1
|
Abbas U, Shah SA, Babar N, Agha P, Khowaja MA, Nasrumminallah M, Arif HE, Hussain N, Hasan SM, Baloch IA. Cardiorespiratory dynamics of type 2 diabetes mellitus: An extensive view of breathing and fitness challenges in a diabetes prevalent population. PLoS One 2024; 19:e0303564. [PMID: 38968192 PMCID: PMC11226084 DOI: 10.1371/journal.pone.0303564] [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: 03/05/2024] [Accepted: 04/27/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is well known for related micro and macrovascular complications. Uncontrolled hyperglycemia in diabetes mellitus leads to endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes which affect multiple organ systems. This study was designed to take an extensive view of cardiorespiratory dynamics in patients with type 2 DM. METHODS One hundred healthy controls (HC) and 100 DM patients were enrolled. We measured and compared the breathing patterns (spirometry), VO2 max levels (heart rate ratio method) and self-reported fitness level (international fitness scale) of individuals with and without diabetes. Data was analyzed in SPSS v.22 and GraphPad Prism v8.0. RESULTS We observed restrictive spirometry patterns (FVC <80%) in 22% of DM as compared to 2% in HC (p = 0.021). There was low mean VO2 max in DM as compared to HC(32.03 ± 5.36 vs 41.91 ± 7.98 ml/kg/min; p value <0.001). When evaluating physical fitness on self-reported IFiS scale, 90% of the HC report average, good, or very good fitness levels. In contrast, only 45% of the DM shared this pattern, with a 53% proportion perceiving their fitness as poor or very poor (p = <0.05). Restrictive respiratory pattern, low VO2 max and fitness level were significantly associated with HbA1c and long-standing DM. CONCLUSION This study shows decreased pulmonary functions, decreased cardiorespiratory fitness (VO2 max) and IFiS scale variables in diabetic population as compared to healthy controls which are also associated with glycemic levels and long-standing DM. Screening for pulmonary functions can aid optimum management in this population.
Collapse
Affiliation(s)
- Uzair Abbas
- Dow University of Health Sciences, Karachi, Pakistan
| | - Shahbaz Ali Shah
- Worcestershire Acute Hospitals, NHS Trust, Worcestershire, United Kingdom
| | - Nisha Babar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Pashmina Agha
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Niaz Hussain
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | - Israr Ahmed Baloch
- Lehigh Valley Hospital Cedar Crest, Allentown, Pennsylvania, United States of America
| |
Collapse
|
2
|
Campos APR, Santana MG, de Oliveira DM, Youngstedt SD, Linares FDC, Passos GS. Sleep, psychological health, and physical activity level in patients with hypertension. J Bodyw Mov Ther 2024; 39:343-349. [PMID: 38876650 DOI: 10.1016/j.jbmt.2024.03.016] [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: 12/14/2022] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 06/16/2024]
Abstract
The aim of this study was to compare sleep, daytime sleepiness, and psychological health in physically active versus inactive patients with hypertension. A cross-sectional design included thirty-seven participants (ACTIVE, n = 15; INACTIVE, n = 22). Sleep was assessed by polysomnography, the Pittsburgh Sleep Quality Index (PSQI) and a one-week daily sleep diary. The sleepiness was assessed with the Epworth Sleepiness Scale and the psychological health was assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Profile of Mood States (POMS). Habitual physical activity was assessed with 7 day-step counts recorded by a pedometer and questionnaire. Significantly lower PSQI score (mean ± S.D.; 7.3 ± 3.4 vs 10.1 ± 3.6) and daytime sleepiness (8.7 ± 4.5 vs. 11.9 ± 4.4) were found in the physically active versus inactive participants, respectively. In addition, higher PSQI-total sleep time (6.9 ± 1.3 vs 5.6 ± 1.1) and vigor/activity (19.7 ± 3.9 vs 16.0 ± 3.9), and lower depressed mood on the POMS scale (8.2 ± 7.9 vs 13.8 ± 10.0) and lower POMS total mood disturbance (21.0 ± 27.0 vs 43.5 ± 32.5) were observed in the active participants compared with the inactive participants. Combining data across both groups, leisure time sport participation correlated negatively with PSQI (r = -0.35; p < 0.05) and BDI (r = -0.42; p < 0.05), and positively with POMS-vigor/activity (r = 0.43; p < 0.05). The results showed regular physical activity was associated with better sleep and psychological health in patients with hypertension.
Collapse
Affiliation(s)
- Anna Paula R Campos
- Universidade Federal de Jataí. Instituto de Ciências da Saúde. Jataí, GO, Brazil
| | - Marcos G Santana
- Universidade Federal de Jataí. Instituto de Ciências da Saúde. Jataí, GO, Brazil
| | - David M de Oliveira
- Universidade Federal de Jataí. Instituto de Ciências da Saúde. Jataí, GO, Brazil
| | - Shawn D Youngstedt
- Arizona State University. Edson College of Nursing and Health Innovation, Phoenix, AZ, United States
| | | | - Giselle S Passos
- Universidade Federal de Jataí. Instituto de Ciências da Saúde. Jataí, GO, Brazil.
| |
Collapse
|
3
|
Nylén E. Age, Race, Sex and Cardiorespiratory Fitness: Implications for Prevention and Management of Cardiometabolic Disease in Individuals with Diabetes Mellitus. Rev Cardiovasc Med 2024; 25:263. [PMID: 39139417 PMCID: PMC11317329 DOI: 10.31083/j.rcm2507263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 08/15/2024] Open
Abstract
Physical inactivity and poor cardiorespiratory fitness (CRF) are strongly associated with type 2 diabetes (DM2) and all-cause and cardiovascular morbidity and mortality. Incorporating physical activity promotion in the management of DM2 has been a pivotal approach modulating the underlying pathophysiology of DM2 of increased insulin resistance, endothelial dysfunction, and abnormal mitochondrial function. Although CRF is considered a modifiable risk factor, certain immutable aspects such as age, race, and gender impact CRF status and is the focus of this review. Results show that diabetes has often been considered a disease of premature aging manifested by early onset of macro and microvascular deterioration with underlying negative impact on CRF and influencing next generation. Certain races such as Native Americans and African Americans show reduced baseline CRF and decreased gain in CRF in randomized trials. Moreover, multiple biological gender differences translate to lower baseline CRF and muted responsivity to exercise in women with increased morbidity and mortality. Although factors such as age, race, and sex may not have major impacts on CRF their influence should be considered with the aim of optimizing precision medicine.
Collapse
Affiliation(s)
- Eric Nylén
- Veterans Affairs Medical Center, Washington, D.C. 20422, USA
- George Washington University School of Medicine, Washington, D.C. 20037, USA
| |
Collapse
|
4
|
Ni D, Kokkinos P, Nylen ES. Glucagon-Like Peptide-1 Receptor Agonists and Sodium Glucose Cotransporter-2 Inhibitors and Cardiorespiratory Fitness Interaction. Mil Med 2024:usae311. [PMID: 38870042 DOI: 10.1093/milmed/usae311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) is a stronger predictor of mortality than traditional risk factors and is a neglected vital sign of health. Enhanced fitness is a cornerstone in diabetes management and is most often delivered concurrently with pharmacological agents, which can have an opposing impact, as has been reported with metformin. Considering the rapid evolution of diabetes medications with improved cardiovascular outcomes, such as glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, it is of importance to consider the influence of these vis-a-vis effects on CRF. MATERIALS AND METHODS Combining the words glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors with cardiorespiratory fitness, an online search was done using PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Cochrane. RESULTS There were only a few randomized controlled studies that included CRF, and the results were mostly neutral. A handful of smaller studies detected improved CRF using sodium glucose cotransporter-2 inhibitors in patients with congestive heart failure. CONCLUSIONS Since CRF is a superior prognosticator for cardiovascular outcomes and both medications can cause lean muscle mass loss, the current review highlights the paucity of relevant interactive analysis.
Collapse
Affiliation(s)
- David Ni
- Department of Endocrinology, VAMC, Washington, DC 20422, USA
| | - Peter Kokkinos
- Department of Cardiology, VAMC, Washington, DC 20422, USA
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, Newark, NJ 07103, USA
- Department of Kinesiology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Eric S Nylen
- Department of Endocrinology, VAMC, Washington, DC 20422, USA
| |
Collapse
|
5
|
Cauwenberghs N, Sente J, Sabovčik F, Ntalianis E, Hedman K, Claes J, Goetschalckx K, Cornelissen V, Kuznetsova T. Cardiorespiratory fitness components in relation to clinical characteristics, disease state and medication intake: A patient registry study. Clin Physiol Funct Imaging 2023; 43:441-452. [PMID: 37317062 DOI: 10.1111/cpf.12842] [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: 11/17/2022] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Interpretation of cardiopulmonary exercise testing (CPET) results requires thorough understanding of test confounders such as anthropometrics, comorbidities and medication. Here, we comprehensively assessed the clinical determinants of cardiorespiratory fitness and its components in a heterogeneous patient sample. METHODS We retrospectively collected medical and CPET data from 2320 patients (48.2% females) referred for cycle ergometry at the University Hospital Leuven, Belgium. We assessed clinical determinants of peak CPET indexes of cardiorespiratory fitness (CRF) and its hemodynamic and ventilatory components using stepwise regression and quantified multivariable-adjusted differences in indexes between cases and references. RESULTS Lower peak load and peak O2 uptake were related to: higher age, female sex, lower body height and weight, and higher heart rate; to the intake of beta blockers, analgesics, thyroid hormone replacement and benzodiazepines; and to diabetes mellitus, chronic kidney disease, non-ST elevation myocardial infarction and atrial fibrillation (p < 0.05 for all). Lower peak load also correlated with obstructive pulmonary diseases. Stepwise regression revealed associations of hemodynamic and ventilatory indexes (including heart rate, O2 pulse, systolic blood pressure and ventilation at peak exercise and ventilatory efficiency) with age, sex, body composition and aforementioned diseases and medications. Multivariable-adjusted differences in CPET metrics between cases and controls confirmed the associations observed. CONCLUSION We described known and novel associations of CRF components with demographics, anthropometrics, cardiometabolic and pulmonary diseases and medication intake in a large patient sample. The clinical implications of long-term noncardiovascular drug intake for CPET results require further investigation.
Collapse
Affiliation(s)
- Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Josephine Sente
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jomme Claes
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Research Unit Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Zhao F, Tomita M, Dutta A. Operational Modal Analysis of Near-Infrared Spectroscopy Measure of 2-Month Exercise Intervention Effects in Sedentary Older Adults with Diabetes and Cognitive Impairment. Brain Sci 2023; 13:1099. [PMID: 37509027 PMCID: PMC10377417 DOI: 10.3390/brainsci13071099] [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: 06/12/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The Global Burden of Disease Study (GBD 2019 Diseases and Injuries Collaborators) found that diabetes significantly increases the overall burden of disease, leading to a 24.4% increase in disability-adjusted life years. Persistently high glucose levels in diabetes can cause structural and functional changes in proteins throughout the body, and the accumulation of protein aggregates in the brain that can be associated with the progression of Alzheimer's Disease (AD). To address this burden in type 2 diabetes mellitus (T2DM), a combined aerobic and resistance exercise program was developed based on the recommendations of the American College of Sports Medicine. The prospectively registered clinical trials (NCT04626453, NCT04812288) involved two groups: an Intervention group of older sedentary adults with T2DM and a Control group of healthy older adults who could be either active or sedentary. The completion rate for the 2-month exercise program was high, with participants completing on an average of 89.14% of the exercise sessions. This indicated that the program was practical, feasible, and well tolerated, even during the COVID-19 pandemic. It was also safe, requiring minimal equipment and no supervision. Our paper presents portable near-infrared spectroscopy (NIRS) based measures that showed muscle oxygen saturation (SmO2), i.e., the balance between oxygen delivery and oxygen consumption in muscle, drop during bilateral heel rise task (BHR) and the 6 min walk task (6MWT) significantly (p < 0.05) changed at the post-intervention follow-up from the pre-intervention baseline in the T2DM Intervention group participants. Moreover, post-intervention changes from pre-intervention baseline for the prefrontal activation (both oxyhemoglobin and deoxyhemoglobin) showed statistically significant (p < 0.05, q < 0.05) effect at the right superior frontal gyrus, dorsolateral, during the Mini-Cog task. Here, operational modal analysis provided further insights into the 2-month exercise intervention effects on the very-low-frequency oscillations (<0.05 Hz) during the Mini-Cog task that improved post-intervention in the sedentary T2DM Intervention group from their pre-intervention baseline when compared to active healthy Control group. Then, the 6MWT distance significantly (p < 0.01) improved in the T2DM Intervention group at post-intervention follow-up from pre-intervention baseline that showed improved aerobic capacity and endurance. Our portable NIRS based measures have practical implications at the point of care for the therapists as they can monitor muscle and brain oxygenation changes during physical and cognitive tests to prescribe personalized physical exercise doses without triggering individual stress response, thereby, enhancing vascular health in T2DM.
Collapse
Affiliation(s)
- Fei Zhao
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Machiko Tomita
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Anirban Dutta
- School of Engineering, University of Lincoln, Lincoln LN67TS, UK
| |
Collapse
|
7
|
Ozemek C, Arena R, Rouleau CR, Campbell TS, Hauer T, Wilton SB, Stone J, Laddu D, Williamson TM, Liu H, Chirico D, Austford LD, Aggarwal S. Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity. J Cardiopulm Rehabil Prev 2023; 43:109-114. [PMID: 36203224 DOI: 10.1097/hcr.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). METHODS This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. RESULTS Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. CONCLUSION Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.
Collapse
Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Drs Ozemek, Arena, and Laddu); TotalCardiology Research Network, Calgary, Canada (Drs Arena, Rouleau, Campbell, Wilton, Stone, Chirico, and Aggarwal and Ms Austford); TotalCardiology™ Rehabilitation, Calgary, Canada (Drs Rouleau and Aggarwal and Ms Hauer); Departments of Psychology (Drs Rouleau, Campbell, and Aggarwal and Ms Williamson), Community Health Sciences (Dr Liu), and Kinesiology (Dr Chirico), University of Calgary, Calgary, Canada; and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada (Drs Wilton, Stone, and Liu)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-Arginine is the substrate used by nitric oxide (NO) synthase (NOS) to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-Arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy 1 bottle containing 1.66 g of L-arginine or 1 bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT) and were assessed their Borg modified 0-10 rating of perceived exertion (BRPE) before starting and at the end of the treatment. Seventy-five patients receiving L-Arginine, and thirty-five receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-Arginine group compared to both baseline and placebo (p<0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR, independently of age, sex, baseline functional capacity, and comorbid conditions. Significance Statement This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent from age, sex, comorbid conditions, and baseline functional capacity.
Collapse
|
9
|
Ee CC, Armour M, Piya MK, McMorrow R, Al-Kanini I, Sabag A. Mindfulness-based interventions for adults with type 2 diabetes mellitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2021. [DOI: 10.1002/14651858.cd014881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carolyn C Ee
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Mike Armour
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Milan K Piya
- School of Medicine; Western Sydney University; Campbelltown Australia
| | - Rita McMorrow
- The Department of General Practice; The University of Melbourne; Melbourne Australia
| | - Ieman Al-Kanini
- School of Medicine, Western Sydney University; Penrith Australia
| | - Angelo Sabag
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| |
Collapse
|
10
|
Huckstep OJ, Burchert H, Williamson W, Telles F, Tan CMJ, Bertagnolli M, Arnold L, Mohamed A, McCormick K, Hanssen H, Leeson P, Lewandowski AJ. Impaired myocardial reserve underlies reduced exercise capacity and heart rate recovery in preterm-born young adults. Eur Heart J Cardiovasc Imaging 2021; 22:572-580. [PMID: 32301979 PMCID: PMC8081423 DOI: 10.1093/ehjci/jeaa060] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 12/20/2022] Open
Abstract
Aims We tested the hypothesis that the known reduction in myocardial functional reserve in preterm-born young adults is an independent predictor of exercise capacity (peak VO2) and heart rate recovery (HRR). Methods and results We recruited 101 normotensive young adults (n = 47 born preterm; 32.8 ± 3.2 weeks’ gestation and n = 54 term-born controls). Peak VO2 was determined by cardiopulmonary exercise testing (CPET), and lung function assessed using spirometry. Percentage predicted values were then calculated. HRR was defined as the decrease from peak HR to 1 min (HRR1) and 2 min of recovery (HRR2). Four-chamber echocardiography views were acquired at rest and exercise at 40% and 60% of CPET peak power. Change in left ventricular ejection fraction from rest to each work intensity was calculated (EFΔ40% and EFΔ60%) to estimate myocardial functional reserve. Peak VO2 and per cent of predicted peak VO2 were lower in preterm-born young adults compared with controls (33.6 ± 8.6 vs. 40.1 ± 9.0 mL/kg/min, P = 0.003 and 94% ± 20% vs. 108% ± 25%, P = 0.001). HRR1 was similar between groups. HRR2 decreased less in preterm-born young adults compared with controls (−36 ± 13 vs. −43 ± 11 b.p.m., P = 0.039). In young adults born preterm, but not in controls, EFΔ40% and EFΔ60% correlated with per cent of predicted peak VO2 (r2 = 0.430, P = 0.015 and r2 = 0.345, P = 0.021). Similarly, EFΔ60% correlated with HRR1 and HRR2 only in those born preterm (r2 = 0.611, P = 0.002 and r2 = 0.663, P = 0.001). Conclusions Impaired myocardial functional reserve underlies reductions in peak VO2 and HRR in young adults born moderately preterm. Peak VO2 and HRR may aid risk stratification and treatment monitoring in this population.
Collapse
Affiliation(s)
- Odaro J Huckstep
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK.,Department of Biology, United States Air Force Academy, 2355 Faculty Drive, Suite 2P389, Colorado 80840, USA
| | - Holger Burchert
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Wilby Williamson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Fernando Telles
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Cheryl M J Tan
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Mariane Bertagnolli
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK.,Hospital Sacré-Coeur Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, 5400 Boulevard Gouin Ouest, Montreal, Quebec H4J1C5, Canada
| | - Linda Arnold
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Afifah Mohamed
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK.,Department of Diagnostic Imaging and Radiotherapy, Facutly of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Kenny McCormick
- Department of Paediatrics, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, Basel 4052, Switzerland
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, John Radcliffe Hospital, Oxford OX39DU, UK
| |
Collapse
|
11
|
Chilton RJ. Beyond the myocardium: Sodium-glucose co-transporter-2 inhibitors in heart failure. Diabetes Obes Metab 2021; 23:1215-1218. [PMID: 33464709 DOI: 10.1111/dom.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Robert J Chilton
- Division of Cardiology, Department of Medicine, University of Texas Health Science Centre at San Antonio, San Antonio, Texas
| |
Collapse
|
12
|
Sabag A, Keating SE, Way KL, Sultana RN, Lanting SM, Twigg SM, Johnson NA. The association between cardiorespiratory fitness, liver fat and insulin resistance in adults with or without type 2 diabetes: a cross-sectional analysis. BMC Sports Sci Med Rehabil 2021; 13:40. [PMID: 33858477 PMCID: PMC8050897 DOI: 10.1186/s13102-021-00261-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/17/2021] [Indexed: 01/23/2023]
Abstract
Background Exercise-induced improvements in cardiorespiratory fitness (CRF) often coincide with improvements in insulin sensitivity and reductions in liver fat content. However, there are limited data concerning the relationship between CRF and liver fat content in adults with varying degrees of metabolic dysfunction. Methods The aim of this study was to examine the association between CRF, liver fat content, and insulin resistance in inactive adults with obesity and with or without type 2 diabetes (T2D), via cross-sectional analysis. CRF was determined via a graded exercise test. Liver fat content was assessed via proton magnetic resonance spectroscopy and insulin resistance was assessed via homeostatic model of insulin resistance (HOMA-IR). A partial correlation analysis, controlling for age and gender, was performed to determine the association between CRF, demographic, cardiometabolic, and anthropometric variables. Independent t tests were performed to compare cardiometabolic outcomes between participants with T2D and participants without T2D. Results Seventy-two adults (46% male) with a mean age of 49.28 ± 10.8 years, BMI of 34.69 ± 4.87 kg/m2, liver fat content of 8.37 ± 6.90%, HOMA-IR of 3.07 ± 2.33 and CRF of 21.52 ± 3.77 mL/kg/min participated in this study. CRF was inversely associated with liver fat content (r = − 0.28, p = 0.019) and HOMA-IR (r = − 0.40, p < 0.001). Participants with T2D had significantly higher liver fat content (+ 3.66%, p = 0.024) and HOMA-IR (+ 2.44, p < 0.001) than participants without T2D. Participants with T2D tended to have lower CRF than participants without T2D (− 1.5 ml/kg/min, p = 0.094). Conclusion CRF was inversely associated with liver fat content and insulin resistance. Participants with T2D had lower CRF than those without T2D, however, the difference was not statistically significant. Further longitudinal studies are required to elucidate the relationship between CRF and the progression of obesity-related diseases such as T2D. Registration: ACTRN12614001220651 (retrospectively registered on the 19th November 2014) and ACTRN12614000723684 (prospectively registered on the 8th July 2014). Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00261-9.
Collapse
Affiliation(s)
- Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia. .,Faculty of Medicine and Health, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia. .,The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW, Australia.
| | - Shelley E Keating
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Kimberley L Way
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia.,The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia.,Division of Cardiac Prevention and Rehabilitation, Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, Ottawa, Canada
| | - Rachelle N Sultana
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia.,The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW, Australia
| | - Sean M Lanting
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, NSW, Australia
| | - Stephen M Twigg
- Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia.,The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
13
|
Sabag A, Little JP, Johnson NA. Low-volume high-intensity interval training for cardiometabolic health. J Physiol 2021; 600:1013-1026. [PMID: 33760255 DOI: 10.1113/jp281210] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 01/02/2023] Open
Abstract
High-intensity interval training (HIIT) is characterised by short bouts of high-intensity submaximal exercise interspersed with rest periods. Low-volume HIIT, typically involving less than 15 min of high-intensity exercise per session, is being increasingly investigated in healthy and clinical populations due to its time-efficient nature and purported health benefits. The findings from recent trials suggest that low-volume HIIT can induce similar, and at times greater, improvements in cardiorespiratory fitness, glucose control, blood pressure, and cardiac function when compared to more traditional forms of aerobic exercise training including high-volume HIIT and moderate intensity continuous training, despite requiring less time commitment and lower energy expenditure. Although further studies are required to elucidate the precise mechanisms of action, metabolic improvements appear to be driven, in part, by enhanced mitochondrial function and insulin sensitivity, whereas certain cardiovascular improvements are linked to increased left ventricular function as well as greater central and peripheral arterial compliance. Beyond the purported health benefits, low-volume HIIT appears to be safe and well-tolerated in adults, with high rates of reported exercise adherence and low adverse effects.
Collapse
Affiliation(s)
- Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Nathan A Johnson
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
14
|
Association between type 2 diabetes and non-exercise estimated cardiorespiratory fitness among adults: evidences from a middle-income country. Public Health 2020; 189:110-114. [PMID: 33212348 DOI: 10.1016/j.puhe.2020.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/16/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this study is to assess the association between type 2 diabetes (T2D) and cardiorespiratory fitness (CRF) estimated through a non-exercise model in a large representative group of Brazilian adults. STUDY DESIGN The study design of this study is a cross-sectional population-based study. METHODS The presence of T2D was assessed through self-report in 42,631 individuals aged 20-59 years. The CRF was predicted from a non-exercise equation containing the following data: sex, age, body mass index, and physical activity level. The corresponding metabolic equivalent (MET) value was used to classify participants into the following four groups based on the cutpoints: <6, 6-9, 10-11, and ≥12 METs. Crude and multivariable-adjusted logistic regressions were carried out to determine the association between CRF and the presence of diabetes. RESULTS Significant linear trends were observed in diabetes across different categories of CRF in men. In women, however, linear trends were not observed in T2D across '10-11' and '≥12' categories. A 1-MET increase in estimated CRF was associated with 29% lower odds of diabetes in men and 14% in women after adjusting all the potential confounders (P < 0.001). CONCLUSIONS The presence of T2D was inversely associated with every CRF level in men and with 6-9 METs when comparing with <6 METs in women, through a non-exercise model in Brazilian adults. This finding suggests that a practical, viable, and low-cost measurement of CRF could be applied in lower income countries to assess the relationship between CRF and T2D. However, new non-exercise models are needed to better detect T2D in women.
Collapse
|
15
|
Malin SK, Stewart NR. Metformin May Contribute to Inter-individual Variability for Glycemic Responses to Exercise. Front Endocrinol (Lausanne) 2020; 11:519. [PMID: 32849302 PMCID: PMC7431621 DOI: 10.3389/fendo.2020.00519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Metformin and exercise independently improve glycemic control. Metformin traditionally is considered to reduce hepatic glucose production, while exercise training is thought to stimulate skeletal muscle glucose disposal. Collectively, combining treatments would lead to the anticipation for additive glucose regulatory effects. Herein, we discuss recent literature suggesting that metformin may inhibit, enhance or have no effect on exercise mediated benefits toward glucose regulation, with particular emphasis on insulin sensitivity. Importantly, we address issues surrounding the impact of metformin on exercise induced glycemic benefit across multiple insulin sensitive tissues (e.g., skeletal muscle, liver, adipose, vasculature, and the brain) in effort to illuminate potential sources of inter-individual glycemic variation. Therefore, the review identifies gaps in knowledge that require attention in order to optimize medical approaches that improve care of people with elevated blood glucose levels and are at risk of cardiovascular disease.
Collapse
Affiliation(s)
- Steven K. Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, United States
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Nathan R. Stewart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| |
Collapse
|
16
|
Low hydration status may be associated with insulin resistance and fat distribution: analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2010. Br J Nutr 2020; 124:199-208. [DOI: 10.1017/s0007114520001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractWe aimed to identify the association of hydration status with insulin resistance (IR) and body fat distribution. A total of 14 344 adults participated in the Korea National Health and Nutrition Examination Survey 2008–2010. We used urine specific gravity (USG) to indicate hydration status, and HOMA-IR (homoeostasis model assessment of IR) and trunk:leg fat ratio (TLR) as primary outcomes. In multivariate logistic regression, the OR per 0·01 increase in USG for high IR was 1·303 (95 % CI 1·185, 1·433; P < 0·001). In multivariate generalised additive model plots, increased USG showed a J-shaped association with logarithmic HOMA-IR, with the lowest Akaike’s information criterion score of USG 1·030. Moreover, increased USG was independently associated with increased trunk fat, decreased leg fat and increased TLR. In mediation analysis, the proportion of mediation effects of USG on TLR via IR was 0·193 (95 % CI 0·132, 0·285; P < 0·001), while the proportion of mediation effects of USG on IR via TLR was 0·130 (95 % CI 0·086, 0·188; P < 0·001). Increased USG, a sign of low hydration status and presumably high vasopressin, was associated with IR and poor fat distribution. Direct effect of low hydration status may be more dominant than indirect effect via IR or fat distribution. Further studies are necessary to confirm our findings.
Collapse
|
17
|
Rey RA. Biomarcadores de hipogonadismo masculino en la infancia y la adolescencia. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190043. [PMCID: PMC10158747 DOI: 10.1515/almed-2019-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 06/28/2023]
Abstract
El eje hipotálamo-hipófiso-testicular es activo en la vida fetal y durante los primeros meses de la vida posnatal: la hipófisis secreta hormona luteinizante (LH) y folículo-estimulante (FSH), mientras que el testículo produce testosterona y factor insulino-símil 3 (INSL3) en las células de Leydig y hormona anti-Mülleriana (AMH) e inhibina B en las células de Sertoli. En la infancia, los niveles séricos de gonadotrofinas, testosterona y factor INSL3 disminuyen a valores prácticamente indetectables, pero los de AMH e inhibina B permanecen altos. En la pubertad, se reactivan las gonadotrofinas y la producción de testosterona e INSL3, aumenta la inhibina y disminuye la AMH, como signo de maduración de la célula de Sertoli. Sobre la base del conocimiento de la fisiología del desarrollo del eje, es posible utilizar clínicamente estos biomarcadores para interpretar la fisiopatología y diagnosticar las diferentes formas de hipogonadismo que pueden presentarse en la infancia y la adolescencia.
Collapse
Affiliation(s)
- Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET-FEI- División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo, 1330, C1425EFD, Buenos Aires, Argentina
| |
Collapse
|
18
|
Hetherington-Rauth M, Magalhães JP, Júdice PB, Melo X, Sardinha LB. Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention, irrespective of changes in cardiorespiratory fitness. Diabetologia 2020; 63:722-732. [PMID: 31960071 DOI: 10.1007/s00125-020-05089-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS Vascular changes in individuals with type 2 diabetes mellitus majorly contribute to the development of cardiovascular disease. Increased cardiorespiratory fitness (CRF) has been associated with improvements in vascular health. Although CRF tends to improve with exercise training, there remains a portion of participants with little or no improvement. Given the importance of vascular function in individuals with type 2 diabetes, we assessed whether individuals who failed to improve CRF following a 1 year exercise intervention also failed to improve arterial stiffness and structural indices. METHODS Individuals with type 2 diabetes with no major micro- and macrovascular complications and aged between 30 and 75 years old (n = 63) participated in a three-arm, 1 year, randomised controlled exercise intervention in Lisbon, Portugal. The study involved a non-exercise control group, a moderate continuous training combined with resistance training (RT) group and a high-intensity interval training with RT group. Allocation of participants into the intervention and control groups was done using a computer-generated list of random numbers. An improvement in CRF was defined as a change in [Formula: see text] ≥5%. Vascular stiffness and structural indices were measured using ultrasound imaging and applanation tonometry. Generalised estimating equations were used to compare changes in vascular measures across individuals in the control group (n = 22) and those in the exercise groups who either had improved CRF (CRF responders; n = 14) or whose CRF did not improve (CRF non-responders; n = 27) following 1 year of exercise training. RESULTS Compared with the control group, exercisers, with and without improvements in CRF, had decreased carotid intima-media thickness (IMT) (CRF responders: β = -2.84 [95% CI -5.63, -0.04]; CRF non-responders: β = -5.89 [95% CI -9.38, -2.40]) and lower-limb pulse wave velocity (PWV) (CRF responders: β = -0.14 [95% CI -0.25, -0.03]; CRF non-responders: β = -0.14 [95% CI -0.25, -0.03]), the latter being an indicator of peripheral arterial stiffness. Only CRF responders had decreased PWV of the upper limb compared with control participants (β = -0.12 [95% CI -0.23, -0.01]). As for central stiffness, CRF non-responders had increased aortic PWV compared with CRF responders (β = 0.19 [95% CI 0.07, 0.31]), whereas only the CRF non-responders had altered carotid distensibility coefficient compared with the control group (β = 0.00 [95% CI 3.01 × 10-5, 0.00]). No interaction effects between the CRF responders and non-responders vs control group were found for the remaining stiffness or haemodynamic indices (p>0.05). CONCLUSIONS/INTERPRETATION Regardless of improvements in CRF, individuals with type 2 diabetes had significant improvements in carotid IMT and lower-limb arterial stiffness following a 1 year exercise intervention. Thus, a lack of improvement in CRF following exercise in people with type 2 diabetes does not necessarily entail a lack of improvement in vascular health. TRIAL REGISTRATION ClinicalTrials.gov NCT03144505 FUNDING: This work was supported by fellowships from the Portuguese Foundation for Science and Technology. This work is also financed by a national grant through the Fundação para a Ciência e Tecnologia (FCT), within the unit I&D 472.
Collapse
Affiliation(s)
- Megan Hetherington-Rauth
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Pedro B Júdice
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Xavier Melo
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
- Ginásio Clube Português, GCP Lab, Lisbon, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.
| |
Collapse
|
19
|
Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Peña-Gil C, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van'tHof AWJ, de Kluiver EP, Laimer M, Wilhelm M. Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study. Cardiovasc Diabetol 2020; 19:37. [PMID: 32192524 PMCID: PMC7081600 DOI: 10.1186/s12933-020-01013-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. Methods 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. Results 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. Conclusions While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166
Collapse
Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña-Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, SERGAS, FIDIS, CIBER CV, University of Santiago de Compostela, Santiago, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P Meindersma
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Arnoud W J Van'tHof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | | | - Markus Laimer
- Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
20
|
Gutiérrez-Camacho LR, Kormanovski A, Del Carmen Castillo-Hernández M, Guevara-Balcázar G, Lara-Padilla E. Alterations in glutathione, nitric oxide and 3-nitrotyrosine levels following exercise and/or hyperbaric oxygen treatment in mice with diet-induced diabetes. Biomed Rep 2020; 12:222-232. [PMID: 32257185 PMCID: PMC7100140 DOI: 10.3892/br.2020.1291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
Oxidative stress is involved in the development of diabetes. Nitric oxide (NO) contributes to oxidative stress, affects the synthesis of glutathione (GSH) in tissues and also regulates important physiological processes. The levels of nitrosative stress, assessed by measuring the levels of 3-nitrotirosina (3NT) as well as the bioavailability of NO are modulated by exercise and hyperbaric oxygenation (HBO). The aim of the present study was to evaluate the effects of exercise and HBO on the levels of NO, 3NT and GSH in tissues of various organs obtained from diabetic mice. Female mice were fed a high-fat/high-fructose diet to induce diabetes. Mice with diabetes were subjected to exercise and/or HBO. Initial and final concentrations of NO, 3NT and GSH were assessed in the muscle, liver, kidney, heart, spleen, lung, brain, visceral adipose, thoracic aorta and small intestine. Diabetes did not affect initial values of NO, although it significantly increased the levels of 3NT. The basal level of GSH in the diabetic group was lower than or comparable to that of the control group in the majority of the organs assessed. A negative correlation was observed between 3NT and GSH levels in the initial values of all tissues of the control group only, whereas all pathological tissues showed a positive correlation between NO and GSH. There was an increase or a stabilization of GSH levels in the majority of the organs in all treated mice despite the increase in nitrosative stress.
Collapse
Affiliation(s)
| | - Alexandre Kormanovski
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Mexico City 11340, Mexico
| | | | | | - Eleazar Lara-Padilla
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Mexico City 11340, Mexico
| |
Collapse
|
21
|
Torres G, Crowther NJ, Rogers G. The Relationship of VO 2 Peak and the Blood Lactate Transition Threshold with Metabolic Syndrome and Its Component Disorders. Metab Syndr Relat Disord 2020; 18:134-140. [PMID: 32119799 DOI: 10.1089/met.2019.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Improvements in cardiorespiratory fitness attenuate the risk for metabolic syndrome (MetS). However, the determinants of cardiorespiratory fitness measurements such as oxygen consumption (VO2) peak and anaerobic threshold (AT) have not been investigated in persons with MetS. Therefore, the main aim of this study was to compare VO2 peak and AT between subjects with and without MetS and to investigate determinants of cardiorespiratory fitness and its effects on the odds for MetS and its individual components. Methods: Thirty-one males with MetS and 24 healthy male participants each performed a VO2 peak and a blood lactate transition threshold test. Waist circumference, body mass index (BMI), blood pressure, fasting plasma triglyceride, total cholesterol, high-density lipoprotein cholesterol, glucose, and insulin levels were measured. Separate multivariable linear regression models were developed in which VO2 peak, AT, and the components of MetS were used as the dependent variables, while a multivariable logistic regression model was used for MetS. Results: The VO2 peak [median (interquartile range)] was lower in subjects with MetS compared with controls [27.9 (23.0-31.0) vs. 35.0 (32.0-45.0) mL·min-1·kg-1; P < 0.0001]. Multivariable regression analysis demonstrated that there was a bidirectional association between MetS and VO2 peak that was mediated by waist circumference and blood pressure. The VO2 peak was a strong negative determinant of waist circumference (β = -0.36, P < 0.0001), but not of BMI (β = -0.13, P = 0.21). Conclusions: A higher VO2 peak is associated with a lower odds ratio for MetS, which is related to greater cardiorespiratory fitness in a cyclical relationship that is mediated by blood pressure and waist circumference. A higher VO2 peak is specifically associated with lower waist circumference, and vice versa, possibly by effects on visceral fat.
Collapse
Affiliation(s)
- Georgia Torres
- School of Therapeutic Sciences, Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Nigel John Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Geoff Rogers
- Department of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| |
Collapse
|
22
|
Caliskan H, Akat F, Omercioglu G, Bastug G, Ficicilar H, Bastug M. Aerobic exercise has an anxiolytic effect on streptozotocin-induced diabetic rats. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Abstract
In insulin resistance, alterations occur in the signalling pathways that modulate glucose uptake into cells, especially skeletal muscle cells, resulting in impaired glucose homeostasis. Glucose uptake into cells is controlled by a number of pathways, some of which are insulin-dependent. During exercise glucose uptake can occur independently of insulin regulation, and hence research into the effects of exercise on insulin resistance must be clearly defined to reflect whether glucose uptake has been enhanced as a result of the utilisation of these insulin-independent pathways, or whether exercise directly affects insulin resistance in cells. Research into the benefits of exercise for insulin resistance is also problematic in the need to clarify whether it is the exercise itself, or the visceral fat/weight loss that has resulted from the exercise, that has led to improved insulin sensitivity. The research presents a promising picture for the benefits of exercise in insulin resistance.
Collapse
Affiliation(s)
- Stephney Whillier
- Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia.
| |
Collapse
|
24
|
Caliskan H, Akat F, Tatar Y, Zaloglu N, Dursun AD, Bastug M, Ficicilar H. Effects of exercise training on anxiety in diabetic rats. Behav Brain Res 2019; 376:112084. [DOI: 10.1016/j.bbr.2019.112084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/20/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022]
|
25
|
Lewis MT, Kasper JD, Bazil JN, Frisbee JC, Wiseman RW. Quantification of Mitochondrial Oxidative Phosphorylation in Metabolic Disease: Application to Type 2 Diabetes. Int J Mol Sci 2019; 20:E5271. [PMID: 31652915 PMCID: PMC6862501 DOI: 10.3390/ijms20215271] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes (T2D) is a growing health concern with nearly 400 million affected worldwide as of 2014. T2D presents with hyperglycemia and insulin resistance resulting in increased risk for blindness, renal failure, nerve damage, and premature death. Skeletal muscle is a major site for insulin resistance and is responsible for up to 80% of glucose uptake during euglycemic hyperglycemic clamps. Glucose uptake in skeletal muscle is driven by mitochondrial oxidative phosphorylation and for this reason mitochondrial dysfunction has been implicated in T2D. In this review we integrate mitochondrial function with physiologic function to present a broader understanding of mitochondrial functional status in T2D utilizing studies from both human and rodent models. Quantification of mitochondrial function is explained both in vitro and in vivo highlighting the use of proper controls and the complications imposed by obesity and sedentary lifestyle. This review suggests that skeletal muscle mitochondria are not necessarily dysfunctional but limited oxygen supply to working muscle creates this misperception. Finally, we propose changes in experimental design to address this question unequivocally. If mitochondrial function is not impaired it suggests that therapeutic interventions and drug development must move away from the organelle and toward the cardiovascular system.
Collapse
Affiliation(s)
- Matthew T Lewis
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Jonathan D Kasper
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
- Present address: Molecular Physiology Institute, Duke University, Durham, NC 27701, USA.
| | - Jason N Bazil
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Jefferson C Frisbee
- Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Robert W Wiseman
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
- Department of Radiology, Michigan State University, East Lansing, MI 48824, USA.
| |
Collapse
|