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Huebschmann AG, Scalzo RL, Yang X, Schmiege SJ, Reusch JEB, Dunn AL, Chapman K, Regensteiner JG. Type 2 diabetes is linked to higher physiologic markers of effort during exercise. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1346716. [PMID: 38741611 PMCID: PMC11089245 DOI: 10.3389/fcdhc.2024.1346716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
Background People with type 2 diabetes (T2D) have lower rates of physical activity (PA) than the general population. This is significant because insufficient PA is linked to cardiovascular morbidity and mortality, particularly in individuals with T2D. Previously, we identified a novel barrier to physical activity: greater perceived effort during exercise in women. Specifically, women with T2D experienced exercise at low-intensity as greater effort than women without T2D at the same low-intensity - based on self-report and objective lactate measurements. A gap in the literature is whether T2D confers greater exercise effort in both sexes and across a range of work rates. Objectives Our overarching objective was to address these gaps regarding the influence of T2D and relative work intensity on exercise effort. We hypothesized that T2D status would confer greater effort during exercise across a range of work rates below the aerobic threshold. Methods This cross-sectional study enrolled males and post-menopausal females aged 50-75 years. Measures of exercise effort included: 1) heart rate, 2) lactate and 3) self-report of Rating of Perceived Exertion (RPE); each assessment was during the final minute of a 5-minute bout of treadmill exercise. Treadmill exercise was performed at 3 work rates: 1.5 mph, 2.0 mph, and 2.5 mph, respectively. To determine factors influencing effort, separate linear mixed effect models assessed the influence of T2D on each outcome of exercise effort, controlling for work rate intensity relative to peak oxygen consumption (%VO2peak). Models were adjusted for any significant demographic associations between effort and age (years), sex (male/female), baseline physical activity, or average blood glucose levels. Results We enrolled n=19 people with T2D (47.4% female) and n=18 people (55.6% female) with no T2D. In the models adjusted for %VO2peak, T2D status was significantly associated with higher heart rate (p = 0.02) and lactate (p = 0.01), without a significant association with RPE (p = 0.58). Discussions Across a range of low-to-moderate intensity work rates in older, sedentary males and females, a diagnosis of T2D conferred higher objective markers of effort but did not affect RPE. Greater objective effort cannot be fully attributed to impaired fitness, as it persisted despite adjustment for %VO2peak. In order to promote regular exercise and reduce cardiovascular risk for people with T2D, 1) further efforts to understand the mechanistic targets that influence physiologic exercise effort should be sought, and 2) comparison of the effort and tolerability of alternative exercise training prescriptions is warranted.
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Affiliation(s)
- Amy G. Huebschmann
- Division of General Internal Medicine, University of Colorado, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, University of Colorado, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, United States
| | - Rebecca L. Scalzo
- Ludeman Family Center for Women’s Health Research, University of Colorado, Aurora, CO, United States
- Division of Endocrinology, University of Colorado, Aurora, CO, United States
- Eastern Colorado Veterans Administration Medical Center, Aurora, CO, United States
| | - Xinyi Yang
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Sarah J. Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Jane E. B. Reusch
- Ludeman Family Center for Women’s Health Research, University of Colorado, Aurora, CO, United States
- Division of Endocrinology, University of Colorado, Aurora, CO, United States
- Eastern Colorado Veterans Administration Medical Center, Aurora, CO, United States
| | - Andrea L. Dunn
- Senior Scientist Emeritus, Klein-Buendel, Inc., Golden, CO, United States
| | - Kristina Chapman
- Division of General Internal Medicine, University of Colorado, Aurora, CO, United States
| | - Judith G. Regensteiner
- Division of General Internal Medicine, University of Colorado, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, University of Colorado, Aurora, CO, United States
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Liu BB, Niu ZR, Jia XJ, Liu XL, Lu Q. Correlation between Insulin Resistance and Cardiopulmonary Function during Physical Exams for Male Patients. Am J Health Behav 2022; 46:600-605. [PMID: 36721285 DOI: 10.5993/ajhb.46.6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: In this study, we investigated the correlation between insulin resistance (IR) and cardiopulmonary function during physical exams for male patients. Methods: We selected 124 healthy male participants in the physical examination center of our hospital. They were divided into 3 groups according to the homeostasis model assessment of insulin resistance values. The oxygen uptake, peak oxygen uptake (VO₂/kg), heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by a cardiopulmonary exercise function tester. We analyzed the correlation between the index of IR and cardiopulmonary function. Results: There were statistically significant differences in body mass index, waist circumference, fasting insulin level, anaerobic threshold SBP, maximum VO2/kg and maximum SBP among the 3 groups (p<.05). However, no significant difference was found in SBP, DBP, total cholesterol, low-density lipoprotein cholesterol and fasting blood glucose levels (p>.05). The anaerobic threshold SBP, maximum VO2/kg and maximum SBP were all negatively correlated with the IR index. Conclusion: Our results indicate that IR is associated with cardiopulmonary function and that there are different correlations between the various cardiopulmonary function indexes and IR.
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Affiliation(s)
- Bin-Bin Liu
- Bin-Bin Liu, Department of Functional Inspection, Qinhuangdao First Hospital, Qinhuangdao, China
| | - Zi-Ru Niu
- Zi-Ru Niu, Department of Endocrinology and Metabolic Diseases, Hebei Medical University, Shijiazhuang, China
| | - Xiao-Jiao Jia
- Xiao-Jiao Jia, Department of Endocrinology, Qinhuangdao First Hospital, Qinhuangdao, China
| | - Xiao-Li Liu
- Xiao-Li Liu, Department of Endocrinology, Qinhuangdao First Hospital, Qinhuangdao, China
| | - Qiang Lu
- Qiang Lu, Department of Endocrinology, Qinhuangdao First Hospital, Qinhuangdao, China;,
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Moxley E, Habtezgi D, Subramanian V, Hwang S, Yalla S, Attewell L. Relationships Between Physical Activity Metrics of Intensity and Diabetes. J Cardiovasc Nurs 2022; 38:00005082-990000000-00035. [PMID: 36037295 DOI: 10.1097/jcn.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Physical activity (PA) prevents diabetes-associated complications. Little is known about what constitutes effective PA interventions to mitigate diabetes. Identifying PA metrics associated with the efficacy of PA interventions will provide insight into devising strategies to treat diabetes. PURPOSE The aim of this study was to analyze the relationships between preclinical and postclinical variables from a 10-week intervention designed to increase PA in adults with diabetes. METHODS A secondary analysis was performed to evaluate data using Wilcoxon rank sum test, permutation test and Spearman correlation to analyze hemoglobin A1c (HbA1c), weight, and PA metrics (maximum steps per episode, cadence, daily steps, and 6-minute walk). RESULTS Poststudy HbA1c level was associated with maximum steps (r = -0.63, P = .03) and 6-minute walk (r = -0.50, P = .09). Baseline weight was associated with average cadence (r = -0.76, P = .007), and poststudy weight was associated with average cadence (r = -0.60, P = .041) and maximum steps (r = -0.62, P = .03). CONCLUSIONS Cadence and maximum steps per episode reflect PA intensity and were associated with HbA1c and weight in adults with diabetes.
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Dantas de Medeiros JL, Carneiro Bezerra B, Araújo Cruz HR, Azevedo de Medeiros K, Cardoso de Melo ME, Sales Craveiro Sarmento A, Abbott Galvão Ururahy M, Fassarella Agnez Lima L, Dos Santos Neto AJ, Gomes Lima J, Resqueti V, Peroni Gualdi L, Fregonezi G, Araújo de Melo Campos JT. Impaired functional exercise capacity and greater cardiovascular response to the 6-min walk test in congenital generalized lipodystrophy. BMC Cardiovasc Disord 2022; 22:384. [PMID: 36008763 PMCID: PMC9414389 DOI: 10.1186/s12872-022-02828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital Generalized Lipodystrophy (CGL) is an ultra-rare disease characterized by metabolic disorders. However, the evaluation of functional exercise capacity, cardiovascular (CV) response to exercise, and peripheral arterial disease (PAD) in CGL is scarce. Here we evaluated the performance and CV response to exercise and their association with PAD in CGL compared to healthy individuals. METHODS Twelve CGL and 12 healthy subjects matched for age and gender were included. Functional exercise capacity, CV response, and PAD were measured using the six-minute walk test (6MWT) and ankle-brachial index (ABI), respectively. RESULTS At baseline, CGL subjects showed reduced predicted walked distance (6MWD) (p = 0.009) and increased heart rate (HR), systolic (SBP), and diastolic (DBP) pressures compared to healthy subjects (p < 0.05). Most CGL subjects presented normal ABI values (1.0 ≤ ABI ≤ 1.4). Only 25% (n = 3) had ABI ≤ 0.9. CGL subjects did not present changes in ABI and blood pressure 12 months after metreleptin (MLP) replacement, but they walked a greater 6MWD than baseline (p = 0.04). Further, 6MWD and right ABI measurements were positively correlated in CGL subjects (p = 0.03). Right ABI negatively correlated with glucose, triglycerides, and VLDL-c (p < 0.05). CONCLUSIONS We observed that CGL subjects had lower functional exercise capacity and higher cardiovascular effort for similar performance of 6MWT, suggesting that strategies for decreasing exercise effort in this population should be essential. Furthermore, better physical performance was associated with high ABI in CGL. Additional studies are needed to clarify leptin's role in preserving functional exercise capacity in CGL.
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Affiliation(s)
- Jorge Luiz Dantas de Medeiros
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Bruno Carneiro Bezerra
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Helen Rainara Araújo Cruz
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | | | - Maria Eduarda Cardoso de Melo
- Laboratório de Biologia Molecular e Genômica, Departamento de Biologia Celular e Genética, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Aquiles Sales Craveiro Sarmento
- Laboratório de Biologia Molecular e Genômica, Departamento de Biologia Celular e Genética, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Marcela Abbott Galvão Ururahy
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Lucymara Fassarella Agnez Lima
- Laboratório de Biologia Molecular e Genômica, Departamento de Biologia Celular e Genética, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | | | - Josivan Gomes Lima
- Departamento de Medicina Clínica, Hospital Universitário Onofre Lopes (HUOL)/UFRN, Natal, RN, Brazil
| | - Vanessa Resqueti
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Lucien Peroni Gualdi
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Guilherme Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Julliane Tamara Araújo de Melo Campos
- Laboratório de Biologia Molecular e Genômica, Departamento de Biologia Celular e Genética, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
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Fell B, Hanekom S, Heine M. A modified six-minute walk test (6MWT) for low-resource settings-a cross-sectional study. Heart Lung 2022; 52:117-122. [PMID: 35007887 DOI: 10.1016/j.hrtlng.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The 6 min walk test (6MWT) is a validated tool used to assess functional capacity in a variety of patient populations. Space constraints often limit the practicality of the 6MWT according to the standard (2002) American Thoracic Society protocol, and therefore, adaptations to this protocol are common with potential implications for research and clinical practice. Furthermore, such implications for research and clinical practice may be augmented in low-resourced settings. OBJECTIVES To determine the agreement between the 6 min walk distance (6MWD) achieved on the standard 30 m (6MWT30), and a straight 10 m (6MWT10), or 10 m figure-of-eight (6MWTF8) configuration, respectively. METHODS A cross-sectional study was conducted in a socioeconomic challenged community. A heterogeneous sample of adults (n = 27) with non-communicable disease were randomized into performing the 6MWT10 (n = 15) or 6MWTF8 (n = 12), in addition to the standard 6MWT30. Pairwise comparison and concordance correlation coefficients were used to assess agreement. RESULTS The mean (SD) 6MWD30 was 437(42) meters, while the mean 6MWD10 was 371(57). The mean difference (SE; p-value) between the 6MWD30 and 6MWD10 was 67 m (8.6; p .01). The mean 6MWD30 was 424(67) meters, while the mean 6MWDF8 was 347(58). The mean difference between the 6MWD30 and 6MWDF8 was 77 m (6.0; p .01). Moderate concordance was found between the 6MWT30 and 6MWTF8 or 6MWD10, respectively. CONCLUSIONS The present data suggest that, independent of configuration, using a shorter pathway significantly reduced the 6MWD. Low-resource settings may benefit from contemporary measures of functional capacity more conducive to resource constraints, or standardization of the test when used in such settings.
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Affiliation(s)
- Brittany Fell
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zyl Drive, Cape Town 8000, South Africa; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zyl Drive, Cape Town 8000, South Africa.
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