1
|
Marôco JL, Arrais I, Silvestre T, Pinto M, Laranjo S, Magalhães J, Santa-Clara H, Fernhall B, Melo X. Post-acute exercise cardiovagal modulation in older male adults with and without type 2 diabetes. Eur J Appl Physiol 2024; 124:1475-1486. [PMID: 38117338 PMCID: PMC11055715 DOI: 10.1007/s00421-023-05357-3] [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: 01/24/2023] [Accepted: 10/28/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE We examined heart rate variability (HRV) and baroreflex sensitivity (BRS) disease- and age-related response at 10-and 60-min after an acute high-intensity interval (HIIE) and moderate continuous exercise (MICE) in older adults with and without type 2 diabetes mellitus (T2DM) and healthy young adults. METHODS Twelve older male adults with (57-84 years) and without T2DM (57-76 years) and 12 healthy young male adults (20-40 years) completed an isocaloric acute bout of HIIE, MICE, and a non-exercise condition in a randomized order. Time and Wavelets-derived frequency domain indices of HRV and BRS were obtained in a supine position and offline over 2-min time-bins using Matlab. RESULTS HIIE but not MICE reduced natural logarithm root mean square of successive differences (Ln-RMSSD) (d = - 0.85; 95% CI - 1.15 to - 0.55 ms, p < 0.001), Ln-high-frequency power (d = - 1.60; 95% CI - 2.24 to - 0.97 ms2; p < 0.001), and BRS (d = - 6.32; 95% CI - 9.35 to - 3.29 ms/mmHg, p < 0.001) in adults without T2DM (averaged over young and older adults without T2DM), returning to baseline 60 min into recovery. These indices remained unchanged in older adults with T2DM after HIIE and MICE. Older adults with T2DM had lower resting Ln-RMSSD and BRS than aged-matched controls (Ln-RMSSD, d = - 0.71, 95% CI - 1.16 to - 0.262 ms, p = 0.001; BRS d = - 3.83 ms/mmHg), 95% CI - 6.90 to - 0.76, p = 0.01). CONCLUSIONS Cardiovagal modulation following acute aerobic exercise is intensity-dependent only in adults without T2DM, and appears age-independent. These findings provide evidence of cardiac autonomic impairments in older adults with T2DM at rest and following aerobic exercise.
Collapse
Affiliation(s)
- João Luís Marôco
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Inês Arrais
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Tiago Silvestre
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, Lisbon, Portugal
| | - Marco Pinto
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
| | - Sérgio Laranjo
- Department of Physiology, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center. NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Magalhães
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Helena Santa-Clara
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Bo Fernhall
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Xavier Melo
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal.
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511, Almada, Portugal.
| |
Collapse
|
2
|
Solanki JD, Hirani CN, Vohra AS, Panjwani SJ, Senta VM, Rudani DK. A Comparative Cross-Sectional Study of Cardiac Autonomic Status by Five Minute Heart Rate Variability among Type 2 Diabetics, Hypertensives and Normotensive-Nondiabetics. Niger Med J 2023; 64:373-381. [PMID: 38974060 PMCID: PMC11223023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Diabetes and hypertension are known to co-exist frequently as adverse cardiovascular risk factors. Both can produce cardiac autonomic neuropathythat can be measured by ECG RR interval-based heart rate variability (HRV). We compared 5 minutes HRV in four groups based on diabetes and hypertension. Methodology A cross sectional study was done on 203 participants divided into four groups- diabetics, hypertensives, diabetic-hypertensives and normotensive-nondiabetics. They were evaluated for current disease control and five minutes HRV was done in supine condition following standard protocols by Variowin HR Software. HRV parameters of time domain, frequency domain and Poincare plot were compared between groups and associated with gender, glycaemic control and blood pressure control. Statistical significance was set at p<0.05. Results Three diseasedgroups had mean age in mid-fifties, mean duration of disease > 6 years, comparable BMI, poor glycaemic and blood pressure control. As compared to normal groups, three diseased groups exhibit reduced HRV with respect to all three domains of HRV with varying statistical significance. Among diseased groups, HRV was associated with blood pressure control better than glycaemic control but not with gender. LF /HF ratio was the most consistent HRV parameter showing statistical significance in tests. Conclusion HRV is reduced in both diabetics more than hypertensives; related to blood pressure control more than glycaemic control. It points altered cardiac autonomic balance, and possibility of cardiovascular risk and early detection of it with timely intervention. It also calls for investigation of same for reinforcement of our observations and further exploration.
Collapse
Affiliation(s)
- Jayesh D Solanki
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | | | | | - Sunil J Panjwani
- Department of General Medicine, Government Medical College, Bhavnagar, Gujarat, India
| | - Vatsal M Senta
- Department of General Medicine, Government Medical College, Bhavnagar, Gujarat, India
| | - Darshit K Rudani
- Department of General Medicine, Government Medical College, Bhavnagar, Gujarat, India
| |
Collapse
|
3
|
Safi M, Borup A, Stevns Hansen C, Rossing P, Thorsten Jensen M, Christoffersen C. Association between plasma apolipoprotein M and cardiac autonomic neuropathy in type 1 diabetes. Diabetes Res Clin Pract 2022; 189:109943. [PMID: 35690270 DOI: 10.1016/j.diabres.2022.109943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
AIM Diabetes may lead to severe complications e.g. cardiac autonomic neuropathy (CAN) characterized by an increased risk of cardiovascular mortality. CAN is diagnosed by a decreased heart rate viability (HRV). Sphingosine-1-Phosphate (S1P) carried by the HDL-associated apolipoprotein M (apoM) is linked to a reduction in the heart rate, and treatment with an S1P-agonist increases HRV. The present study aimed to investigate if plasma apoM was associated with an increased risk of CAN. METHODS The study includes 278 individuals with Type 1 Diabetes recruited from Steno Diabetes Center in Copenhagen from 2010 to 2012. RESULTS A change of 0.1 µM plasma apoM was associated with the diagnosis of CAN (Odds ratio: 1.11 (1.02; 1.21), p = 0.013). ApoM plasma levels were also positively associated with CAN when adjusted for age and gender (Odds ratio: 1.11 (1.02; 1.21), p = 0.013) as well as lipids, beta-blockers, blood pressure, and alcohol (Odds ratio: 1.14 (1.04; 1.26), p = 0.005) and Hbga1c and time with diabetes (Odds ratio: 1.13 (1.02; 1.25), p = 0.01). Plasma apoM was also associated with a significantly lower SDNN as well as high frequency power in all adjusted models. CONCLUSION Increased plasma apoM was associated with an increased risk of CAN as well as a significant reduction in HRV indices. This could represent changes in parasympathetic activity, but, further studies are needed to also explore additional molecular alterations behind such observations.
Collapse
Affiliation(s)
- Mostafa Safi
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Anna Borup
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Magnus Thorsten Jensen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Amager Hvidovre, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark.
| |
Collapse
|
4
|
Cardiac autonomic recovery in response to aerobic versus resistance exercise in type 2 diabetes mellitus patients. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
5
|
Silva LRB, Gentil P, Seguro CS, de Oliveira GT, Silva MS, Zamunér AR, Beltrame T, Rebelo ACS. High Fasting Glycemia Predicts Impairment of Cardiac Autonomic Control in Adults With Type 2 Diabetes: A Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:760292. [PMID: 34858333 PMCID: PMC8630737 DOI: 10.3389/fendo.2021.760292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is characterized by a metabolic disorder that elevates blood glucose concentration. Chronic hyperglycemia has been associated with several complications in patients with T2D, one of which is cardiac autonomic dysfunction that can be assessed from heart rate variability (HRV) and heart rate recovery (HRR) response, both associated with many aspects of health and fitness, including severe cardiovascular outcomes. OBJECTIVE To evaluate the effects of T2D on cardiac autonomic modulation by means of HRV and HRR measurements. MATERIALS AND METHODS This study has an observational with case-control characteristic and involved ninety-three middle-aged adults stratified into two groups (control group - CG, n = 34; diabetes group - DG, n = 59). After signing the free and informed consent form, the patients were submitted to the evaluation protocols, performed biochemical tests to confirm the diagnosis of T2D, collection of R-R intervals for HRV analysis and cardiopulmonary effort test to quantify HRR. RESULTS At rest, the DG showed a reduction in global HRV (SDNN= 19.31 ± 11.72 vs CG 43.09 ± 12.74, p < 0.0001), lower parasympathetic modulation (RMSSD= 20.49 ± 14.68 vs 52.41 ± 19.50, PNN50 = 4.76 ± 10.53 vs 31.24 ± 19.24, 2VD%= 19.97 ± 10.30 vs 28.81 ± 9.77, p < 0.0001 for both indices) and higher HRrest when compared to CG. After interruption of physical exercise, a slowed heart rate response was observed in the DG when compared to the CG. Finally, a simple linear regression showed that fasting glycemia was able to predict cardiac autonomic involvement in volunteers with T2D. CONCLUSION Patients with T2D presented lower parasympathetic modulation at rest and slowed HRR after physical exercise, which may be associated with higher cardiovascular risks. The findings show the glycemic profile as an important predictor of impaired cardiac autonomic modulation.
Collapse
Affiliation(s)
- Lucas Raphael Bento Silva
- Department of Physical Education, Araguaia University Center, Goiânia, Brazil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- *Correspondence: Lucas Raphael Bento Silva,
| | - Paulo Gentil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Hypertension League, Federal University of Goias, Goiânia, Brazil
| | - Camila Simões Seguro
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
| | | | - Maria Sebastiana Silva
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
| | - Antônio Roberto Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
| | - Thomas Beltrame
- Institute of Computing, University of Campinas, São Paulo, Brazil
- Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Ana Cristina Silva Rebelo
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Department of Morphology, Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
| |
Collapse
|
6
|
Okutucu S, Akboga MK, Oto A. Cardiac autonomic recovery in type 2 diabetes mellitus and coexistent hypertension: Cutoff values, dipping status, and medications. Indian Heart J 2018; 70 Suppl 3:S499-S500. [PMID: 30595317 PMCID: PMC6310703 DOI: 10.1016/j.ihj.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/01/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
- Sercan Okutucu
- Memorial Ankara Hospital, Department of Cardiology, Ankara, Turkey.
| | - Mehmet Kadri Akboga
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ali Oto
- Memorial Ankara Hospital, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
7
|
Effect of glycemic control and disease duration on cardiac autonomic function and oxidative stress in type 2 diabetes mellitus. J Diabetes Metab Disord 2018; 17:149-158. [PMID: 30918849 DOI: 10.1007/s40200-018-0354-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/27/2018] [Indexed: 12/14/2022]
Abstract
Purpose Cardiac autonomic neuropathy (CAN) is a commonly overlooked complication of type 2 diabetes mellitus (T2DM), with a complex pathogenesis involving hyperglycemia-induced oxidative stress which results in neuronal ischemia and cellular death. The level of hyperglycemia as well as disease duration might be significant determinants of the prognosis of T2DM, but limited studies have explored their relationship with these diabetic complications. Therefore, the purpose of this study was to examine the effect of glycemic control and disease duration on cardiac autonomic function and oxidative stress in patients with T2DM. Methods 60 T2DM patients along with 63 healthy controls were recruited for the study. Diabetic patients were further classified based on glycemic control (HbA1c levels <8% vs. ≥8%) and disease duration (<5 vs. 5-10 vs. >10 years). All participants were assessed for cardiac autonomic function (HRR: heart rate recovery; HRV: heart rate variability), levels of antioxidant enzymes (CAT: catalase; SOD: superoxide dismutase), serum nitric oxide (NO) and other cardiometabolic risk factors (resting blood pressure, glycemic and lipid profile). Results T2DM patients showed a significant reduction in HRR, HRV, CAT, SOD and an increase in LFnu, LF: HF ratio and NO. These impairments were significantly greater for the group with poor glycemic control (p < 0.05). However, no difference for these parameters was observed with respect to different disease durations. Conclusion Cardiac autonomic regulation and endogenous antioxidant defense were compromised and levels of nitric oxide found to be raised in patients with Type 2 diabetes. These findings were more pronounced in subjects with poor glycemic control.
Collapse
|