL-c levels, was seen in all three intervention subtypes. There was no difference between the EDU vs. the control group in terms of HbA1c, blood pressure or HDL-c and LDL-c. CONCLUSION DIET intervention showed an improvement in HbA1c, systolic/diastolic blood pressure and HDL-c, with an exception of LDL-c and BMI, suggesting that nutritional intervention had a significant impact on the quality of life by reducing the cardiovascular risk in type 2 diabetes patients.
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Affiliation(s)
- Xiao-Li Huang
- Department of Nephrology, The First Hospital of Wuhan, China.
| | - Jian-Hua Pan
- Department of Nephrology, The First Hospital of Wuhan, China
| | - Dan Chen
- Department of Nephrology, The First Hospital of Wuhan, China
| | - Jing Chen
- Department of Nephrology, The First Hospital of Wuhan, China
| | - Fang Chen
- Department of Nephrology, The First Hospital of Wuhan, China
| | - Tao-Tao Hu
- Department of Nephrology, The First Hospital of Wuhan, China
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Figueira FR, Umpierre D, Cureau FV, Zucatti ATN, Dalzochio MB, Leitão CB, Schaan BD. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med 2015; 44:1557-72. [PMID: 25047852 DOI: 10.1007/s40279-014-0226-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes is associated with marked cardiovascular morbidity and mortality. However, the association between different types of exercise training and blood pressure (BP) changes is not fully clear in type 2 diabetes. OBJECTIVE The aim of this systematic review and meta-analysis of randomized controlled clinical trials (RCTs) was to determine the effects of structured exercise training (aerobic [AER], resistance [RES], or combined [COMB]) and physical activity (PA) advice only on BP changes in patients with type 2 diabetes. METHODS Searches in five electronic databases were conducted to retrieve studies published from 1980 to 2013. Eligible studies were RCTs consisting of structured exercise training or PA advice versus no intervention in patients with type 2 diabetes. We used random effect models to derive weighted mean differences (WMDs) of exercises on absolute changes in systolic BP (SBP) and diastolic BP (DBP). RESULTS A total of 30 RCTs of structured training (2,217 patients) and 21 of PA advice (7,323 patients) were included. Data were extracted independently in duplicate. Structured exercise was associated with reductions in SBP (WMD -4.22 mmHg; 95% confidence interval [CI] -5.89 to -2.56) and DBP (WMD -2.07 mmHg; 95% CI -3.03 to -1.11) versus controls. In structured exercise interventions, AER and RES were associated with declines in BP, and COMB was not associated with BP changes. However, in sensitivity analysis, a high-intensity protocol within COMB was associated with declines in SBP (WMD -3.30 mmHg; 95% CI -4.71 to -1.89). Structured exercise longer than 150 min/week was associated with greater BP reductions. PA advice only was associated with reduction in SBP (WMD -2.97 mmHg; 95% CI -4.52 to -1.43) and DBP (WMD -1.41 mmHg; 95% CI -1.94 to -0.88) versus controls. CONCLUSIONS AER, RES, and high-intensity combined training are associated with BP reduction in patients with type 2 diabetes, especially in exercise programs lasting more than 150 min/week. PA advice only is also associated with lower BP levels.
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Affiliation(s)
- Franciele R Figueira
- Exercise Pathophysiology Research Laboratory, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, Brazil
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Chen L, Pei JH, Kuang J, Chen HM, Chen Z, Li ZW, Yang HZ. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism 2015; 64:338-47. [PMID: 25467842 DOI: 10.1016/j.metabol.2014.10.018] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/19/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The effect of lifestyle intervention on clinical risk factors in patients with type 2 diabetes is unclear. The aim of this meta-analysis was to evaluate the effects of comprehensive lifestyle change, such as diet, exercise, and education, on clinical markers that are risk-factors for cardiovascular disease in patients with type 2 diabetes. METHODS We searched Medline, Cochrane, EMBASE, and Google Scholar (up to August 31, 2013) for randomized controlled trials that compared standard of care (control group) with treatment regimens that included changes in lifestyle (intervention group). The primary outcome was reduction in risk factors of cardiovascular disease including body mass index (BMI), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). RESULTS A total of 16 studies were included in the meta-analysis. The standardized difference in means of change from baseline significantly favored the intervention compared with the control group in BMI (-0.29; 95% CI, -0.52 to -0.06, P=0.014), HbA1c (-0.37; 95% CI, -0.59 to -0.14, P=0.001), SBP (-0.16: 95% CI, -0.29 to -0.03, P=0.016), DBP (-0.27, 95% CI=-0.41 to -0.12, P<0.001). There was no difference between the intervention and control groups in HDL-c (0.05; 95% CI, -0.10 to 0.21; P=0.503) and LDL-c (-0.14; 95% CI, -0.29 to 0.02; P=0.092). CONCLUSIONS The meta-analysis found that lifestyle intervention showed significant benefit in risk factors that are known to be associated with development of cardiovascular disease in patients with type 2 diabetes.
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Affiliation(s)
- Liang Chen
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China.
| | - Jian-Hao Pei
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
| | - Jian Kuang
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
| | - Hong-Mei Chen
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
| | - Zhong Chen
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
| | - Zhong-Wen Li
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
| | - Hua-Zhang Yang
- The First Division in Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106th of Zhongshan Er Road, Guangzhou 510080, China
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Montero D, Vinet A, Roberts CK. Effect of combined aerobic and resistance training versus aerobic training on arterial stiffness. Int J Cardiol 2014; 178:69-76. [PMID: 25464222 DOI: 10.1016/j.ijcard.2014.10.147] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/04/2014] [Accepted: 10/18/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND While aerobic exercise training may decrease arterial stiffness, the impact of combined aerobic and resistance training is unclear. Therefore, the aim of this study was to systematically review and quantify the effect of combined aerobic and resistance training on arterial stiffness, as determined by arterial pulse wave velocity (PWV), and compare it with aerobic training. METHODS MEDLINE, EMBASE and Web of Science were searched through November 2013 for randomized controlled trials evaluating the effect of aerobic or combined aerobic and resistance training on PWV. A meta-analysis was performed to determine the standardized mean difference (SMD) in PWV between exercise and control groups. Subgroup analyses were used to study potential moderating factors. RESULTS Twenty-one randomized controlled trials comparing exercise and control groups (overall n=752), met the inclusion criteria. After data pooling, PWV was decreased in aerobic trained groups compared with controls (10 trials, SMD=-0.52, 95% CI= -0.76, -0.27; P<0.0001) but did not reach statistical significance in combined trained groups compared with controls (11 trials, SMD=-0.23, 95% CI=-0.50, 0.04; P=0.10). The effect in aerobic trained groups did not differ compared with combined trained groups (P=0.12). In addition, aerobic training resulted in significantly lower SMD in PWV compared with combined training in interventions including a higher volume of aerobic training or assessing carotid-femoral PWV. CONCLUSIONS These data suggest that combined aerobic and resistance training interventions may have reduced beneficial effects on arterial stiffness compared with control interventions, but do not appear to differ significantly with aerobic training alone.
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Affiliation(s)
- David Montero
- Avignon University, LAPEC EA4278, F-84000 Avignon, France; Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Agnès Vinet
- Avignon University, LAPEC EA4278, F-84000 Avignon, France
| | - Christian K Roberts
- Exercise Physiology and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California, Los Angeles, CA, United States
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Ashor AW, Lara J, Siervo M, Celis-Morales C, Mathers JC. Effects of exercise modalities on arterial stiffness and wave reflection: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9:e110034. [PMID: 25333969 PMCID: PMC4198209 DOI: 10.1371/journal.pone.0110034] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/06/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity is associated with lower cardiovascular and all-cause mortality. However, the effects of different exercise modalities on arterial stiffness are currently unclear. Our objectives were to investigate the effects of exercise modalities (aerobic, resistance or combined) on pulse wave velocity (PWV) and augmentation index (AIx), and to determine whether the effects on these indices differed according to the participants' or exercise characteristics. METHODS We searched the Medline, Embase and Cochrane Library databases from inception until April 2014 for randomized controlled trials lasting ≥ 4 weeks investigating the effects of exercise modalities on PWV and AIx in adults aged ≥ 18 years. RESULTS Forty-two studies (1627 participants) were included in this analysis. Aerobic exercise improved both PWV (WMD: -0.63 m/s, 95% CI: -0.90, -0.35) and AIx (WMD:-2.63%, 95% CI: -5.25 to -0.02) significantly. Aerobic exercise training showed significantly greater reduction in brachial-ankle (WMD: -1.01 m/s, 95% CI: -1.57, -0.44) than in carotid-femoral (WMD: -0.39 m/s, 95% CI: -0.52, -0.27) PWV. Higher aerobic exercise intensity was associated with larger reductions in AIx (β: -1.55%, CI -3.09, 0.0001). In addition, aerobic exercise had a significantly larger effect in reducing PWV (WMD:-1.0 m/s, 95% CI: -1.43, -0.57) in participants with stiffer arteries (PWV ≥ 8 m/s). Resistance exercise had no effect on PWV and AIx. There was no significant effect of combined exercise on PWV and AIx. CONCLUSIONS We conclude that aerobic exercise improved arterial stiffness significantly and that the effect was enhanced with higher aerobic exercise intensity and in participants with greater arterial stiffness at baseline. TRIAL REGISTRATION PROSPERO Database registration: CRD42014009744.
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Affiliation(s)
- Ammar W. Ashor
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, United Kingdom
- College of Medicine, University of Al-Mustansiriyah, Baghdad, Iraq
- * E-mail:
| | - Jose Lara
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, United Kingdom
| | - Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, United Kingdom
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, United Kingdom
| | - John C. Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, United Kingdom
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Donley DA, Fournier SB, Reger BL, DeVallance E, Bonner DE, Olfert IM, Frisbee JC, Chantler PD. Aerobic exercise training reduces arterial stiffness in metabolic syndrome. J Appl Physiol (1985) 2014; 116:1396-404. [PMID: 24744384 DOI: 10.1152/japplphysiol.00151.2014] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The metabolic syndrome (MetS) is associated with a threefold increase risk of cardiovascular disease (CVD) mortality partly due to increased arterial stiffening. We compared the effects of aerobic exercise training on arterial stiffening/mechanics in MetS subjects without overt CVD or type 2 diabetes. MetS and healthy control (Con) subjects underwent 8 wk of exercise training (ExT; 11 MetS and 11 Con) or remained inactive (11 MetS and 10 Con). The following measures were performed pre- and postintervention: radial pulse wave analysis (applanation tonometry) was used to measure augmentation pressure and index, central pressures, and an estimate of myocardial efficiency; arterial stiffness was assessed from carotid-femoral pulse-wave velocity (cfPWV, applanation tonometry); carotid thickness was assessed from B-mode ultrasound; and peak aerobic capacity (gas exchange) was performed in the seated position. Plasma matrix metalloproteinases (MMP) and CVD risk (Framingham risk score) were also assessed. cfPWV was reduced (P < 0.05) in MetS-ExT subjects (7.9 ± 0.6 to 7.2 ± 0.4 m/s) and Con-ExT (6.6 ± 1.8 to 5.6 ± 1.6 m/s). Exercise training reduced (P < 0.05) central systolic pressure (116 ± 5 to 110 ± 4 mmHg), augmentation pressure (9 ± 1 to 7 ± 1 mmHg), augmentation index (19 ± 3 to 15 ± 4%), and improved myocardial efficiency (155 ± 8 to 168 ± 9), but only in the MetS group. Aerobic capacity increased (P < 0.05) in MetS-ExT (16.6 ± 1.0 to 19.9 ± 1.0) and Con-ExT subjects (23.8 ± 1.6 to 26.3 ± 1.6). MMP-1 and -7 were correlated with cfPWV, and both MMP-1 and -7 were reduced post-ExT in MetS subjects. These findings suggest that some of the pathophysiological changes associated with MetS can be improved after aerobic exercise training, thereby lowering their cardiovascular risk.
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Affiliation(s)
- David A Donley
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Sara B Fournier
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia; and
| | - Brian L Reger
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Evan DeVallance
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia; and
| | - Daniel E Bonner
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - I Mark Olfert
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia; and
| | - Jefferson C Frisbee
- Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia; and Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Paul D Chantler
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia; and
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Dobrosielski DA, Barone Gibbs B, Chaudhari S, Ouyang P, Silber HA, Stewart KJ. Effect of exercise on abdominal fat loss in men and women with and without type 2 diabetes. BMJ Open 2013; 3:e003897. [PMID: 24282247 PMCID: PMC3845055 DOI: 10.1136/bmjopen-2013-003897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the effect of exercise on abdominal adipose tissue in adults with and without type 2 diabetes mellitus (T2DM). DESIGN Post hoc analysis of two randomised controlled trials. SETTING Outpatient secondary prevention programme in Baltimore, Maryland, USA. PARTICIPANTS 97 men and women with prehypertension, stage 1 or medically controlled hypertension. 49% of the sample was also diagnosed with T2DM. INTERVENTION All participants completed a 26-week (6.5 months) supervised aerobic and resistance exercise programme following American College of Sports Medicine guidelines. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes in this post hoc analysis were total abdominal adipose tissue (TAT), subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) measured by MRI. Secondary outcomes were to determine whether the magnitude of abdominal fat change differed by diabetes status in men and women and to identify the predictors of change in abdominal fat distribution with exercise. RESULTS Overall, participants (mean age 61±6 years; 45% women) significantly improved peak oxygen uptake by 15% (p<0.01) and reduced weight by 2% (p<0.01). No change in SAT was observed after training. The reduction in VAT following exercise was attenuated in participants with T2DM (-3%) compared with participants who were non-T2DM (-18%, p<0.001 for the difference in change). The magnitude of VAT loss was associated with a decrease in body weight (r=0.50, p<0.001). After adjustment for weight change using regression analysis, diabetes status remained an independent predictor of the change in VAT. CONCLUSIONS Although participants with and without T2DM attained an exercise training effect as evidenced by increased fitness, VAT was unchanged in T2DM compared to those without T2DM, suggesting that these individuals may be resistant to this important benefit of exercise. The strategies for reducing cardiovascular disease risk in T2DM may be most effective when they include a weight loss component. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov Registry NCT00212303.
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Affiliation(s)
- Devon A Dobrosielski
- Department of Kinesiology, Towson University, Towson, Maryland, USA
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sameer Chaudhari
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Harry A Silber
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kerry J Stewart
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Barone Gibbs B, Dobrosielski DA, Althouse AD, Stewart KJ. The effect of exercise training on ankle-brachial index in type 2 diabetes. Atherosclerosis 2013; 230:125-30. [PMID: 23958264 PMCID: PMC3775271 DOI: 10.1016/j.atherosclerosis.2013.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/24/2013] [Accepted: 07/02/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM). METHODS Participants (n = 140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention. RESULTS Baseline ABI was 1.02 ± 0.02 in exercisers and 1.03 ± 0.01 in controls (p = 0.57). At 6 months, exercisers vs. controls improved ABI by 0.04 ± 0.02 vs. -0.03 ± 0.02 (p = 0.001). This change was driven by an increase in ankle pressures (p < 0.01) with no change in brachial pressures (p = 0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI <1.0 (0.14 ± 0.03 vs. 0.02 ± 0.02, p = 0.004), but not in those with a baseline ABI ≥1.0 (p = 0.085). The prevalence of ABI between 1.0 and 1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β = 0.061, p = 0.004). CONCLUSION These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. Clinicaltrials.gov Registry Number: NCT00212303.
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Affiliation(s)
- Bethany Barone Gibbs
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh, PA
| | | | | | - Kerry J. Stewart
- Johns Hopkins University School of Medicine, Division of Cardiology
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The effects of an exercise and lifestyle intervention program on cardiovascular, metabolic factors and cognitive performance in middle-aged adults with type II diabetes: a pilot study. Can J Diabetes 2013; 37:214-219. [PMID: 24070883 DOI: 10.1016/j.jcjd.2013.03.369] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Canada is experiencing a rise in type II diabetes mellitus (T2DM), a known risk factor for accelerated cognitive decline and dementia. Within the context of an aging population, this will impose significant individual and societal burden, making the development of prevention programs imperative. OBJECTIVE This pilot study examines the effects of the Diabetes Exercise and Healthy Lifestyle Service, a 24-week intervention program, on cardiovascular, metabolic regulation and cognitive function in adults with T2DM. METHODS Seventeen middle-aged participants provided blood samples for biological markers, underwent cognitive testing and a physical stress test pre- and post-intervention. Cognitive performance was evaluated using the California Verbal Learning Test (CVLT), Digit Symbol Substitution Tasl (DSST) and fluency test. RESULTS Adjusted models reveal participants displayed increased cardiovascular fitness (VO2 peak: Mchange=4.09 mL∙kg∙min(-1) SE=1.4), peak heart rate (Mchange= 9.28 beats⋅min(-1) SE=2.68) and change in heart rate (Mchange=10.71 SE=1.76) in response to the stress test (ps<0.05) following the 24-week intervention. A decrease in body mass index (BMI) (Mchange= -1.03 SE=0.40) and depressive symptomatology (CES-D: Mchange = -3.62 SE=1.44) was also found (ps<0.05). No change was found for lipid and glucose levels. Surprisingly, analyses showed that cognitive performance on the CVLT immediate recall (M= -4.37 SE=2.21), CVTL short-delay recall (M= -1.06 SE=0.55), DSST (Mchange= -3 SE=0.53) and category fluency (Mchange= -1.69 SE=0.78) declined following the intervention (ps<0.05); however, decline on the CVLT was limited to adults with co-morbid T2DM and hypertension. CONCLUSION Additional research is needed to evaluate the benefit of an exercise and lifestyle program that targets cognitive health in those with T2DM.
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Umpierre D, Ribeiro PAB, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 2013; 56:242-51. [PMID: 23160642 DOI: 10.1007/s00125-012-2774-z] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/29/2012] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Supervised exercise programmes improve glycaemic control in type 2 diabetes, but training characteristics associated with reduction in HbA(1c) remain unclear. We conducted a systematic review with meta-regression analysis of randomised clinical trials (RCTs) assessing the association between intensity and volume of exercise training (aerobic, resistance or combined) and HbA(1c) changes in patients with type 2 diabetes. METHODS Five electronic databases were searched (1980-2012) to retrieve RCTs of at least 12 weeks' duration, consisting of supervised exercise training vs no intervention, that reported HbA(1c) changes and exercise characteristics. Two independent reviewers conducted study selection and data extraction. RESULTS Twenty-six RCTs (2,253 patients) met the inclusion criteria. In multivariate analysis, baseline HbA(1c) and exercise frequency explained nearly 58% of between-study variance. Baseline HbA(1c) was inversely correlated with HbA(1c) reductions after the three types of exercise training. In aerobic training, exercise volume (represented by frequency of sessions) was associated with changes in HbA(1c) (weighted r = -0.64), while no variables were correlated with glycaemic control induced by resistance training. In combined training, weekly volume of resistance exercise explained heterogeneity in multivariate analysis and was associated with changes in HbA(1c) levels (weighted r = -0.70). CONCLUSIONS/INTERPRETATION Reduction in HbA(1c) is associated with exercise frequency in supervised aerobic training, and with weekly volume of resistance exercise in supervised combined training. Therefore, exercise volume is a major determinant of glycaemic control in patients with type 2 diabetes.
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Affiliation(s)
- D Umpierre
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Centro de Pesquisa Clínica-LaFiex, Porto Alegre, RS, Brazil.
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Barone Gibbs B, Dobrosielski DA, Bonekamp S, Stewart KJ, Clark JM. A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis 2012; 224:446-53. [PMID: 22889573 PMCID: PMC3459298 DOI: 10.1016/j.atherosclerosis.2012.07.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of an exercise intervention on flow-mediated dilation (FMD) and circulating endothelial biomarkers in adults with type 2 diabetes (T2DM). METHODS Sedentary adults (n = 140), aged 40-65, with T2DM and untreated pre or Stage I hypertension or treated hypertension were randomized to a 6-month, supervised, exercise program (3× week) or a sedentary control. Assessments included BMI, body and visceral fat, blood pressure, lipids, HbA1c, insulin sensitivity (QUICKI), fitness, FMD, E-selectin, P-selectin, intracellular and vascular cellular adhesion molecules (ICAM, VCAM), and tissue plasminogen activator (tPA). Intervention effects were compared by t-tests. Pearson's correlations were calculated between changes in cardiovascular risk factors and endothelial outcomes. RESULTS Exercisers significantly improved BMI (-0.6 kg/m(2)), body fat % (-1.4%), HbA1c (-0.5%), and fitness (2.9 mL/kg min) vs. controls (p < 0.05). However, there were no differences between groups in changes in FMD, E-selectin, P-selectin, ICAM, VCAM, or tPA. Among exercisers, changes in cardiovascular risk factors correlated with several biomarkers. Decreased P-selectin correlated with decreased BMI (r = 0.29, p = 0.04) and increased HDL cholesterol (r = -0.36, p = 0.01). Decreased ICAM correlated with decreased triglycerides and HbA1c (r = 0.30, p = 0.04; r = 0.31, p = 0.03) and increased QUICKI (r = - 0.28, p = 0.05). Decreased tPA correlated with decreased total body and visceral fat (r = 0.28, p = 0.05; r = 0.38, p = 0.008) and increased QUICKI (r = -0.38, p = 0.007). CONCLUSIONS While exercise resulted in improved fitness, body composition, and glycemic control, there were no changes in FMD or circulating endothelial biomarkers. The associations of changes in cardiovascular risk factors and endothelial biomarkers suggest that improvement in risk factors could mediate the exercise-induced improvements in endothelial function seen in prior studies.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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