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Watso JC, Robinson AT, Singar SAB, Cuba JN, Koutnik AP. Advanced cardiovascular physiology in an individual with type 1 diabetes after 10-year ketogenic diet. Am J Physiol Cell Physiol 2024; 327:C446-C461. [PMID: 38912731 PMCID: PMC11427101 DOI: 10.1152/ajpcell.00694.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
Adults with type 1 diabetes (T1D) have an elevated risk for cardiovascular disease (CVD) compared with the general population. HbA1c is the primary modifiable risk factor for CVD in T1D. Fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KD; ≤50 g carbohydrate/day) may improve glycemia and downstream vascular dysfunction in T1D by reducing HbA1c and insulin load. However, there are concerns regarding the long-term CVD risk from a KD. Therefore, we compared data collected in a 60-day window in an adult with T1D on exogenous insulin who consumed a KD for 10 years versus normative values in those with T1D (T1D norms). The participant achieved euglycemia with an HbA1c of 5.5%, mean glucose of 98 [5] mg/dL (median [interquartile range]), 90 [11]% time-in-range 70-180 mg/dL (T1D norms: 1st percentile for all), and low insulin requirements of 0.38 ± 0.03 IU/kg/day (T1D norms: 8th percentile). Seated systolic blood pressure (SBP) was 113 mmHg (T1D norms: 18th percentile), while ambulatory awake SBP was 132 ± 15 mmHg (T1D target: <130 mmHg), blood triglycerides were 69 mg/dL (T1D norms: 34th percentile), low-density lipoprotein was 129 mg/dL (T1D norms: 60th percentile), heart rate was 56 beats/min (T1D norms: >1SD below the mean), carotid-femoral pulse wave velocity was 7.17 m/s (T1D norms: lowest quartile of risk), flow-mediated dilation was 12.8% (T1D norms: >1SD above mean), and cardiac vagal baroreflex gain was 23.5 ms/mmHg (T1D norms: >1SD above mean). Finally, there was no indication of left ventricular diastolic dysfunction from echocardiography. Overall, these data demonstrate below-average CVD risk relative to T1D norms despite concerns regarding the long-term impact of a KD on CVD risk.NEW & NOTEWORTHY Adults with type 1 diabetes (T1D) have a 10-fold higher risk for cardiovascular disease (CVD) compared with the general population. We assessed cardiovascular health metrics in an adult with T1D who presented with a euglycemic HbA1c after following a ketogenic diet for the past 10 years. Despite concerns about the ketogenic diet increasing CVD risk, the participant exhibited below-average CVD risk relative to others with T1D when considering all outcomes together.
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Affiliation(s)
- Joseph C Watso
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, Indiana University, Bloomington, Indiana, United States
| | - Saiful Anuar Bin Singar
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jens N Cuba
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Andrew P Koutnik
- Sansum Diabetes Research Institute, Santa Barbara, California, United States
- Human Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
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Durans LHF, Santos ERV, Miranda TDC, Silva HNDSE, Júnior NDJSS, Macedo SRD, Mostarda CT. Impacts of covid-19 on sleep quality and autonomic function in elderly diabetic women. Auton Neurosci 2023; 249:103118. [PMID: 37657370 DOI: 10.1016/j.autneu.2023.103118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/19/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
AIM to analyze the quality of sleep and cardiac autonomic modulation of elderly diabetic women in the post-covid-19 syndrome. METHODOLOGY 41 elderly women, aged 60-75 years, with a diagnosis of Type 2 Diabetes Mellitus and who had covid-19 were included, divided into three groups: 14 in the Diabetes without covid-19 group (DG), 15 in the Diabetes with covid-19 group (CG), 12 in the Diabetes with covid-19 group who had Pulmonary Compromise (IG). Sleep quality was assessed using the Pittsburgh questionnaire, anamnesis, capillary blood glucose, blood pressure collection, anthropometry, resting electrocardiogram for 10 min for heart rate variability (HRV) analysis. Data were analyzed by 1-way ANOVA followed by Tukey-Kramer Multiple Comparisons Test, significance for p ≤ 0.05. RESULTS there was no significant difference in age, blood glucose, blood pressure, and body composition between the groups. In the analysis of sleep quality, there was significance in the following indices: sleep duration, sleep efficiency, sleep disturbances, and daytime sleepiness. Further, there was a reduction in autonomic indices between CG vs. DG: VarRR (ms2), SDNN (ms), SD1 (ms), TINN (ms), HF-log (ms2), LF-log (ms2); and between IG vs. DG: VarRR (ms2), SDNN (ms), RMSSD (ms), SD1 (ms), SD2 (ms), and HF-log (ms2). CONCLUSION it is suggestive that diabetic elderly women who had covid-19, with and without pulmonary impairment, have impaired sleep quality and interference on HRV with decreased parasympathetic autonomic modulation.
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Affiliation(s)
- Leonardo Hesley Ferraz Durans
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Ellian Robert Vale Santos
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Thamyres da Cruz Miranda
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Helen Nara da Silva E Silva
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Nivaldo de Jesus Silva Soares Júnior
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Sarah Raquel Dutra Macedo
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Cristiano Teixeira Mostarda
- Laboratory of Cardiovascular Adaptation to Exercise (LACORE), Physical Education Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.
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Saki H, Nazem F, Fariba F, Sheikhsharbafan R. A High intensity Interval training (running and swimming) and resistance training intervention on heart rate variability and the selected biochemical factors in boys with type 1 diabetes. Diabetes Res Clin Pract 2023; 204:110915. [PMID: 37742805 DOI: 10.1016/j.diabres.2023.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The purpose of this research is to investigate the effect of High Intensity Interval Training and Resistance training (HIITR) on heart rate variability (HRV), blood glucose, and plasma biomarkers levels in adolescents with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS 24 boys with T1D (FBS: 274.66 ± 52.99, age: 15.2 ± 1.78 years, and BMI = 19.61 ± 1.11) and 12 healthy boys (FBS: 92.75 ± 5.22, age: 15.08 ± 1.67 years, and BMI = 20.26 ± 2.66) were divided into three groups: Diabetes Training (DT, n = 12), Diabetes Control (DC, n = 12), and Healthy Control (HC, n = 12). HRV (24 h) was computed in time and frequency domains, anthropometric, biochemical parameters at rest, and aerobic capacity (VO2peak) obtained during a graded exercise testing (GXT). All variables were evaluated at the baseline and following 12 weeks of exercise training, done 3 days weekly. The statistical method used for data analysis was analysis of covariance (ANCOVA) test. RESULTS HRV, Hemoglobin A1c (HbA1c) and Fasting blood sugar (FBS), VO2peak, norepinephrine (NEP), and HDL-C indicated significant differences between both T1D groups compared to HC at baseline (p < 0.001). BMI, LDL-C, TC, and TG parameters were similar in all groups. HRV parameters, VO2peak and HDL-C, and NEP were significantly improved by exercise training, and HbA1c and FBS levels were significantly reduced (p < 0.001). There is a negative and significant correlation between LF/HF Ratio Difference (post-test minus pre-test) and VO2Peak Difference variables (post-test minus pre-test) (p < 0.001). CONCLUSIONS The present study suggests the importance of early screening for CVD risk factors in adolescent males with T1D. Also, it was revealed HIITR training compared to other training patterns, and cardiovascular health improves via enhancement of autonomic modulation, VO2peak, plasma lipids, and catecholamine levels.
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Affiliation(s)
- Hossein Saki
- Department of Exercise Physiology, Sports Science Faculty, Hamadan Bu Ali Sina University, Iran
| | - Farzad Nazem
- Department of Exercise Physiology, Sports Science Faculty, Hamadan Bu Ali Sina University, Iran.
| | - Farnaz Fariba
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Sheikhsharbafan
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Sousa AS, Passos MP, Ruberti OM, Jarrete AP, Delbin MA. Evaluation of coronary function in female rats with severe type 1 diabetes: Effects of combined treatment with insulin and pyridoxamine. Microvasc Res 2023; 146:104474. [PMID: 36592817 DOI: 10.1016/j.mvr.2022.104474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/06/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to evaluate the coronary function, myocardium, and epicardial adipose tissue (EAT) in female rats with severe type 1 diabetes and the effects of combined treatment with insulin and pyridoxamine (AGEs inhibitor). METHODS Female Wistar rats were divided into groups: control (CTR, n = 13), type 1 diabetes (DM1, n = 12), type 1 diabetes treated with insulin (DM1 + INS, n = 11), and type 1 diabetes treated with insulin and pyridoxamine (DM1 + INS + PDX, n = 14). The vascular responsiveness was performed in the septal coronary artery and the protein expressions of AGE, RAGE, GPER, NF-kB was evaluated in the left ventricle (LV), as well as the reactive oxygen species (ROS) was measured in LV and in EAT. We analyzed plasma levels of glucose, estradiol, Nε-carboxymethylisine (CML), thiobarbituric acid reactive substances (TBARS), catalase (CAT), and superoxide dismutase (SOD). RESULTS The maximal responses to ACh were reduced in the DM1 compared with the CTR group, accompanied by an increase in circulating glucose, CML, and TBARS. Additionally, the expression of NF-kB in LV and generation of ROS in the presence of MnTMPyP (SOD mimetic) were increased in the DM1 group compared with CTR. Only the combined treatment was effective for fully re-establish ACh relaxation response, NF-kB protein expression, ROS generation, and increased SOD activity in the DM1 + INS + PDX group. CONCLUSION The reduction of the endothelium-dependent relaxation response in the septal coronary artery of female rats with severe type 1 diabetes was normalized with the combined treatment with insulin and pyridoxamine, associated with reduced inflammation and oxidative stress in the myocardium and increased circulating antioxidant activity.
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Affiliation(s)
- Andressa S Sousa
- Department of Structural and Functional Biology, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Matheus P Passos
- Department of Structural and Functional Biology, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Olivia M Ruberti
- Department of Structural and Functional Biology, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Aline P Jarrete
- Department of Structural and Functional Biology, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria A Delbin
- Department of Structural and Functional Biology, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
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Oliveira Júnior FD, Pereira R, Silva A, Brito Alves JD, Costa-Silva J, Braga V, Balarini C. Different acquisition systems for heart rate variability analysis may lead to diverse outcomes. Braz J Med Biol Res 2022; 55:e11720. [PMID: 35137854 PMCID: PMC8852161 DOI: 10.1590/1414-431x2021e11720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
Heart rate variability (HRV) is a relevant physiological variable for the estimation of cardiac autonomic function. Although the gold standard for HRV registration is the electrocardiogram (ECG), several applications (APPs) have been increasingly developed. The evaluation carried out by these devices must be compatible with ECG standards. The aim of this study was to compare the data obtained simultaneously with ECG and APP with chest heart rate transmitters. Fifty-six healthy individuals (28 men and 28 women) were evaluated at rest through a short simultaneous HRV measurement with both devices. Data from both acquisition systems were analyzed separately using their own analysis software and exported and analyzed using a validated software. Signal recordings were compatible between the two acquisition systems (Pearson r=0.99; P<0.0001). Although a high correlation was found for the HRV variables obtained in the time domain (Spearman r=0.99; P<0.0001), the correlation decreased in the frequency domain (Pearson r=0.85; P<0.0001) when two software programs were used. Comparison of the averages of spectral analysis parameters also showed differences when HRV data were analyzed separately in each device for low-frequency (LF) and high-frequency (HF) bands. Although the portability of these mobile devices allows for optimal HRV evaluation, the direct analysis obtained from these devices must be carefully evaluated with respect to frequency domain parameters.
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Gunlu S, Aktan A. Evaluation of the heart rate variability in cardiogenic vertigo patients. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2022. [DOI: 10.4103/ijca.ijca_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Macartney MJ, Notley SR, Herry CL, Seely AJE, Sigal RJ, Kenny GP. Cardiac autonomic modulation in type 1 diabetes during exercise-heat stress. Acta Diabetol 2020; 57:959-963. [PMID: 32144491 DOI: 10.1007/s00592-020-01505-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/14/2020] [Indexed: 12/30/2022]
Abstract
AIMS Cardiac autonomic modulation, as assessed by heart rate variability (HRV), is independently attenuated by both type 1 diabetes (T1D) and exercise-heat stress, although their combined effects remain unclear. We therefore assessed HRV during exercise-heat stress in young individuals (18-37 years) with (n = 14) and without type 1 diabetes (n = 14). METHODS Participants completed 30-min seated rest and three, 30-min bouts of semi-recumbent cycling at light, moderate, and vigorous metabolic heat productions (200, 250, 300 W/m2, respectively), each followed by 30-min recovery. Body core temperature (Tcore) and electrocardiogram were recorded throughout and analyzed during the final 5-min of rest and each exercise period. RESULTS Relative to baseline, Tcore was increased in both groups, albeit to a greater extent in type 1 diabetes during vigorous exercise (T1D, 1.1 ± 0.3 °C; control, 0.8 ± 0.3 °C; P < 0.05). Overall HRV (as reflected by entropy) was attenuated throughout exercise relative to baseline in both groups, with the magnitude of the reduction greater in type 1 diabetes during vigorous exercise (T1D, - 108%; control, - 70%; P < 0.05). CONCLUSIONS Given the negative correlations between decreased HRV and cardiac risk, our novel observations indicate that vigorous exercise in hot environments may pose a health concern for individuals with type 1 diabetes.
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Affiliation(s)
- Michael J Macartney
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christophe L Herry
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Andrew J E Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Thoracic Surgery and Critical Care Medicine, The Ottawa Hospital, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Mourot L, Fornasiero A, Rakobowchuk M, Skafidas S, Brighenti A, Stella F, Zignoli A, Savoldelli A, Pellegrini B, Danese E, Lippi G, Tarperi C, Schena F. Similar cardiovascular and autonomic responses in trained type 1 diabetes mellitus and healthy participants in response to half marathon. Diabetes Res Clin Pract 2020; 160:107995. [PMID: 31901470 DOI: 10.1016/j.diabres.2019.107995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/04/2019] [Accepted: 12/30/2019] [Indexed: 01/30/2023]
Abstract
AIMS This field experiment examined whether trained people with type 1 diabetes mellitus (T1D) have similar cardiovascular and baroreflex alterations after a 21-km running race when compared to healthy people. METHODS Nine T1D (39.0 ± 11.1 yr; 175.0 ± 10.2 cm; 70.8 ± 8.7 kg) were matched with 9 healthy participants (42.4 ± 5.8 yr; 175.7 ± 6.7 cm; 72.1 ± 8.5 kg) who ran an official half-marathon. Before and 1-hour after the race, cardiovascular variables, sympathetic activity (catecholamines), parasympathetic (heart rate variability analysis) modulation and cardiac baroreflex function (transfer function analysis) were assessed during supine rest and a squat stand test (forced blood pressure change). RESULTS Performance time and weight loss [104.0 ± 13.2 and 111.0 ± 18.7 min; -2.57 ± 1.05 kg (-1.88 ± 0.88%) and -2.29 ± 1.15 kg (-1.59 ± 0.59%)] for healthy and T1D participants, respectively) were similar. Before running, no significant differences in any cardiovascular or autonomic variables were noted between the groups. After 1 h of recovery, both groups exhibited post-exercise hypotension, accompanied by increased sympathetic activity, decreased parasympathetic modulation, and reduced cardiac baroreflex sensitivity. CONCLUSIONS Our results showed that the pattern of change in cardiovascular and autonomic nervous activity to strenuous exercise are well maintained in T1D participants with a training history of at least 5 years.
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Affiliation(s)
- Laurent Mourot
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Platform, University of Bourgogne Franche-Comté, Besançon, France; National Research Tomsk Polytechnic University, Tomsk, Russia.
| | - Alessandro Fornasiero
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mark Rakobowchuk
- Department of Biological Sciences, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Spyros Skafidas
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alfredo Brighenti
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Platform, University of Bourgogne Franche-Comté, Besançon, France; CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Stella
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Zignoli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Aldo Savoldelli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Barbara Pellegrini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Danese
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Cantor Tarperi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Bonete G, Dias BAL, Leandro DAM, Fernandes ATNSF, Pereira CH, Ribeiro CTD, Sousa AGP, Resqueti V, Fregonezi GAF, Dias FAL. Impaired heart rate variability, Valsalva and 30:15 ratio indexes are associated with reduced submaximal exercise capacity in subjects with diabetes mellitus. Diabetes Res Clin Pract 2019; 155:107813. [PMID: 31408665 DOI: 10.1016/j.diabres.2019.107813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 01/28/2023]
Abstract
AIMS To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). METHODS Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. RESULTS Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms2 (IQR:18.6-35.4) vs. 45.1 (IQR:39.2-62.67), p < 0.001] and Total Power [median 785 ms2 (IQR:256-1264) vs. 1757 ms2 (IQR:1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 ± 6.4 vs. 95.2 ± 11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (ρ = -0.40), SDNN pre-6MWT (ρ = 0.39), TP pre-6MWT (ρ = 0.38), Valsalva ratio (ρ = 0.39) and 30:15 ratio (ρ = 0.38) were all correlated with maximal walked distance. CONCLUSIONS DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30:15 ratios), was associated with lower exercise capacity.
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Affiliation(s)
- Gislaine Bonete
- Federal University of Paraná - UFPR, Graduate Program in Physiology, Curitiba, PR, Brazil
| | - Bruna Alice L Dias
- Federal University of Rio Grande do Norte - UFRN, Department of Physical Therapy, Natal, RN, Brazil
| | - Daniela A M Leandro
- Federal University of Rio Grande do Norte - UFRN, Department of Physical Therapy, Natal, RN, Brazil
| | | | | | | | - André Gustavo Pires Sousa
- Federal University of Rio Grande do Norte - UFRN, Department of Clinical Medicine, Natal, RN, Brazil
| | - Vanessa Resqueti
- Federal University of Rio Grande do Norte - UFRN, Department of Physical Therapy, Natal, RN, Brazil
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Affiliation(s)
- Paula F. Martinez
- Faculdade de Fisioterapia, Universidade Federal de Mato Grosso do
Sul, Campo Grande - Brazil
| | - Marina P. Okoshi
- Departamento de Clínica Médica - Faculdade de
Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu,
SP – Brazil
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Rodrigues JAL, Ferrari GD, Fernandes IA, Ferezin LP, Trapé ÁA, Bueno Júnior CR. Caracterização da variabilidade da frequência cardíaca em indivíduos com síndrome metabólica. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172303164578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: A variabilidade da frequência cardíaca (VFC) tem sido considerada um mecanismo de modulação do sistema nervoso autônomo. A diminuição da VFC pode estar associada à síndrome metabólica (SM). Objetivo: Comparar a VFC e variáveis de saúde em indivíduos com e sem SM. Métodos: Cento e dezenove participantes foram divididos em dois grupos: sem SM (SSM, n = 68) e com SM (CSM, n = 51). Foi avaliada a análise espectral da VFC em repouso, durante teste cardiopulmonar de exercício (TCPE) e na recuperação em bandas de baixa frequência (LF = 0,04-0,15 Hz), alta frequência (HF = 0,15-0,4 Hz) e razão LF/HF. Adicionalmente, a frequência cardíaca (FC) de repouso (FCrep), FC máxima (FCmáx), pressão arterial sistólica (PAS) e diastólica (PAD), glicemia, perfil lipídico, consumo de oxigênio pico (VO2pico) e composição corporal foram avaliados. Resultados: A FCrep e o VO2pico não apresentaram diferenças entre o CSM e o SSM (73,3 ± 9,1 vs. 70,1 ± 11,0 bpm) (26,8 ± 4,6 vs. 28,1 ± 6,6 ml.kg-1.min-1), respectivamente. A VFC foi similar entre os grupos nos diferentes momentos analisados. A glicemia (99,8 ± 22,5 vs. 87,6 ± 8,6 mg/dl) foi superior no CSM comparado ao SSM. Os valores de triglicérides (159,5 ± 68,8 vs. 89,2 ± 34,3 mg/dl) e VLDL-c (31,9 ± 13,8 vs. 17,8 ± 6,9 mg/dl) foram superiores no CSM comparado ao SSM. O HDL-c (40,7 ± 11,5 vs. 49,3 ± 9,8 mg/dl) foi menor no CSM comparado ao SSM. O IMC (33,1 ± 4,7 vs. 30,8 ± 3,8 Kg/m²) foi superior no CSM comparado ao SSM. A PAS (128,6 ± 12,9 vs. 119,5 ± 11,3 mmHg) e a PAD (77,2 ± 10,5 vs. 72,9 ± 8,1 mmHg) foram superiores no CSM comparado ao SSM, p < 0,05. Conclusão: Os resultados sugerem que a presença de SM não é suficiente para provocar alterações nos índices de VFC em repouso, durante teste cardiopulmonar de exercício (TCPE) e na recuperação quando os pacientes são comparados a indivíduos sem a doença.
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Lenasi H, Klonizakis M. Assessing the evidence: Exploring the effects of exercise on diabetic microcirculation. Clin Hemorheol Microcirc 2017; 64:663-678. [PMID: 27767975 DOI: 10.3233/ch-168022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes mellitus (DM) is associated with cardiovascular complications. Impairment of glycemic control induces noxious glycations, an increase in oxydative stress and dearangement of various metabolic pathways. DM leads to dysfunction of micro- and macrovessels, connected to metabolic, endothelial and autonomic nervous system. Thus, assessing vascular reactivity might be one of the clinical tools to evaluate the impact of harmful effects of DM and potential benefit of treatment; skin and skeletal muscle microcirculation have usually been tested. Physical exercise improves vascular dysfunction through various mechanisms, and is regarded as an additional effective treatment strategy of DM as it positively impacts glycemic control, improves insulin sensitivity and glucose uptake in the target tissues, thus affecting glucose and lipid metabolism, and increases the endothelium dependent vasodilation. Yet, not all patients respond in the same way so titrating the exercise type individualy would be desirable. Resistance training has, apart from aerobic one, been shown to positively correlate to glycemic control, and improve vascular reactivity. It has been prescribed in various forms or in combination with aerobic training. This review would assess the impact of different modes of exercise, the mechanisms involved, and its potential positive and negative effects on treating patients with Type I and Type II DM, focusing on the recent literature.
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Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Markos Klonizakis
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
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Mascarenhas LPG, Decimo JP, Lima VAD, Kraemer GDC, Lacerda KRCD, Nesi-França S. Physical exercise in type 1 diabetes: recommendations and care. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600040001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Ferreira MJ, Zanesco A. Heart rate variability as important approach for assessment autonomic modulation. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-65742016000200001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Angelina Zanesco
- Universidade Estadual Paulista "Julio de Mesquita Filho", Brazil
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Katlandur H, Ozbek K, Keser A. Letter to the Editor: The effect of autonomic nervous system on the impairment of glucose uptake and lipid metabolism in epicardial adipose tissue. Am J Physiol Endocrinol Metab 2016; 310:E862. [PMID: 27182057 DOI: 10.1152/ajpendo.00047.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/21/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Huseyin Katlandur
- Department of Cardiology, Mevlana University, Faculty of Medicine, Konya, Turkey
| | - Kerem Ozbek
- Department of Cardiology, Mevlana University, Faculty of Medicine, Konya, Turkey
| | - Ahmet Keser
- Department of Cardiology, Mevlana University, Faculty of Medicine, Konya, Turkey
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Bradley TJ, Slorach C, Mahmud FH, Dunger DB, Deanfield J, Deda L, Elia Y, Har RLH, Hui W, Moineddin R, Reich HN, Scholey JW, Mertens L, Sochett E, Cherney DZI. Early changes in cardiovascular structure and function in adolescents with type 1 diabetes. Cardiovasc Diabetol 2016; 15:31. [PMID: 26879273 PMCID: PMC4754808 DOI: 10.1186/s12933-016-0351-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/05/2016] [Indexed: 01/24/2023] Open
Abstract
Background Children with type 1 diabetes (T1D) are at higher risk of early adult-onset cardiovascular disease. We assessed cardiovascular structure and function in adolescents with T1D compared with healthy controls and the relationships between peripheral vascular function and myocardial parameters. Methods and results 199 T1D [14.4 ± 1.6 years, diabetes duration 6.2 (2.0–12.8) years] and 178 controls (14.4 ± 2.1 years) completed endothelial function by flow mediated vasodilatation (FMD), arterial stiffness using pulse wave velocity (PWV) along with M-mode, pulse wave and tissue Doppler, and myocardial deformation echocardiographic imaging. Systolic (113 ± 10 vs. 110 ± 9 mmHg; p = 0.0005) and diastolic (62 ± 7 vs. 58 ± 7 mmHg; p < 0.0001) blood pressures, carotid femoral PWV and endothelial dysfunction measurements were increased in T1D compared with controls. Systolic and diastolic left ventricular dimensions and function by M-mode and pulse wave Doppler assessment were not significantly different. Mitral valve lateral e’ (17.6 ± 2.6 vs. 18.6 ± 2.6 cm/s; p < 0.001) and a’ (5.4 ± 1.1 vs. 5.9 ± 1.1 cm/s; p < 0.001) myocardial velocities were decreased and E/e’ (7.3 ± 1.2 vs. 6.7 ± 1.3; p = 0.0003) increased in T1D. Left ventricular mid circumferential strain (−20.4 ± 2.3 vs. −19.5 ± 1.7 %; p < 0.001) was higher, whereas global longitudinal strain was lower (−19.0 ± 1.9 vs. −19.8 ± 1.5 % p < 0.001) in T1D. Conclusions Adolescents with T1D exhibit early changes in blood pressure, peripheral vascular function and left ventricular myocardial deformation indices with a shift from longitudinal to circumferential shortening. Longitudinal follow-up of these changes in ongoing prospective trials may allow detection of those most at risk for cardiovascular abnormalities including hypertension that could preferentially benefit from early therapeutic interventions.
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Affiliation(s)
- Timothy J Bradley
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Cameron Slorach
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Farid H Mahmud
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - David B Dunger
- Department of Pediatrics, University of Cambridge, Cambridge, UK.
| | - John Deanfield
- University College Hospital, London, UK. .,Heart Hospital and Great Ormond Street Hospital, London, UK.
| | - Livia Deda
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Yesmino Elia
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Ronnie L H Har
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Wei Hui
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Heather N Reich
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
| | - James W Scholey
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Etienne Sochett
- Department of Paediatrics, Division of Endocrinology, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) Sick Kids Multicenter Clinical Trial Center, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, 8 N-845, Toronto, ON, M5G 2N2, Canada.
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