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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] [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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Schwensfeier L, Kreutz T, Brinkmann C. Is there a different rating of perceived exertion in men with type 2 diabetes mellitus? J Diabetes Metab Disord 2023; 22:1399-1404. [PMID: 37969914 PMCID: PMC10638251 DOI: 10.1007/s40200-023-01261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 11/17/2023]
Abstract
Objective Studies show that patients with type 2 diabetes mellitus (T2DM) do not engage in regular exercise as often as individuals without T2DM. In addition to numerous barriers to engaging in regular exercise, a different rating of perceived exertion (RPE) during physical activity has been hypothesized to play a role. Therefore, this study investigates whether T2DM affects RPE. Methods RPE values (BORG scale ratings) and heart rate (HR) data were analyzed during an endurance step test (25 W + 25 W every 2 min) at different workloads relative to the individual maximum load (50%, 70% and 90% of peak workload (Wpeak)) in patients with T2DM and in non-diabetic control (CON) subjects (n = 12 in each group). Furthermore, in a larger group of overweight patients with T2DM (n = 81), it was investigated whether glycated hemoglobin (HbA1c) levels correlate with RPE values at the different relative loads. Results Neither RPE nor HR values significantly differed between T2DM and CON subjects at 50%, 70% or 90% of Wpeak. No significant correlations were identified between HbA1c levels and RPE values. Conclusion There is no evidence in our study that T2DM leads to a different perception of physical exertion. Other causes must therefore be responsible for the increased lack of motivation of T2DM patients to engage in regular exercise.
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Affiliation(s)
- Leon Schwensfeier
- Institute of Cardiovascular Research and Sport Medicine, Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Thorsten Kreutz
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
| | - Christian Brinkmann
- Institute of Cardiovascular Research and Sport Medicine, Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
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3
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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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MacDonald TL, Pattamaprapanont P, Cooney EM, Nava RC, Mitri J, Hafida S, Lessard SJ. Canagliflozin Prevents Hyperglycemia-Associated Muscle Extracellular Matrix Accumulation and Improves the Adaptive Response to Aerobic Exercise. Diabetes 2022; 71:881-893. [PMID: 35108373 PMCID: PMC9044131 DOI: 10.2337/db21-0934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
Chronic hyperglycemia is associated with low response to aerobic exercise training in rodent models and humans, including reduced aerobic exercise capacity and impaired oxidative remodeling in skeletal muscle. Here, we investigated whether glucose lowering with the sodium-glucose cotransporter 2 inhibitor (SGLT2i), canagliflozin (Cana; 30 mg/kg/day), could restore exercise training response in a model of hyperglycemia (low-dose streptozotocin [STZ]). Cana effectively prevented increased blood glucose in STZ-treated mice. After 6 weeks of voluntary wheel running, Cana-treated mice displayed improvements in aerobic exercise capacity, higher capillary density in striated muscle, and a more oxidative fiber-type in skeletal muscle. In contrast, these responses were blunted or absent in STZ-treated mice. Recent work implicates glucose-induced accumulation of skeletal muscle extracellular matrix (ECM) and hyperactivation of c-Jun N-terminal kinase (JNK)/SMAD2 mechanical signaling as potential mechanisms underlying poor exercise response. In line with this, muscle ECM accretion was prevented by Cana in STZ-treated mice. JNK/SMAD2 signaling with acute exercise was twofold higher in STZ compared with control but was normalized by Cana. In human participants, ECM accumulation was associated with increased JNK signaling, low VO2peak, and impaired metabolic health (oral glucose tolerance test-derived insulin sensitivity). These data demonstrate that hyperglycemia-associated impairments in exercise adaptation can be ameliorated by cotherapy with SGLT2i.
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Affiliation(s)
- Tara L. MacDonald
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Roberto C. Nava
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Joanna Mitri
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Samar Hafida
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarah J. Lessard
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
- Corresponding author: Sarah J. Lessard,
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5
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Kim YS, van der Ster BJP, Brassard P, Secher NH, van Lieshout JJ. Cerebral vs. Cardiovascular Responses to Exercise in Type 2 Diabetic Patients. Front Physiol 2021; 11:583155. [PMID: 33519500 PMCID: PMC7844205 DOI: 10.3389/fphys.2020.583155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for "central" fatigue during exhaustive exercise is addressed in relation to brain's attenuated vascular response to exercise in type 2 diabetic subjects.
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Affiliation(s)
- Yu-Sok Kim
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Björn J. P. van der Ster
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Niels H. Secher
- Department of Anesthesia, The Copenhagen Muscle Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Johannes J. van Lieshout
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, United Kingdom
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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6
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Van Ryckeghem L, Keytsman C, Verboven K, Verbaanderd E, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D. Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients. Eur J Prev Cardiol 2020; 28:1756-1766. [PMID: 33623980 DOI: 10.1093/eurjpc/zwaa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) is associated with reduced exercise capacity and cardiovascular diseases, both increasing morbidity and risk for premature death. As exercise intolerance often relates to cardiac dysfunction, it remains to be elucidated to what extent such an interplay occurs in T2DM patients without overt cardiovascular diseases. Design: Cross-sectional study, NCT03299790. METHODS AND RESULTS Fifty-three T2DM patients underwent exercise echocardiography (semi-supine bicycle) with combined ergospirometry. Cardiac output (CO), left ventricular longitudinal strain (LS), oxygen uptake (O2), and oxygen (O2) extraction were assessed simultaneously at rest, low-intensity exercise, and high-intensity exercise. Glycaemic control and lipid profile were assessed in the fasted state. Participants were assigned according to their exercise capacity being adequate or impaired (EXadequate: O2peak <80% and EXimpaired: O2peak ≥80% of predicted O2peak) to compare O2 extraction, CO, and LS at all stages. Thirty-eight participants (EXimpaired: n = 20 and EXadequate: n = 18) were included in the analyses. Groups were similar regarding HbA1c, age, and sex (P > 0.05). At rest, CO was similar in the EXimpaired group vs. EXadequate group (5.1 ± 1 L/min vs. 4.6 ± 1.4 L/min, P > 0.05) and increased equally during exercise. EXimpaired patients displayed a 30.7% smaller increase in O2 extraction during exercise compared to the EXadequate group (P = 0.016) which resulted in a lower O2 extraction at high-intensity exercise (12.5 ± 2.8 mL/dL vs. 15.3 ± 3.9 mL/dL, P = 0.012). Left ventricular longitudinal strain was similar at rest but increased significantly less in the EXimpaired vs. EXadequate patients (1.9 ± 2.5% vs. 5.9 ± 4.1%, P = 0.004). CONCLUSIONS In asymptomatic T2DM patients, an impaired exercise capacity is associated with an impaired response in oxygen extraction and myocardial deformation (LS). TRIAL REGISTRY Effect of High-intensity Interval Training on Cardiac Function and Regulation of Glycemic Control in Diabetic Cardiomyopathy (https://clinicaltrials.gov/ct2/show/NCT03299790).
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Affiliation(s)
| | - Charly Keytsman
- Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Kenneth Verboven
- Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Elvire Verbaanderd
- Physical Activity, Department of Sport & Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Ines Frederix
- Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), Faculty of Medicine & Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Elise Bakelants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department of cardiology, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Thibault Petit
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Siddharth Jogani
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Sarah Stroobants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Paul Dendale
- Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Virginie Bito
- Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Jan Verwerft
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Dominique Hansen
- Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
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7
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Bozdemir-Ozel C, Arikan H, Calik-Kutukcu E, Karadüz BN, Inal-Ince D, Kabakci G, Sumer E, Dagdelen S. Subclinical Inflammation Is Associated With Reductions in Muscle Oxygenation, Exercise Capacity and Quality of Life in Adults With Type 2 Diabetes. Can J Diabetes 2020; 44:422-427. [PMID: 32616275 DOI: 10.1016/j.jcjd.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 02/13/2020] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Exercise capacity is related to both morbidity and mortality in patients with type 2 diabetes (T2DM). The aim of this study was to investigate the relationship between subclinical inflammation level, exercise capacity, muscle oxygenation and quality of life in T2DM. METHODS This study includes 28 patients with T2DM (mean age, 51.5±5.0 years; male-to-female ratio, 6:22). Exercise capacity was evaluated using an incremental symptom-limited maximal exercise test on a bicycle ergometer. Muscle oxygenation was investigated using a wearable lactate-measuring device. Diabetes-specific quality of life was assessed using the Diabetes Quality of Life Questionnaire (DQOL). Subclinical inflammation was assessed using C-reactive protein (CRP) levels. RESULTS CRP level was negatively correlated with peak workload during the test (r=-0.588, p=0.002), muscle oxygenation (r=-0.465, p=0.019) and the psychological impact of treatment subscale of the DQOL (r=-0.540, p=0.017), and positively correlated with body mass index (r=0.519, p=0.008), waist circumference (r=0.426, p=0.038) and fat percentage (r=0.573, p=0.004). There was no correlation between CRP and fasting blood glucose or glycated hemoglobin level (p>0.05). Peak workload was inversely related to fat percentage (r=-0.467, p=0.016) and the DQOL worry about the future impact of diabetes subscale (r=-0.501, p=0.021). CONCLUSIONS In our study, subclinical inflammation negatively affected muscle oxygenation, exercise capacity and quality of life independently of glycemic indicators. Our findings suggest that the degree of glycemic control is insufficient to explain lower exercise capacity. Further studies are needed to investigate subclinical inflammation-reducing interventions in T2DM.
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Affiliation(s)
- Cemile Bozdemir-Ozel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Hülya Arikan
- Faculty of Health Sciences, Department of Physiotherapy, Atılım University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Beyza Nur Karadüz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Giray Kabakci
- Department of Cardiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Sumer
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Selçuk Dagdelen
- Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey
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8
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Abushamat LA, McClatchey PM, Scalzo RL, Schauer I, Huebschmann AG, Nadeau KJ, Liu Z, Regensteiner JG, Reusch JEB. Mechanistic Causes of Reduced Cardiorespiratory Fitness in Type 2 Diabetes. J Endocr Soc 2020; 4:bvaa063. [PMID: 32666009 PMCID: PMC7334033 DOI: 10.1210/jendso/bvaa063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) has been rising in prevalence in the United States and worldwide over the past few decades and contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable cardiovascular (CV) risk factor in the general population and in people with T2D. Young people and adults with T2D have reduced CRF when compared with their peers without T2D who are similarly active and of similar body mass index. Furthermore, the impairment in CRF conferred by T2D is greater in women than in men. Various factors may contribute to this abnormality in people with T2D, including insulin resistance and mitochondrial, vascular, and cardiac dysfunction. As proof of concept that understanding the mediators of impaired CRF in T2D can inform intervention, we previously demonstrated that an insulin sensitizer improved CRF in adults with T2D. This review focuses on how contributing factors influence CRF and why they may be compromised in T2D. Functional exercise capacity is a measure of interrelated systems biology; as such, the contribution of derangement in each of these factors to T2D-mediated impairment in CRF is complex and varied. Therefore, successful approaches to improve CRF in T2D should be multifaceted and individually designed. The current status of this research and future directions are outlined.
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Affiliation(s)
- Layla A Abushamat
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Rebecca L Scalzo
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Irene Schauer
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amy G Huebschmann
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Zhenqi Liu
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jane E B Reusch
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Senefeld JW, D’Astice SE, Harmer AR, Hunter SK. Increased Cardiovascular Response to a 6-Minute Walk Test in People With Type 2 Diabetes. Diabetes Spectr 2020; 33:104-110. [PMID: 32116462 PMCID: PMC7026755 DOI: 10.2337/ds19-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Exercise is a cornerstone of management for type 2 diabetes; however, little is known about the cardiovascular (CV) response to submaximal functional exercise in people with type 2 diabetes. The aim of this study was to compare performance and CV response during a 6-minute walk test (6MWT) between people with type 2 diabetes and matched control subjects. METHODS CV response and distance walked during the 6MWT were assessed in 30 people with type 2 diabetes, matched for age, body composition, physical activity, and estimated aerobic capacity with 34 control subjects (type 2 diabetes group: 16 men, 59.8 ± 8.8 years of age, 33.3 ± 10.9% body fat, physical activity of 7,968 ± 3,236 steps·day-1, estimated aerobic capacity 31.9 ± 11.1 mLO2·kg-1·min-1; control group: 19 men, 59.3 ± 8.8 years of age, 32.7 ± 8.5% body fat, physical activity 8,228 ± 2,941 steps·day-1, estimated aerobic capacity 34.9 ± 15.4 mLO2·kg-1·min-1). RESULTS People with type 2 diabetes walked a similar distance (590 ± 75 vs. 605 ± 69 m; P = 0.458) compared with control subjects during the 6MWT and had similar ratings of perceived exertion (RPE) after the 6MWT (4.19 ± 1.56 vs. 3.65 ± 1.54, P = 0.147). However, at the end of the 6MWT, people with type 2 diabetes had a higher heart rate (108 ± 23 vs. 95 ± 18 beats·min-1; P = 0.048), systolic blood pressure (169 ± 26 vs. 147 ± 22 mmHg, P = 0.003), and rate-pressure product (18,762 ± 5,936 vs. 14,252 ± 4,330, P = 0.009) than control subjects. CONCLUSION Although people with type 2 diabetes had similar performance and RPE during the 6MWT compared with control subjects, the CV response was greater for people with type 2 diabetes, indicating greater cardiac effort for similar perceived effort and performance of 6MWT. These data suggest that observation and prescription of exercise intensity should include both perceived effort and CV response.
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Affiliation(s)
- Jonathon W. Senefeld
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Sarah E. D’Astice
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Alison R. Harmer
- Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Sandra K. Hunter
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI
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A Couples-Based Approach for Increasing Physical Activity Among Adults With Type 2 Diabetes: A Pilot Feasibility Randomized Controlled Trial. DIABETES EDUCATOR 2019; 45:629-641. [DOI: 10.1177/0145721719881722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PurposeThe purpose of the study was to examine feasibility outcomes and obtain initial efficacy data on an intervention testing collaborative implementation intentions (IIs) for physical activity (PA) among participants with type 2 diabetes.MethodsThe study used a pilot randomized design and enrolled people with diabetes (PWD) and their partners (N = 40 couples, 80 individuals). PWD reported psychosocial measures, including self-efficacy for PA, diabetes partner investment in diabetes self-management, and PA-related social support. Accelerometers (objective) and the International Physical Activity Questionnaire (self-report) were used to assess PA.ResultsParticipants in both experimental conditions reported being satisfied with the intervention and highly committed to their PA plans. Participants were able to follow instructions and completed the intervention in less than 30 minutes. Participants in the collaborative IIs condition reported a greater increase in PA-related social support (partial2= .185, P < .05) and self-reported recreational PA (partial2= .210, P < .05) at 6 weeks compared to the other 2 conditions. In this pilot study, there were no significant group differences on other psychosocial outcomes or for objective PA; however, time in light PA trended higher for the collaborative IIs condition compared to the other 2 conditions (partial2= .237, P = .056).ConclusionsThis study provides initial support for collaborative IIs for PA with PWD and their partners. This brief intervention was feasible and highly acceptable, and it may improve relationship dynamics around PA as well as ultimately increase PA.
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Scalzo RL, Rafferty D, Schauer I, Huebschmann AG, Cree-Green M, Reusch JEB, Regensteiner JG. Sitagliptin improves diastolic cardiac function but not cardiorespiratory fitness in adults with type 2 diabetes. J Diabetes Complications 2019; 33:561-566. [PMID: 31182338 PMCID: PMC7278036 DOI: 10.1016/j.jdiacomp.2019.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2D) have preclinical cardiac and vascular dysfunction associated with low cardiorespiratory fitness (CRF). This is especially concerning because CRF is a powerful predictor of cardiovascular mortality, a primary issue in T2D management. Glucagon-like pepetide-1 (GLP-1) augments cardiovascular function and our previous data in rodents demonstrate that potentiating the GLP-1 signal with a dipeptidyl peptidase-4 (DPP4) inhibitor augments CRF. Lacking are pharmacological treatments which can target T2D-specific physiological barriers to exercise to potentially permit adaptations necessary to improve CRF and thereby health outcomes in people with T2D. We therefore hypothesized that administration of a DPP4-inhibitor (sitagliptin) would improve CRF in adults with T2D. METHODS AND RESULTS Thirty-eight participants (64 ± 1 years; mean ± SE) with T2D were randomized in a double-blinded study to receive 100 mg/day sitagliptin, 2 mg/day glimepiride, or placebo for 3 months after baseline measurements. Fasting glucose decreased with both glimepiride and sitagliptin compared with placebo (P = 0.002). CRF did not change in any group (Placebo: Pre: 15.4 ± 0.9 vs. Post: 16.1 ± 1.1 ml/kg/min vs. Glimepiride: 18.5 ± 1.0 vs. 17.7 ± 1.2 ml/kg/min vs. Sitagliptin: 19.1 ± 1.2 vs. 18.3 ± 1.1 ml/kg/min; P = 0.3). Sitagliptin improved measures of cardiac diastolic function, however, measures of vascular function did not change with any treatment. CONCLUSIONS Three months of sitagliptin improved diastolic cardiac function, however, CRF did not change. These data suggest that targeting the physiological contributors to CRF with sitagliptin alone is not an adequate strategy to improve CRF in people with T2D. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov NCT01951339.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America.
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Irene Schauer
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Amy G Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Melanie Cree-Green
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Division of Pediatric Endocrinology, University of Colorado School of Medicine, United States of America
| | - Jane E B Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
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Bartholomae EM, Moore J, Ward K, Kressler J. Sex differences in postprandial glucose response to short bouts of exercise: A randomized controlled trial. J Sci Med Sport 2019; 22:181-185. [DOI: 10.1016/j.jsams.2018.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
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De Schutter A, Kachur S, Lavie CJ, Menezes A, Shum KK, Bangalore S, Arena R, Milani RV. Cardiac rehabilitation fitness changes and subsequent survival. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:173-179. [PMID: 29701805 DOI: 10.1093/ehjqcco/qcy018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Aims Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. This study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared with low-responders (LowRes) and high-responders (HighRes) after CR. Methods and results A total of 1171 CHD patients were referred for a phase II CR programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between 1 January 2000 and 30 June 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF (i.e. change in peak oxygen consumption expressed in mL⋅kg-1⋅min-1). Mortality was analysed after 0.5-13.4 years of follow-up (mean 6.4 years). A total of 266 (23%) subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes, and LowRes had a statistically significant three-fold and two-fold higher mortality, respectively, when compared with HighRes (HighRes 8% vs. LowRes 17% vs. NonRes 22%; P < 0.001). Age, female gender, baseline CRF, hostility, and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusion Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sergey Kachur
- Department of Graduate Medical Education, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Arthur Menezes
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Kelly K Shum
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
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Shakil-ur-Rehman S, Karimi H, Gillani SA, Amjad I, Ahmad S, Yaseen A. Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus – Does Gender Make a Difference? A Randomized Controlled Clinical Trial. J Natl Med Assoc 2018; 110:431-439. [DOI: 10.1016/j.jnma.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/06/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
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Saanijoki T, Nummenmaa L, Koivumäki M, Löyttyniemi E, Kalliokoski KK, Hannukainen JC. Affective Adaptation to Repeated SIT and MICT Protocols in Insulin-Resistant Subjects. Med Sci Sports Exerc 2018; 50:18-27. [PMID: 28857909 DOI: 10.1249/mss.0000000000001415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to investigate affective responses to repeated sessions of sprint interval training (SIT) in comparison with moderate-intensity continuous training (MICT) in insulin-resistant subjects. METHODS Twenty-six insulin-resistant adults (age, 49 (4) yr; 10 women) were randomized into SIT (n = 13) or MICT (n = 13) groups. Subjects completed six supervised training sessions within 2 wk (SIT session, 4-6 × 30 s all-out cycling/4-min recovery; MICT session, 40-60 min at 60% peak work load). Perceived exertion, stress, and affective state were assessed with questionnaires before, during and after each training session. RESULTS Perceived exertion, displeasure, and arousal were higher during the SIT compared with MICT sessions (all P < 0.01). These, however, alleviated similarly in response to SIT and MICT over the 6 d of training (all P < 0.05). SIT versus MICT exercise increased perceived stress and decreased positive affect and feeling of satisfaction acutely after exercise especially in the beginning of the intervention (all P < 0.05). These negative responses declined significantly during the training period: perceived stress and positive activation were no longer different between the training groups after the third, and satisfaction after the fifth training session (P > 0.05). CONCLUSIONS The perceptual and affective responses are more negative both during and acutely after SIT compared with MICT in untrained insulin-resistant adults. These responses, however, show significant improvements already within six training sessions, indicating rapid positive affective and physiological adaptations to continual exercise training, both SIT and MICT. These findings suggest that even very intense SIT is mentally tolerable alternative for untrained people with insulin resistance.
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Affiliation(s)
- Tiina Saanijoki
- 1Turku PET Centre, University of Turku, Turku, FINLAND; 2Department of Psychology, University of Turku, Turku, FINLAND; 3Department of Nursing Science, University of Turku, Turku, FINLAND; and 4Department of Biostatistics, University of Turku, Turku, FINLAND
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Wahl MP, Scalzo RL, Regensteiner JG, Reusch JEB. Mechanisms of Aerobic Exercise Impairment in Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2018; 9:181. [PMID: 29720965 PMCID: PMC5915473 DOI: 10.3389/fendo.2018.00181] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
The prevalence of diabetes in the United States and globally has been rapidly increasing over the last several decades. There are now estimated to be 30.3 million people in the United States and 422 million people worldwide with diabetes. Diabetes is associated with a greatly increased risk of cardiovascular mortality, which is the leading cause of death in adults with diabetes. While exercise training is a cornerstone of diabetes treatment, people with diabetes have well-described aerobic exercise impairments that may create an additional diabetes-specific barrier to adding regular exercise to their lifestyle. Physiologic mechanisms linked to exercise impairment in diabetes include insulin resistance, cardiac abnormalities, mitochondrial function, and the ability of the body to supply oxygen. In this paper, we highlight the abnormalities of exercise in type 2 diabetes as well as potential therapeutic approaches.
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Affiliation(s)
- Matthew P. Wahl
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Veterans Administration Eastern Colorado Health Care System, Denver, CO, United States
| | - Rebecca L. Scalzo
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith G. Regensteiner
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E. B. Reusch
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
- Veterans Administration Eastern Colorado Health Care System, Denver, CO, United States
- Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- *Correspondence: Jane E. B. Reusch,
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Scalzo RL, Moreau KL, Ozemek C, Herlache L, McMillin S, Gilligan S, Huebschmann AG, Bauer TA, Dorosz J, Reusch JEB, Regensteiner JG. Exenatide improves diastolic function and attenuates arterial stiffness but does not alter exercise capacity in individuals with type 2 diabetes. J Diabetes Complications 2017; 31:449-455. [PMID: 27884660 PMCID: PMC5787373 DOI: 10.1016/j.jdiacomp.2016.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise is recommended as a cornerstone of treatment for type 2 diabetes mellitus (T2DM), however, it is often poorly adopted by patients. Even in the absence of apparent cardiovascular disease, persons with T2DM have an impaired ability to carry out maximal and submaximal exercise and these impairments are correlated with cardiac and endothelial dysfunction. Glucagon-like pepetide-1 (GLP-1) augments endothelial and cardiac function in T2DM. We hypothesized that administration of a GLP-1 agonist (exenatide) would improve exercise capacity in T2DM. METHODS AND RESULTS Twenty-three participants (64±4years; mean±SE) with uncomplicated T2DM were randomized in a double-blinded manner to receive either 10μg BID of exenatide or matching placebo after baseline measurements. Treatment with exenatide did not improve VO2peak (P=0.1464) or VO2 kinetics (P=0.2775). Diastolic function, assessed via resting lateral E:E', was improved with administration of exenatide compared with placebo (Placebo Pre: 7.6±1.0 vs. Post: 8.4±1.2 vs. Exenatide Pre: 8.1±0.7 vs. Post: 6.7±0.6; P=0.0127). Additionally, arterial stiffness measured by pulse wave velocity, was reduced with exenatide treatment compared with placebo (Placebo Pre: 10.5±0.8 vs. Post: 11.5±1.1s vs. Exenatide Pre: 11.4±1.8 vs. Post: 10.2±1.4s; P=0.0373). Exenatide treatment did not improve endothelial function (P=0.1793). CONCLUSIONS Administration of exenatide improved cardiac function and reduced arterial stiffness, however, these changes were not accompanied by improved functional exercise capacity. In order to realize the benefits of this drug on exercise capacity, combining exenatide with aerobic exercise training in participants with T2DM may be warranted.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Kerrie L Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; VAMC-Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado 80215
| | - Cemal Ozemek
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Leah Herlache
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Shawna McMillin
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Sarah Gilligan
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Amy G Huebschmann
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Tim A Bauer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Jennifer Dorosz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Jane E B Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Veterans Administration Medical Center (VAMC), Denver, Colorado 80215
| | - Judith G Regensteiner
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215.
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Leone RJ, Lalande S. Intermittent hypoxia as a means to improve aerobic capacity in type 2 diabetes. Med Hypotheses 2017; 100:59-63. [PMID: 28236850 DOI: 10.1016/j.mehy.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/15/2016] [Accepted: 01/21/2017] [Indexed: 11/18/2022]
Abstract
Physical inactivity and a low maximal aerobic capacity (VO2max) strongly predict morbidity and mortality in patients with type 2 diabetes (T2D). Patients with T2D have a reduced VO2max when compared with healthy individuals of similar age, weight, and physical activity levels, and this lower aerobic capacity is usually attributed to a reduced oxygen delivery to the working muscles. The oxygen carrying capacity of the blood, as well as increases in cardiac output and blood flow, contribute to the delivery of oxygen to the active muscles during exercise. Hemoglobin mass (Hb mass), a key determinant of oxygen carrying capacity, is suggested to be reduced in patients with T2D following the observation of a lower blood volume (BV) in combination with normal hematocrit levels in this population. Therefore, a lower Hb mass, in addition to a reported lower BV and impaired cardiovascular response to exercise, likely contributes to the reduced oxygen delivery and VO2max in patients with T2D. While exercise training increases Hb mass, BV, and consequently VO2max, the majority of patients with T2D are not physically active, highlighting the need for alternative methods to improve VO2max in this population. Exposure to hypoxia triggers the release of erythropoietin, the hormone regulating red blood cell production, which increases Hb mass and consequently BV. Exposure to mild intermittent hypoxia (IH), characterized by few and short episodes of hypoxia at a fraction of inspired oxygen ranging between 10 and 14% interspersed with cycles of normoxia, increased red blood cell volume, Hb mass, and plasma volume in patients with coronary artery disease or chronic obstructive pulmonary disease, which resulted in an improved VO2max in both populations. We hypothesize that 12 exposures to mild IH over a period of 4weeks will increase Hb mass, BV, cardiac function, and VO2max in patients with T2D. Therefore, exposures to mild IH may increase oxygen delivery and VO2max without the need to perform exercise in patients with T2D.
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Affiliation(s)
- R J Leone
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA.
| | - S Lalande
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
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Prescott SL, Logan AC. Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111075. [PMID: 27827896 PMCID: PMC5129285 DOI: 10.3390/ijerph13111075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
Abstract
The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.
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Affiliation(s)
- Susan L Prescott
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- School of Paediatrics and Child Health Research, University of Western Australia, P.O. Box D184, Princess Margaret Hospital, Perth 6001, Australia.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- PathLight Synergy, 23679 Calabassas Road, Suite 542, Calabassas, CA 91302, USA.
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Flandez J, Belando N, Gargallo P, Fernández-Garrido J, Vargas-Foitzick RA, Devis-Devis J, Colado JC. Metabolic and Functional Profile of Premenopausal Women With Metabolic Syndrome After Training With Elastics as Compared to Free Weights. Biol Res Nurs 2016; 19:190-197. [PMID: 27803043 DOI: 10.1177/1099800416674307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to compare the effects of a strength training program (STP) using free weights (FW) versus elastic tubing (ET) in 62 premenopausal, sedentary women diagnosed with metabolic syndrome (MS). Participants were randomly assigned to the FW or ET experimental group (EG) or a control group whose members remained sedentary. Members of each EG followed their assigned STP for 12 weeks, and biomarkers (BMs) related to MS and motor function (MF) parameters were evaluated. Both EGs showed a significant reduction in C-reactive protein level and a positive trend in the other BMs. Almost all MF parameters increased significantly in both EGs. No positive changes were found in the CG. These results indicate that the implementation of an STP, with either FW or ET, improves both metabolic health and MF and should be considered part of the basic approach to health care in women.
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Affiliation(s)
| | - Noelia Belando
- 2 Research Group in Sport and Health, University of Valencia, Valencia, Spain
| | - Pedro Gargallo
- 2 Research Group in Sport and Health, University of Valencia, Valencia, Spain
| | - Julio Fernández-Garrido
- 3 Nursing Department, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
| | | | - Jose Devis-Devis
- 5 Department of Physical Education and Sports, University of Valencia, Valencia, Spain
| | - Juan C Colado
- 2 Research Group in Sport and Health, University of Valencia, Valencia, Spain.,5 Department of Physical Education and Sports, University of Valencia, Valencia, Spain
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[For diabetics sports are more strenuous]. MMW Fortschr Med 2016; 158:42. [PMID: 26979216 DOI: 10.1007/s15006-016-7935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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