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Sui X, Kokkinos P, Faselis C, Samuel IBH, Pittaras A, Gollie J, Patel S, Lavie CJ, Zhang J, Myers J. Cardiorespiratory Fitness and Mortality in Patients With Chronic Kidney Disease: A Prospective Cohort Study. Mayo Clin Proc 2025:S0025-6196(24)00488-9. [PMID: 40186598 DOI: 10.1016/j.mayocp.2024.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/01/2024] [Accepted: 09/10/2024] [Indexed: 04/07/2025]
Abstract
OBJECTIVE To assess the association between objectively measured cardiorespiratory fitness (CRF) and mortality in patients with chronic kidney disease (CKD). PATIENTS AND METHODS From a large cohort of US veterans (n=750,302) based on the ETHOS (Exercise Testing and Health Outcomes) study, we identified 45,674 men and women aged 30 to 95 years (mean, 65.1 ± 8.8 years) who completed an exercise treadmill test (ETT) within the Veterans Affairs hospitals across the United States. All were diagnosed with CKD before the ETT by International Classification of Diseases 9th and 10th revision codes. Age- and-sex-specific CRF categories (quintiles) were established based on peak metabolic equivalents (METs) achieved during the ETT. We computed HRs and 95% CIs with Cox regression analyses adjusted for comorbidities and medications. RESULTS During 15.9 years of follow-up, 24,310 individuals (53.2%) died. The adjusted association between CRF and mortality risk was inverse and graded. For each 1-MET increase in CRF, the adjusted HR for mortality was 12% lower (HR, 0.88; 95% CI, 0.875 to 0.885; P<.001). When risk was assessed across CRF categories using the least-fit CRF category as the referent, the adjusted HRs and CIs were 0.76 (95% CI, 0.73 to 0.78), 0.63 (95% CI, 0.61 to 0.66), 0.49 (95% CI, 0.47 to 0.51), and 0.33 (95% CI, 0.30 to 0.35), for low-fit, moderate-fit, fit, and high-fit individuals, respectively. The pattern of the CRF mortality risk association was similar regardless of age, race, or sex. CONCLUSION In this large multiethnic study, we found an independent, inverse, and graded association between CRF and mortality in CKD patients. These findings underscore the importance of increasing CRF in CKD patients to lower the risk of mortality.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA.
| | - Peter Kokkinos
- Veterans Affairs Medical Center, Washington, DC, USA; Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA; Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Immanuel Babu Henry Samuel
- Veterans Affairs Medical Center, Washington, DC, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Washington, DC, USA; BRAIN Lab, War Related Illness and Injury Study Center, Washington, DC, USA
| | | | - Jared Gollie
- Veterans Affairs Medical Center, Washington, DC, USA
| | - Samir Patel
- Veterans Affairs Medical Center, Washington, DC, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, New Orleans, LA, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics (J.Z.), University of South Carolina, Columbia, SC, USA
| | - Jonathan Myers
- Department of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Cardiology, Stanford University, Stanford, CA, USA
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Cheng J, Bu C, Zheng X. Prospective association of estimated cardiorespiratory fitness and risk of chronic kidney diseases. Sci Rep 2025; 15:5260. [PMID: 39939393 PMCID: PMC11821850 DOI: 10.1038/s41598-025-89569-x] [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: 10/19/2024] [Accepted: 02/06/2025] [Indexed: 02/14/2025] Open
Abstract
Previous studies have reported that cardiorespiratory fitness (CRF) was associated with decreased risk of chronic kidney disease (CKD) in westerner. The aim of present study was to investigate the potential association between estimated eCRF (eCRF) and CKD risk in Chinese general population. A total of 5,199 participants from the China Health and Retirement Longitudinal Study were including in analysis. The sex-specific models including age, physical activity, resting heart rate, and waist circumference were used to calculate eCRF. Participants were divided into three subgroups according to age and sex-specific tertiles of eCRF. Cox proportional hazards regression models were used to examine the associations between eCRF and CKD. During 9 years of follow-up, a total of 511 respondents experienced CKD. After adjustment for potential variables, the hazard ratio (95% confidence intervals) for the tertile 2 and tertile 3 of eCRF- WC was 0.80 (0.66-0.96) and 0.74 (0.60-0.92), respectively, compared with the lowest tertiles. Moreover, each 1-SD increase of eCRF- WC was associated with 6% (95%CIs, 1-11%) decreased risk of CKD. Similar associations were also found in both male and female subgroups. When the current study calculated eCRF using body mass index instead of waist circumference, the highest tertiles of eCRF- BMI was significantly associated with decreased risk of CKD in overall and female participants. A higher eCRF was associated with a decreased risk of CKD in general Chinese population. Future well-designed prospective clinical studies are needed to verify our findings and to assess the effect of eCRF interventions in CKD prevention.
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Affiliation(s)
- Jufang Cheng
- Department of Neonatology, Wuxi Children's Hospital, Wuxi School of Medicine, Affiliated Children's Hospital of Jiangnan University, Jiangnan University, Wuxi, China
| | - Chaozhi Bu
- Research Institute for Reproductive Health and Genetic Diseases, Wuxi School of Medicine, Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi, 214002, China.
| | - Xiaowei Zheng
- Public Health Research Center, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Wuxi, 214122, Jiangsu Province, China.
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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; 189:2369-2373. [PMID: 38870042 DOI: 10.1093/milmed/usae311] [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: 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.
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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
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Chen Z, Cai L, Qin Q, Li X, Lu S, Sun L, Zhang Y, Qi L, Zhou T. Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007-2018. J Phys Act Health 2024; 21:756-764. [PMID: 38684209 DOI: 10.1123/jpah.2023-0576] [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: 10/05/2023] [Revised: 03/02/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses. METHODS This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks. RESULTS We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99). CONCLUSIONS Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.
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Affiliation(s)
- Zhaojun Chen
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Lishan Cai
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Qianni Qin
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Shaoyou Lu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Litao Sun
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Yang Zhang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tao Zhou
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Kaze AD, Santhanam P, Ahima RS, Bertoni AG, Echouffo-Tcheugui JB. Association Between Microvascular Disease and Cardiorespiratory Fitness Among Adults With Type 2 Diabetes. Diabetes Care 2024; 47:1408-1414. [PMID: 38837904 PMCID: PMC11272972 DOI: 10.2337/dc24-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Little is known about the extent to which microvascular disease is associated with cardiorespiratory fitness (CRF) among individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 4,766 participants with type 2 diabetes underwent maximal exercise testing in the Look AHEAD (Action for Health in Diabetes) study at baseline. Low CRF was defined based on the Aerobics Center Longitudinal Study reference standards. Microvascular disease was defined as having one or more of diabetes-related kidney disease (DKD), retinopathy, and neuropathy. The burden of microvascular disease was defined as the number of microvascular beds affected. RESULTS Of the 4,766 participants (mean age 58.9 ± 6.7 years, 58.5% women, 66.1% White individuals), 1,761 (37%) had microvascular disease. Participants with microvascular complications in three vascular territories had a lower CFR than those without any microvascular disease (mean adjusted metabolic equivalent of task [MET] 6.58 vs. 7.26, P = 0.001). Participants with any microvascular disease had higher odds of low CRF than those without microvascular disease (adjusted odds ratio [OR] 1.45, 95% CI 1.24-1.71). An increasing burden of microvascular disease was associated with higher odds of low CRF (for microvascular disease in three vascular territories, adjusted OR 2.82, 95% CI 1.36-5.85). Adjusted ORs for low CRF were 1.24 (95% CI 0.99-1.55), 1.34 (95% CI 1.02-1.76), and 1.44 (95% CI 1.20-1.73) for neuropathy, retinopathy, and DKD associations, respectively. CONCLUSIONS In a large cohort of adults with type 2 diabetes, the presence of microvascular disease and its burden were independently associated with lower CRF.
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Affiliation(s)
- Arnaud D. Kaze
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Medicine, LifePoint Health, Danville, VA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rexford S. Ahima
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Welch Prevention Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
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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.
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Affiliation(s)
- Eric Nylén
- Veterans Affairs Medical Center, Washington, D.C. 20422, USA
- George Washington University School of Medicine, Washington, D.C. 20037, USA
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Li W, Peng J, Shang Q, Yang D, Zhao H, Xu H. Periodontitis and the risk of all-cause and cause-specific mortality among US adults with diabetes: A population-based cohort study. J Clin Periodontol 2024; 51:288-298. [PMID: 37967814 DOI: 10.1111/jcpe.13901] [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: 02/13/2023] [Revised: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 11/17/2023]
Abstract
AIM To evaluate the association between periodontitis, all-cause and cause-specific mortality, and its prognostic utility among adults with diabetes. MATERIALS AND METHODS Periodontal health records were retrieved from the NHANES database for 4297 participants with diabetes aged >30 years at baseline during 1988-1994, 1999-2004 and 2009-2014. Multivariable Cox proportional hazards regression model was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for moderate/severe periodontitis with all-cause and cause-specific mortality in participants with diabetes. Area under the curve (AUC) was used to assess predictive value. RESULTS During a median follow-up of 15.41 years, 1701 deaths occurred. After multivariate adjustments, moderate/severe periodontitis was significantly associated with increased risk of all-cause (HR: 1.27; 95% CI: 1.07-1.50; p = .005) and cardiovascular disease (CVD)-related (HR: 1.35, 95% CI: 1.03-1.76, p = .031) mortality in participants with diabetes. The absolute risk difference based on the cumulative incidence information was 0.022 (5-year, 95% CI: 0.021-0.023) and 0.044 (10-year, 95% CI: 0.041-0.048). Periodontitis improved the prediction of all-cause (AUC: 0.652; 95% CI: 0.627-0.676) and CVD-related (AUC: 0.649; 95% CI: 0.624-0.676) mortality over standard risk factors (all-cause: AUC: 0.631; 95% CI: 0.606-0.656; CVD-related: AUC: 0.629; 95% CI: 0.604-0.655). CONCLUSIONS Moderate/severe periodontitis is associated with an increased risk of all-cause and CVD-related mortality in adults with diabetes. Periodontitis might represent a marker for residual risk.
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Affiliation(s)
- Weiqi Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Jiakuan Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Qianhui Shang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Dan Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Hang Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
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Kokkinos P, Myers J. Cardiorespiratory Fitness and Health Outcomes Across the Spectra of Age, Gender, and Race. Rev Cardiovasc Med 2024; 25:15. [PMID: 39077644 PMCID: PMC11262390 DOI: 10.31083/j.rcm2501015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 07/31/2024] Open
Affiliation(s)
- Peter Kokkinos
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ 08901, USA
- Veterans Affairs Medical Center, Washington, D.C. 20422, USA
- George Washington University School of Medicine and Health Sciences, Washington, D.C. 20052, USA
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Cardiology, Stanford University, Stanford, CA 94305, USA
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Blioumpa C, Karanasiou E, Antoniou V, Batalik L, Kalatzis K, Lanaras L, Pepera G. Efficacy of supervised home-based, real time, videoconferencing telerehabilitation in patients with type 2 diabetes: a single-blind randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:628-639. [PMID: 37350165 PMCID: PMC10665715 DOI: 10.23736/s1973-9087.23.07855-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Exercise-based interventions prevent or delay symptoms and complications of type 2 diabetes (T2D) and are highly recommended for T2D patients; though with very low participation rates. Τelerehabilitation (TR) could act as an alternative to overcome the barriers preventing the promotion of T2D patients' well-being. AIM Determine the effects of a six-week TR program on glycemic control, functional capacity, muscle strength, PA, quality of life and body composition in patients with T2D. DESIGN A multicenter randomized, single-blind, parallel-group clinical study. SETTING Clinical trial. POPULATION Patients with T2D. METHODS Thirty T2D patients (75% male, 60.1±10.9 years) were randomly allocated to an intervention group (IG) and a control group (CG) with no exercise intervention. IG enrolled in a supervised, individualized exercise program (combination of aerobic and resistance exercises), 3 times/week for 6 weeks at home via a TR platform. Glycated hemoglobin (HbA1c), six-minute walk test (6MWT), muscle strength (Hand Grip Strength Test [HGS], 30-Second Chair Stand test [30CST] physical activity [IPAQ-SF]), quality of life (SF-36) and anthropometric variables were assessed. RESULTS Two-way repeated-ANOVA showed a statistically significant interaction between group, time and test differences (6MWT, muscle strength) (V=0.33, F [2.17]=4.14, P=0.03, partial η2=0.22). Paired samples t-test showed a statistically significant improvement in HbA1c (Z=-2.7), 6MWT (Μean ∆=-36.9±27.2 m, t=-4.5), muscle strength (Μean ∆=-1.5±1.4 kg, t=-2.22). Similarly, SF-36 (mental health [Μean ∆=-13.3±21.3%], general health [Μean ∆=-11.4±16.90%]) were statistically improved only in IG. CONCLUSIONS The findings of this study indicate that a 6-week supervised home-based TR exercise program induced significant benefits in patients with T2D, thus enabling telehealth implementation in rehabilitation practice as an alternative approach. CLINICAL REHABILITATION IMPACT Home-based exercise via the TR platform is a feasible and effective alternative approach that can help patients with T2D eliminate barriers and increase overall rehabilitation utilization.
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Affiliation(s)
- Christina Blioumpa
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Evmorfia Karanasiou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ladislav Batalik
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic
| | | | - Leonidas Lanaras
- Department of Internal Medicine, General Hospital of Lamia, Lamia, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece -
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Huang WM, Chang HC, Chen CN, Huang CJ, Yu WC, Cheng HM, Guo CY, Chiang CE, Chen CH, Sung SH. Symptom-limited exercise capacity is associated with long-term survival. Medicine (Baltimore) 2023; 102:e34948. [PMID: 37773832 PMCID: PMC10545336 DOI: 10.1097/md.0000000000034948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 10/01/2023] Open
Abstract
The prognostic value of exercise capacity has been demonstrated in subjects with established cardiovascular diseases. We aim to evaluate the independence of exercise capacity measured by treadmill exercise test (TET) in predicting long-term outcomes among various comorbidities. This study was conducted from January 2003 to December 2012 in a tertiary medical center in Taiwan. Subjects referred for symptom-limited TET were recruited. Peak achieved metabolic equivalents (METs) were determined by treadmill grade and speed at peak exercise. The main outcomes were cardiovascular and all-cause mortality by linking to the National Death Registry. A total of 18,954 participants (57.8 ± 12.8 years, 62% men) achieved a mean peak METs of 9.2. Subjects in the lowest tertile of peak METs were older, had poorer renal function, lower hemoglobin, and more comorbidities. During a median follow-up of 4.3 years, there were 642 mortalities and 132 cardiovascular deaths. Peak METs significantly predicted cardiovascular death and all-cause mortality in the multivariable Cox regression models [hazard ratio (95% confidence intervals): 0.788 (0.660-0.940) and 0.835 (0.772-0.903), respectively]. The prognostic influence of peak METs consistently appeared in the subgroups, regardless of age, gender, body weight, comorbidities, use of beta-blockers, or the presence of exercise-induced ischemia. The fitness was more predictive of long-term outcomes in young or those with ischemic changes during TET (P for interaction: 0.035 and 0.018, respectively). The benefit of fitness was nonlinearly associated with long-term survival. The prognostic impacts of exercise capacity were universally observed in subjects with or without various comorbidities.
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Affiliation(s)
- Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Kinmen Hospital, Ministry of Health and Welfare, Taiwan
| | - Hao-Chih Chang
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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Nambi G, Alghadier M, Vellaiyan A, Ebrahim EE, Aldhafian OR, Mohamed SHP, Albalawi HFA, Chevidikunnan MF, Khan F, Mani P, Saleh AK, Alshahrani NN. Role of Tele-Physical Therapy Training on Glycemic Control, Pulmonary Function, Physical Fitness, and Health-Related Quality of Life in Patients with Type 2 Diabetes Mellitus (T2DM) Following COVID-19 Infection-A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1791. [PMID: 37372908 PMCID: PMC10298068 DOI: 10.3390/healthcare11121791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The use of tele-rehabilitation (TR) in type 2 diabetes mellitus (T2DM) following COVID-19 infection remains unexplored. Hence, the purpose of this study was to determine the clinical effects of tele-physical therapy (TPT) on T2DM following COVID-19 infection. The eligible participants were randomized into two groups, a tele-physical therapy group (TPG; n = 68) and a control group (CG; n = 68). The TPG received tele-physical therapy for four sessions a week for eight weeks, and the CG received patient education for 10 min. The outcome measures were HbA1c levels, pulmonary function (forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, maximum voluntary ventilation (MVV), and peak exploratory flow (PEF)), physical fitness, and quality of life (QOL). The difference between the groups in HbA1c levels at 8 weeks was 0.26 (CI 95% 0.02 to 0.49), which shows greater improvement in the tele-physical therapy group than the control group. Similar changes were noted between the two groups after 6 months and at 12 months resulting in 1.02 (CI 95% 0.86 to 1.17). The same effects were found in pulmonary function (FEV1, FVC, FEV1/FVC, MVV, and PEF), physical fitness, and QOL (p = 0.001). The reports of this study show that tele-physical therapy programs may result in improved glycemic control and improve the pulmonary function, physical fitness, and quality of life of T2DM patients following COVID-19 infection.
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Affiliation(s)
- Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Arul Vellaiyan
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.V.); (E.E.E.)
| | - Elturabi Elsayed Ebrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (A.V.); (E.E.E.)
| | - Osama R. Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (O.R.A.); (A.K.S.)
| | - Shahul Hameed Pakkir Mohamed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia; (S.H.P.M.); (H.F.A.A.)
| | - Hani Fahad Ateeq Albalawi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia; (S.H.P.M.); (H.F.A.A.)
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.F.C.); (F.K.)
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.F.C.); (F.K.)
| | - Paramasivan Mani
- Department of Rehabilitation Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Mubaraz 36428, Saudi Arabia;
| | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (O.R.A.); (A.K.S.)
- Department of Orthopedic, Faculty of Medicine for Girls, Al-Azhar University, Cairo 11651, Egypt
| | - Naif N. Alshahrani
- Orthopedic Surgery Department, King Fahad Medical City, Ministry of Health, Riyadh 12231, Saudi Arabia;
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12
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Gaesser GA. Type 2 Diabetes Incidence and Mortality: Associations with Physical Activity, Fitness, Weight Loss, and Weight Cycling. Rev Cardiovasc Med 2022; 23:364. [PMID: 39076198 PMCID: PMC11269068 DOI: 10.31083/j.rcm2311364] [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: 06/13/2022] [Revised: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 07/31/2024] Open
Abstract
Cardiometabolic diseases, including cardiovascular disease (CVD) and type 2 diabetes (T2D), are the leading cause of death globally. Because T2D and obesity are strongly associated, weight loss is the cornerstone of treatment. However, weight loss is rarely sustained, which may lead to weight cycling, which is associated with increased mortality risk in patients with T2D. Meta-analyses show that weight loss is not generally associated with reduced mortality risk in T2D, whereas weight cycling is associated with increased all-cause and CVD mortality. This may be attributable in part to increased variability in CVD risk factors that often accompany weight cycling, which studies show is consistently associated with adverse CVD outcomes in patients with T2D. The inconsistent associations between weight loss and mortality risk in T2D, and consistent findings of elevated mortality risk associated with weight cycling, present a conundrum for a weight-loss focused T2D prevention and treatment strategy. This is further complicated by the findings that among patients with T2D, mortality risk is lowest in the body mass index (BMI) range of ~25-35 kg/ m 2 . Because this "obesity paradox" has been consistently demonstrated in 7 meta-analyses, the lower mortality risk for individuals with T2D in this BMI range may not be all that paradoxical. Physical activity (PA), cardiorespiratory fitness (CRF), and muscular fitness (MF) are all associated with reduced risk of T2D, and lower risk of CVD and all-cause mortality in individuals with T2D. Reducing sedentary behavior, independent of PA status, also is strongly associated with reduced risk of T2D. Improvements in cardiometabolic risk factors with exercise training are comparable to those observed in weight loss interventions, and are largely independent of weight loss. To minimize risks associated with weight cycling, it may be prudent to adopt a weight-neutral approach for prevention and treatment of individuals with obesity and T2D by focusing on increasing PA and improving CRF and MF without a specific weight loss goal.
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Affiliation(s)
- Glenn A. Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
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13
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Nylén E. Newer Diabetes Management Options and Physical Fitness to Promote Cardiovascular Benefits. Rev Cardiovasc Med 2022; 23:282. [PMID: 39076636 PMCID: PMC11266947 DOI: 10.31083/j.rcm2308282] [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: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 07/31/2024] Open
Abstract
A plethora of diabetes studies and established clinical guidelines show the strong salutary benefit of aerobic, resistance, and/or combination exercise for improved glycemic and cardiovascular outcomes. Promotion of physical fitness is a cornerstone approach to improved diabetes management especially since subjects with diabetes have reduced baseline aerobic exercise capacity (i.e., reduced cardiorespiratory fitness) with associated increased risk for premature all-cause and cardiovascular mortality. Since medications are often used in conjunction with fitness promotion this can result in complex interaction between management modalities. More recently, newer options such as glucose transporter-2 inhibitors and incretin agonists have shown to improve cardiovascular disease (CVD) outcomes in cardiovascular outcomes trials. Indeed, both classes of agents have experimentally the potential to synergize with exercise training but clinical data vis-à-vis cardiorespiratory fitness is still preliminary. Review of the interaction of exercise and metformin shows no improvement in cardiorespiratory fitness. The use of glucose transporter-2 inhibitors may improve fitness performance in those with diabetes and heart failure. Although incretin agonists have physiological effects on the vasculature and heart, they lack similar clinical supportive data.
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Affiliation(s)
- Eric Nylén
- Veterans Affairs Medical Center, George Washington University School of Medicine, Washington, DC 20422, USA
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14
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Wills AC, Arreola EV, Olaiya MT, Curtis JM, Hellgren MI, Hanson RL, Knowler WC. Cardiorespiratory Fitness, BMI, Mortality, and Cardiovascular Disease in Adults with Overweight/Obesity and Type 2 Diabetes. Med Sci Sports Exerc 2022; 54:994-1001. [PMID: 35175249 PMCID: PMC9117407 DOI: 10.1249/mss.0000000000002873] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We estimated the effects of cardiorespiratory fitness (CRF) and body mass index (BMI) at baseline on mortality and cardiovascular disease events in people with type 2 diabetes who participated in the Look AHEAD randomized clinical trial. METHODS Look AHEAD compared effects of an intensive lifestyle intervention with diabetes support and education on cardiovascular disease events in 5145 adults age 45-76 yr with overweight/obesity and type 2 diabetes. In 4773 participants, we performed a secondary analysis of the association of baseline CRF during maximal treadmill test (expressed as metabolic equivalents (METs)) on mortality and cardiovascular disease events during a mean follow-up of 9.2 yr. RESULTS The mean (SD) CRF was 7.2 (2.0) METs. Adjusted for age, sex, race/ethnicity, BMI, intervention group, and β-blocker use, all-cause mortality rate was 30% lower per SD greater METs (hazard ratio (HR) = 0.70 (95% confidence interval, 0.60 to 0.81); rate difference (RD), -2.71 deaths/1000 person-years (95% confidence interval, -3.79 to -1.63)). Similarly, an SD greater METs predicted lower cardiovascular disease mortality (HR, 0.45; RD, -1.65 cases/1000 person-years) and a composite cardiovascular outcome (HR, 0.72; RD, -6.38). Effects of METs were homogeneous on the HR scale for most baseline variables and outcomes but heterogeneous for many on the RD scale, with greater RD in subgroups at greater risk of the outcomes. For example, all-cause mortality was lower by 7.6 deaths/1000 person-years per SD greater METs in those with a history of cardiovascular disease at baseline but lower by only 1.6 in those without such history. BMI adjusted for CRF had little or no effect on these outcomes. CONCLUSIONS Greater CRF is associated with reduced risks of mortality and cardiovascular disease events.
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Affiliation(s)
- Andrew C. Wills
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Elsa Vazquez Arreola
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Muideen T. Olaiya
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Jeffrey M. Curtis
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- Valleywise Community Health Center, Phoenix, AZ
| | - Margareta I. Hellgren
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- The Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Robert L. Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
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15
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Chen Y, Su J, Qin Y, Luo P, Shen C, Pan E, Lu Y, Miao D, Zhang N, Zhou J, Yu X, Wu M. Fresh fruit consumption, physical activity, and five-year risk of mortality among patients with type 2 diabetes: A prospective follow-up study. Nutr Metab Cardiovasc Dis 2022; 32:878-888. [PMID: 35078677 DOI: 10.1016/j.numecd.2021.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS We explored the associations among fruit consumption, physical activity, and their dose-response relationship with all-cause and cardiovascular disease (CVD) mortality in type 2 diabetic patients. METHODS AND RESULTS We prospectively followed 20,340 community-dwelling type 2 diabetic patients aged 21-94 years. Information on diets and physical activity was collected using standardized questionnaires. All-cause and CVD mortality were assessed. Hazard ratios (HRs) for all-cause mortality were estimated with Cox regression models, and HRs for CVD mortality were derived from a competing risk model. Restricted cubic spline regression was used to analyze dose-response relationships. We identified 1362 deaths during 79,844 person-years. Compared to non-consumption, fruit consumption >42.9 g/d was inversely associated with all-cause mortality (HR 0.76; 95% CI 0.64-0.88), CVD mortality (HR 0.69, 0.51-0.94) and stroke mortality (HR 0.57, 0.36-0.89), but not with heart disease mortality (HR 0.93, 0.56-1.52). The HRs comparing the top vs bottom physical activity quartiles were 0.44 (0.37-0.53) for all-cause mortality, 0.46 (0.33-0.64) for CVD mortality, 0.46 (0.29-0.74) for stroke mortality and 0.51 (0.29-0.88) for heart disease mortality. Lower fruit consumption combined with a lower physical activity level was associated with a greater mortality risk. A nonlinear threshold of 80 g fruit/day was identified; all-cause mortality risk was reduced by approximately 24% at this value. A physical activity threshold of eight metabolic equivalents (MET) h/day was also identified, after which the risk of mortality did not decrease. CONCLUSIONS Fruit consumption and physical activity may reduce all-cause, CVD, and stroke mortality in type 2 diabetic patients.
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Affiliation(s)
- Yijia Chen
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, 210003, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Pengfei Luo
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Yan Lu
- Department of Chronic Disease Prevention and Control, Suzhou City Center for Disease Control and Prevention, Suzhou, 215003, China
| | - Dandan Miao
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Ning Zhang
- Changshu County Center for Disease Control and Prevention, Suzhou, 215500, China
| | - Jinyi Zhou
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Xiaojin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Ming Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China.
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16
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Van Ryckeghem L, Keytsman C, De Brandt J, Verboven K, Verbaanderd E, Marinus N, Franssen WMA, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D. Impact of continuous vs. interval training on oxygen extraction and cardiac function during exercise in type 2 diabetes mellitus. Eur J Appl Physiol 2022; 122:875-887. [PMID: 35038022 DOI: 10.1007/s00421-022-04884-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Exercise training improves exercise capacity in type 2 diabetes mellitus (T2DM). It remains to be elucidated whether such improvements result from cardiac or peripheral muscular adaptations, and whether these are intensity dependent. METHODS 27 patients with T2DM [without known cardiovascular disease (CVD)] were randomized to high-intensity interval training (HIIT, n = 15) or moderate-intensity endurance training (MIT, n = 12) for 24 weeks (3 sessions/week). Exercise echocardiography was applied to investigate cardiac output (CO) and oxygen (O2) extraction during exercise, while exercise capacity [([Formula: see text] (mL/kg/min)] was examined via cardiopulmonary exercise testing at baseline and after 12 and 24 weeks of exercise training, respectively. Changes in glycaemic control (HbA1c and glucose tolerance), lipid profile and body composition were also evaluated. RESULTS 19 patients completed 24 weeks of HIIT (n = 10, 66 ± 11 years) or MIT (n = 9, 61 ± 5 years). HIIT and MIT similarly improved glucose tolerance (pTime = 0.001, pInteraction > 0.05), [Formula: see text] (mL/kg/min) (pTime = 0.001, pInteraction > 0.05), and exercise performance (Wpeak) (pTime < 0.001, pInteraction > 0.05). O2 extraction increased to a greater extent after 24 weeks of MIT (56.5%, p1 = 0.009, pTime = 0.001, pInteraction = 0.007). CO and left ventricular longitudinal strain (LS) during exercise remained unchanged (pTime > 0.05). A reduction in HbA1c was correlated with absolute changes in LS after 12 weeks of MIT (r = - 0.792, p = 0.019, LS at rest) or HIIT (r = - 0.782, p = 0.038, LS at peak exercise). CONCLUSION In patients with well-controlled T2DM, MIT and HIIT improved exercise capacity, mainly resulting from increments in O2 extraction capacity, rather than changes in cardiac output. In particular, MIT seemed highly effective to generate these peripheral adaptations. TRIAL REGISTRATION NCT03299790, initially released 09/12/2017.
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Affiliation(s)
- Lisa Van Ryckeghem
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium. .,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Charly Keytsman
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jana De Brandt
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kenneth Verboven
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elvire Verbaanderd
- Physical Activity, Sport and Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wouter M A Franssen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ines Frederix
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Faculty of Medicine and 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.,Hôpitaux Universitaires de Genève (HUG), Geneva, 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
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Virginie Bito
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Verwerft
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
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17
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Ely MR, Taylor JA. The Practical Utility of Functional Electrical Stimulation Exercise for Cardiovascular Health in Individuals with Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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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: 0.6] [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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19
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Patoulias D, Stavropoulos K, Imprialos K, Athyros V, Doumas M, Karagiannis A. Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice. Curr Vasc Pharmacol 2020; 18:125-138. [PMID: 32013815 DOI: 10.2174/1570161117666190426162746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2DM require a multilevel therapeutic approach, both for primary and secondary prevention of CVD. OBJECTIVE To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2DM. METHODS We conducted a comprehensive search of the literature on MEDLINE from its inception till today, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials. RESULTS There is a trend towards more intensified therapeutic interventions in T2DM, concerning glycemic, lipid and blood pressure control. New drugs, such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting the renin-angiotensinaldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone and LCZ696 have provided significant results in cardiovascular outcome studies; however, their role in T2DM has to be further elucidated. CONCLUSION Pharmaceutical approach of CVD in T2DM is multilevel and complex. Drug classes featuring pleiotropic effects may boost our armamentarium in the fight against CVD.
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Affiliation(s)
- Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Athyros
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Medical Center, and George Washington University, Washington, DC, United States
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, General Hospital "Hippokration", Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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Abstract
Functional capacity represents an important predictor for cardiovascular and all-cause mortality in patients with diabetes mellitus (DM). Impaired cardiopulmonary fitness is frequently seen in DM patients, and it might partly explain morbidity and mortality in these patients. There are several potential reasons that could explain impaired functional capacity in DM patients: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes. These changes are partly reversible, and improvement of any of these components might increase functional capacity in DM patients and improve their outcome. Physical activity is related with decreased cardiovascular disease and all-cause mortality in patients with type 2 DM. Diabetic cardiomyopathy is the most important clinical entity in DM patients that involves left ventricular diastolic dysfunction and cardiac autonomic neuropathy, which potentially induce heart failure with preserved ejection fraction. Development of diabetic cardiomyopathy may slow oxygen uptake kinetics and affect the cardiorespiratory fitness in DM patients, but it can also induce development of heart failure. Improvement of functional capacity in DM patients represents an important therapeutic task, and it can be achieved mainly with exercise training and significantly less with pharmacological treatment. Exercise training reduces body weight and improves glycemic control, as well as left ventricular structure and function. The aim of this review was to summarize current knowledge about importance of functional capacity in DM patients, as well as possible mechanisms that could explain the relationship between DM and oxygen kinetics.
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22
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Pippi R, Di Blasio A, Aiello C, Fanelli C, Bullo V, Gobbo S, Cugusi L, Bergamin M. Effects of a Supervised Nordic Walking Program on Obese Adults with and without Type 2 Diabetes: The C.U.R.I.A.Mo. Centre Experience. J Funct Morphol Kinesiol 2020; 5:E62. [PMID: 33467277 PMCID: PMC7739339 DOI: 10.3390/jfmk5030062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Exercise is a convenient non-medical intervention, commonly recommended in metabolic syndrome and type 2 diabetes (DM2) managements. Aerobic exercise and aerobic circuit training have been shown to be able to reduce the risk of developing DM2-related complications. Growing literature proves the usefulness of Nordic walking as exercise therapy in different disease populations, therefore it has a conceivable use in DM2 management. Aims of this study were to analyze and report the effects of two different supervised exercises (gym-based exercise and Nordic walking) on anthropometric profile, blood pressure values, blood chemistry and fitness variables in obese individuals with and without DM2. In this study, 108 obese adults (aged 45-65 years), with or without DM2, were recruited and allocated into one of four subgroups: (1) Gym-based exercise program (n = 49) or (2) Nordic walking program (n = 37) for obese adults; (3) Gym-based exercise program (n = 10) or (4) Nordic walking program (n = 12) for obese adults with DM2. In all exercise subgroups, statistically significant improvements in body weight, body mass index, fat mass index, muscular flexibility and maximal oxygen uptake (VO2 max) were observed. Moreover, a higher percentage of adherence to the gym-based program compared to Nordic walking was recorded. Our findings showed that, notwithstanding the lower adherence, a supervised Nordic walk is effective as a conventional gym-based program to improve body weight control, body composition parameters, muscular flexibility and VO2 max levels in obese adults with and without type 2 diabetes.
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Affiliation(s)
- Roberto Pippi
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. d’Annunzio’ University of Chieti-Pescara, 66100 Chieti Scalo, Italy;
| | - Cristina Aiello
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Carmine Fanelli
- Healthy Lifestyle Institute, C.U.R.I.A.Mo (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19 06126 Perugia, Italy; (R.P.); (C.A.); (C.F.)
| | - Valentina Bullo
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
| | - Stefano Gobbo
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Marco Bergamin
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (V.B.); (M.B.)
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23
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Duruturk N. Telerehabilitation intervention for type 2 diabetes. World J Diabetes 2020; 11:218-226. [PMID: 32547696 PMCID: PMC7284018 DOI: 10.4239/wjd.v11.i6.218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/02/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
Diabetes has become an increasingly important health problem worldwide due to its prevalence. Although effective treatments for diabetes management have been developed, many patients have difficulty in achieving their therapeutic goals. Regular exercise training is suggested to prevent or delay the symptoms and complications of type 2 diabetes along with other medical treatments. It has become necessary to develop new rehabilitation models and practices in order to cope with the changing needs of the population. Treatment models using technology can be effective in disease management. Telerehabilitation may be effective as part of the rehabilitation program in the home environment, especially for patients who are unable to participate in conventional center-based rehabilitation due to transport difficulties or work resumption. Telerehabilitation is defined as the delivery of rehabilitation services via telecommunication technology, including phone, internet, and videoconference communications between the patient and health care provider. It is possible that telerehabilitation may benefit people with type 2 diabetes in similar ways with telemonitoring and interactive health communication systems. Although the applicability of telehealth methods has been proven in previous studies, telerehabi-litation studies in type 2 diabetes are inadequate in the literature. With larger, multi-centered randomized controlled studies, established clinical guidelines can be developed that will ultimately improve patient outcomes.
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Affiliation(s)
- Neslihan Duruturk
- Department of Physiotherapy and Rehabilitation, Baskent University, Faculty of Health Sciences, Ankara 06790, Turkey
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24
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Duruturk N, Özköslü MA. Effect of tele-rehabilitation on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes: A double blind randomized controlled trial. Prim Care Diabetes 2019; 13:542-548. [PMID: 31014938 DOI: 10.1016/j.pcd.2019.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
AIM To determine the effect of a tele-rehabilitation (TR) program on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes mellitus (DM). METHOD Fifty type 2 DM participants were enrolled in the study and divided randomly into two groups; TR (n = 25, mean age: 52.82 ± 11.86) or control (n = 25, mean age: 53.04 ± 10.45) group. Participants in the TR group performed breathing and callisthenic exercises, three times a week, for 6 weeks, at home by internet based video conferences. Outcome measures including, HbA1c level, 6 min walk testing, physical fitness and muscle strength dynamometer measurement, Beck Depression Inventory were performed before and after the 6 weeks. RESULTS HbA1c (p = 0.00), 6 min walking distance (p = 0.00), physical fitness subparameters; sit-up (p = 0.00), sit-and-reach (p = 0.04), back scratch (p = 0.00), lateral flexion right (p = 0.04), left (p = 0.00) and time up go tests (p = 0.00), muscles strength (p = 0.00); deltoideus-anterior, middle, quadriceps femoris and gluteus maximus, and depression levels (p = 0.00) changed significantly (p = 0.00) in TR groups. There were no significant improvements in control group (p > 0.05). CONCLUSION Our findings suggest that TR interventions found to be safe and effective, and may be an alternative treatment model for type 2 DM management. In addition to these health benefits, patients and rehabilitation team may save time, labor and treatment costs by using TR.
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Affiliation(s)
- Neslihan Duruturk
- Baskent University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Manolya Acar Özköslü
- Baskent University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
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25
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Myers J, de Souza E Silva CG, Doom R, Fonda H, Chan K, Kamil-Rosenberg S, Kokkinos P. Cardiorespiratory Fitness and Health Care Costs in Diabetes: The Veterans Exercise Testing Study. Am J Med 2019; 132:1084-1090. [PMID: 31047866 DOI: 10.1016/j.amjmed.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. METHODS Health care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. RESULTS Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 103) (mean ± standard deviation) that were on average $32,178 and $30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness, annual cost savings per person were $5,193 and $3,603 for individuals with and without diabetes, respectively. CONCLUSIONS Higher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Calif; Division of Cardiovascular Medicine, Stanford University, Calif.
| | | | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Calif
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26
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Beri N, Dang P, Bhat A, Venugopal S, Amsterdam EA. Usefulness of Excellent Functional Capacity in Men and Women With Ischemic Exercise Electrocardiography to Predict a Negative Stress Imaging Test and Very Low Late Mortality. Am J Cardiol 2019; 124:661-665. [PMID: 31300200 DOI: 10.1016/j.amjcard.2019.05.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
Exercise electrocardiography (ExECG) is widely employed to assess patients for coronary artery disease but it has limited diagnostic accuracy. Many patients with positive (ischemic) tests based on exercise-induced ST depression undergo secondary evaluation by noninvasive stress imaging. We hypothesized that high functional capacity in patients with positive ExECG could predict: (1) negative results in secondary evaluation by exercise echocardiography (ESE) or myocardial perfusion scintigraphy (MPS) and (2) low mortality on late follow-up. We evaluated 511 consecutive patients (312 men, 199 women; age 51 ± 9 years) referred for ESE or MPS after an ischemic ExECG at a treadmill workload of ≥10 metabolic equivalents. All-cause mortality was also obtained. Of 511 patients, 401 underwent ESE and 110 had MPS for secondary study. ESE was negative in 94% (376 of 401) and positive in 6% (25 of 401). MPS was also negative in 94% (103 of 110) and positive in 6% (7 of 110). Total stress imaging results were negative in 92% (286 of 312) of men and 97% (193 of 199) of women. During follow-up of approximately 6 years, there were 3 deaths with total all-cause mortality of 0.6% and average annual mortality of 0.1%. In conclusion, high functional capacity in patients with an ischemic ExECG predicts a negative ESE or MPS in a large majority of patients and very favorable late survival in both men and women. These results suggest that patients with ischemic ExECGs and a workload of ≥10 metabolic equivalents during ExECG may not require additional noninvasive or invasive evaluation.
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27
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McGee JE, Barefoot SG, Gniewek NR, Brophy PM, Clark A, Dubis GS, Ryan TE, Houmard JA, Vos P, Raedeke TD, Swift DL. High-intensity exercise to promote accelerated improvements in cardiorespiratory fitness (HI-PACE): study protocol for a randomized controlled trial. Trials 2019; 20:484. [PMID: 31395096 PMCID: PMC6686537 DOI: 10.1186/s13063-019-3611-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background African Americans have a disproportionate prevalence and incidence of type 2 diabetes compared with Caucasians. Recent evidence indicates that low cardiorespiratory fitness (CRF) level, an independent risk factor for type 2 diabetes, is also more prevalent in African Americans than Caucasians. Numerous studies in Caucasian populations suggest that vigorous exercise intensity may promote greater improvements in CRF and other type 2 diabetes risk factors (e.g., reduction of glucose/insulin levels, pulse wave velocity, and body fat) than moderate intensity. However, current evidence comparing health benefits of different aerobic exercise intensities on type 2 diabetes risk factors in African Americans is negligible. This is clinically important as African Americans have a greater risk for type 2 diabetes and are less likely to meet public health recommendations for physical activity than Caucasians. The purpose of the HI-PACE (High-Intensity exercise to Promote Accelerated improvements in CardiorEspiratory fitness) study is to evaluate whether high-intensity aerobic exercise elicits greater improvements in CRF, insulin action, and arterial stiffness than moderate-intensity exercise in African Americans. Methods/Design A randomized controlled trial will be performed on overweight and obese (body mass index of 25–45 kg/m2) African Americans (35–65 years) (n = 60). Participants will be randomly assigned to moderate-intensity (MOD-INT) or high-intensity (HIGH-INT) aerobic exercise training or a non-exercise control group (CON) for 24 weeks. Supervised exercise will be performed at a heart rate associated with 45–55% and 70–80% of VO2 max in the MOD-INT and HIGH-INT groups, respectively, for an exercise dose of 600 metabolic equivalents of task (MET)-minutes per week (consistent with public health recommendations). The primary outcome is change in CRF. Secondary outcomes include change in insulin sensitivity (measured via an intravenous glucose tolerance test), skeletal muscle mitochondrial oxidative capacity (via near-infrared spectroscopy), skeletal muscle measurements (i.e., citrate synthase, COX IV, GLUT-4, CPT-1, and PGC1-α), arterial stiffness (via carotid-femoral pulse wave velocity), body fat, C-reactive protein, and psychological outcomes (quality of life/exercise enjoyment). Discussion The anticipated results of the HI-PACE study will provide vital information on the health effects of high-intensity exercise in African Americans. This study will advance health disparity research and has the potential to influence future public health guidelines for physical activity. Trial registration ClinicalTrials.gov identifier: NCT02892331. Registered on September 8, 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3611-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joshua E McGee
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA. .,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.
| | - Savanna G Barefoot
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA
| | - Nicole R Gniewek
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA
| | - Patricia M Brophy
- The East Carolina Diabetes & Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Angela Clark
- The East Carolina Diabetes & Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Gabriel S Dubis
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,The East Carolina Diabetes & Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Terence E Ryan
- Department of Physiology, Brody School of Medicine, Greenville, NC, 27858, USA.,The East Carolina Diabetes & Obesity Institute, East Carolina University, Greenville, NC, 27858, USA.,Present affiliation: Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, 32611, USA
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA
| | - Paul Vos
- Department of Biostatistics, East Carolina University, Greenville, NC, 27858, USA
| | - Thomas D Raedeke
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA
| | - Damon L Swift
- Department of Kinesiology, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA.,Human Performance Laboratory, East Carolina University, 388 Ward Sports Medicine Building, Greenville, NC, 27858, USA
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28
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Ghosh S, Hota M, Chai X, Kiranya J, Ghosh P, He Z, Ruiz-Ramie JJ, Sarzynski MA, Bouchard C. Exploring the underlying biology of intrinsic cardiorespiratory fitness through integrative analysis of genomic variants and muscle gene expression profiling. J Appl Physiol (1985) 2019; 126:1292-1314. [PMID: 30605401 PMCID: PMC6589809 DOI: 10.1152/japplphysiol.00035.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 11/02/2018] [Accepted: 12/09/2018] [Indexed: 12/22/2022] Open
Abstract
Intrinsic cardiorespiratory fitness (CRF) is defined as the level of CRF in the sedentary state. There are large individual differences in intrinsic CRF among sedentary adults. The physiology of variability in CRF has received much attention, but little is known about the genetic and molecular mechanisms that impact intrinsic CRF. These issues were explored in the present study by interrogating intrinsic CRF-associated DNA sequence variation and skeletal muscle gene expression data from the HERITAGE Family Study through an integrative bioinformatics guided approach. A combined analytic strategy involving genetic association, pathway enrichment, tissue-specific network structure, cis-regulatory genome effects, and expression quantitative trait loci was used to select and rank genes through a variation-adjusted weighted ranking scheme. Prioritized genes were further interrogated for corroborative evidence from knockout mouse phenotypes and relevant physiological traits from the HERITAGE cohort. The mean intrinsic V̇o2max was 33.1 ml O2·kg-1·min-1 (SD = 8.8) for the sample of 493 sedentary adults. Suggestive evidence was found for gene loci related to cardiovascular physiology (ATE1, CASQ2, NOTO, and SGCG), hematopoiesis (PICALM, SSB, CA9, and CASQ2), skeletal muscle phenotypes (SGCG, DMRT2, ADARB1, and CASQ2), and metabolism (ATE1, PICALM, RAB11FIP5, GBA2, SGCG, PRADC1, ARL6IP5, and CASQ2). Supportive evidence for a role of several of these loci was uncovered via association between DNA variants and muscle gene expression levels with exercise cardiovascular and muscle physiological traits. This initial effort to define the underlying molecular substrates of intrinsic CRF warrants further studies based on appropriate cohorts and study designs, complemented by functional investigations. NEW & NOTEWORTHY Intrinsic cardiorespiratory fitness (CRF) is measured in the sedentary state and is highly variable among sedentary adults. The physiology of variability in intrinsic cardiorespiratory fitness has received much attention, but little is known about the genetic and molecular mechanisms that impact intrinsic CRF. These issues were explored computationally in the present study, with further corroborative evidence obtained from analysis of phenotype data from knockout mouse models and human cardiovascular and skeletal muscle measurements.
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Affiliation(s)
- Sujoy Ghosh
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Monalisa Hota
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Xiaoran Chai
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Jencee Kiranya
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Palash Ghosh
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School , Singapore
| | - Zihong He
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
- Department of Biology, China Institute of Sport Science , Beijing , China
| | - Jonathan J Ruiz-Ramie
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
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Ramírez Meléndez A, Arias Vázquez PI, Lucatero Lecona I, Luna Garza R. [Correlation between the six-minute walk test and maximal exercise test in patients with type ii diabetes mellitus]. Rehabilitacion (Madr) 2019; 53:2-7. [PMID: 30929828 DOI: 10.1016/j.rh.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/20/2018] [Accepted: 09/01/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The 6-minute walk test is an exercise test that has been used in diabetic patients to assess the effectiveness of exercise programmes and has been correlated with clinical parameters; however, the correlation with the maximum workload registered during stress testing has not been determined in diabetic patients. OBJECTIVE To establish the correlation between the 6-minute walk test and the maximum workload registered during a stress test in patients with type ii diabetes mellitus and its association with glycemic control. MATERIALS AND METHODS We included 42 patients with type ii diabetes mellitus and mean age of 61.1 years, who underwent physical examination, a 6-minute walk test, a treadmill stress test and laboratory studies. RESULTS The 6-minute walk test had high reproducibility in diabetic patients and showed a moderate-low correlation with maximum workload on the treadmill (r=49, p=0.001). A significant association was found between the 6-minute walk test and glycosylated haemoglobin A1C values (RP 1.57, χ2 <0.05). CONCLUSION The 6-minute walk test is a highly reproducible test and has a significant correlation with maximum physical workload in the diabetic patients tested. Therefore, it can be used as a test for assessing functional capacity in this population.
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Affiliation(s)
- A Ramírez Meléndez
- Servicio de Medicina Física y Rehabilitación, Centro Médico Nacional 20 deNoviembre, Ciudad de México, México.
| | - P I Arias Vázquez
- Departamento de Rehabilitación, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - I Lucatero Lecona
- Servicio de Medicina Física y Rehabilitación, Centro Médico Nacional 20 deNoviembre, Ciudad de México, México
| | - R Luna Garza
- Hospital del Niño y la Mujer, San Luis, S.L.P., México
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Ross R, Goodpaster BH, Koch LG, Sarzynski MA, Kohrt WM, Johannsen NM, Skinner JS, Castro A, Irving BA, Noland RC, Sparks LM, Spielmann G, Day AG, Pitsch W, Hopkins WG, Bouchard C. Precision exercise medicine: understanding exercise response variability. Br J Sports Med 2019; 53:1141-1153. [PMID: 30862704 PMCID: PMC6818669 DOI: 10.1136/bjsports-2018-100328] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
There is evidence from human twin and family studies as well as mouse and rat selection experiments that there are considerable interindividual differences in the response of cardiorespiratory fitness (CRF) and other cardiometabolic traits to a given exercise programme dose. We developed this consensus statement on exercise response variability following a symposium dedicated to this topic. There is strong evidence from both animal and human studies that exercise training doses lead to variable responses. A genetic component contributes to exercise training response variability. In this consensus statement, we (1) briefly review the literature on exercise response variability and the various sources of variations in CRF response to an exercise programme, (2) introduce the key research designs and corresponding statistical models with an emphasis on randomised controlled designs with or without multiple pretests and post-tests, crossover designs and repeated measures designs, (3) discuss advantages and disadvantages of multiple methods of categorising exercise response levels—a topic that is of particular interest for personalised exercise medicine and (4) outline approaches that may identify determinants and modifiers of CRF exercise response. We also summarise gaps in knowledge and recommend future research to better understand exercise response variability.
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Affiliation(s)
- Robert Ross
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Lauren G Koch
- Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Mark A Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Neil M Johannsen
- Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.,School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington, Indiana, USA
| | - Alex Castro
- Department of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert C Noland
- John S Mcilhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Werner Pitsch
- Economics and Sociology of Sport, Saarland University, Saarbrücken, Saarland, Germany
| | - William G Hopkins
- College of Sport and Exercise Science, Victoria University, Melbourne, Victoria, Australia
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Vukomanovic V, Suzic-Lazic J, Celic V, Cuspidi C, Petrovic T, Ilic S, Skokic D, Armando Morris D, Tadic M. Association between functional capacity and heart rate variability in patients with uncomplicated type 2 diabetes. Blood Press 2019; 28:184-190. [DOI: 10.1080/08037051.2019.1586431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Tijana Petrovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Sanja Ilic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Dusan Skokic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Daniel Armando Morris
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Bukht MS, Ahmed KR, Hossain S, Masud P, Sultana S, Khanam R. Association between physical activity and diabetic complications among Bangladeshi type 2 diabetic patients. Diabetes Metab Syndr 2019; 13:806-809. [PMID: 30641812 DOI: 10.1016/j.dsx.2018.11.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the study was to assess the association of physical activity (PA) with the presence of diabetes related complications among Bangladeshi type 2 diabetic subjects. METHODS This cross-sectional study was conducted in the Out Patient Department (OPD) of BIRDEM, Bangladesh. A group of 977 subjects were randomly selected and followed up. Diabetes was diagnosed following the WHO study group criteria. The level of PA was categorized into inactive/low (<150 min/week) and moderate-to-vigorous (≥150 min/week). The WHO recommended Asian criteria was used to identify general obesity. Retinopathy was detected by fundal photography, CKD by serum creatinine and hypertension was diagnosed clinically. Univariate and multivariate analyses were used to assess the associations of PA with diabetes related complications. RESULTS Out of the 977 subjects investigated, 468 were male and 509 were female (mean ± SD of age, 56 ± 8 years). In the study subjects, 74% were either inactive or in low PA and of them 65.1% were overweight/obese. Analysis showed that inactive/low PA was associated with all the three diabetes related complications (p < 0.001)-hypertension, retinopathy, and nephropathy. Multivariate analysis showed that inactive/low level of PA was strongly associated with complications like retinopathy (p < 0.001) and hypertension (p = 0.01) in the female patients. It was also found to be highly associated with retinopathy (p < 0.001) among the male patients. CONCLUSION A large number of urban Bangladeshi population are involved only in low PA or remain inactive themselves, which is leading to obesity and it seems to have a strong association with diabetes related complications in this population.
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Affiliation(s)
| | - Kazi Rumana Ahmed
- Dept of Health Promotion and Health Education, Bangladesh University of Health Sciences, Bangladesh; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Sahadat Hossain
- Dept of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
| | | | - Shuhana Sultana
- Dept of Health Promotion and Health Education, Bangladesh University of Health Sciences, Bangladesh.
| | - Rasheda Khanam
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.
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Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open 2018; 1:e183605. [PMID: 30646252 PMCID: PMC6324439 DOI: 10.1001/jamanetworkopen.2018.3605] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness. OBJECTIVE To assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (≥97.7th percentile). EXPOSURES Cardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS The study population included 122 007 patients (mean [SD] age, 53.4 [12.6] years; 72 173 [59.2%] male). Death occurred in 13 637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P < .001; elite vs high: adjusted HR, 0.77; 95% CI, 0.63-0.95; P = .02). The increase in all-cause mortality associated with reduced cardiorespiratory fitness (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P < .001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P < .001) was comparable to or greater than traditional clinical risk factors (coronary artery disease: adjusted HR, 1.29; 95% CI, 1.24-1.35; P < .001; smoking: adjusted HR, 1.41; 95% CI, 1.36-1.46; P < .001; diabetes: adjusted HR, 1.40; 95% CI, 1.34-1.46; P < .001). In subgroup analysis, the benefit of elite over high performance was present in patients 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04) and patients with hypertension (adjusted HR, 0.70; 95% CI, 0.50-0.99; P = .05). Extreme cardiorespiratory fitness (≥2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups. CONCLUSIONS AND RELEVANCE Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.
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Affiliation(s)
| | - Serge Harb
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul Cremer
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Wael Jaber
- Cleveland Clinic Foundation, Cleveland, Ohio
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Zang L, Maddison LA, Chen W. Zebrafish as a Model for Obesity and Diabetes. Front Cell Dev Biol 2018; 6:91. [PMID: 30177968 PMCID: PMC6110173 DOI: 10.3389/fcell.2018.00091] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/25/2018] [Indexed: 12/13/2022] Open
Abstract
Obesity and diabetes now considered global epidemics. The prevalence rates of diabetes are increasing in parallel with the rates of obesity and the strong connection between these two diseases has been coined as “diabesity.” The health risks of overweight or obesity include Type 2 diabetes mellitus (T2DM), coronary heart disease and cancer of numerous organs. Both obesity and diabetes are complex diseases that involve the interaction of genetics and environmental factors. The underlying pathogenesis of obesity and diabetes are not well understood and further research is needed for pharmacological and surgical management. Consequently, the use of animal models of obesity and/or diabetes is important for both improving the understanding of these diseases and to identify and develop effective treatments. Zebrafish is an attractive model system for studying metabolic diseases because of the functional conservation in lipid metabolism, adipose biology, pancreas structure, and glucose homeostasis. It is also suited for identification of novel targets associated with the risk and treatment of obesity and diabetes in humans. In this review, we highlight studies using zebrafish to model metabolic diseases, and discuss the advantages and disadvantages of studying pathologies associated with obesity and diabetes in zebrafish.
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Affiliation(s)
- Liqing Zang
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States.,Graduate School of Regional Innovation Studies, Mie University, Tsu, Japan
| | - Lisette A Maddison
- Center for Reproductive Biology, Washington State University, Pullman, WA, United States
| | - Wenbiao Chen
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
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Peterson K, Anderson J, Boundy E, Ferguson L, McCleery E, Waldrip K. Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map. Am J Public Health 2018; 108:e1-e11. [PMID: 29412713 PMCID: PMC5803811 DOI: 10.2105/ajph.2017.304246] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Continued racial/ethnic health disparities were recently described as "the most serious and shameful health care issue of our time." Although the 2014 US Affordable Care Act-mandated national insurance coverage expansion has led to significant improvements in health care coverage and access, its effects on life expectancy are not yet known. The Veterans Health Administration (VHA), the largest US integrated health care system, has a sustained commitment to health equity that addresses all 3 stages of health disparities research: detection, understanding determinants, and reduction or elimination. Despite this, racial disparities still exist in the VHA across a wide range of clinical areas and service types. OBJECTIVES To inform the health equity research agenda, we synthesized evidence on racial/ethnic mortality disparities in the VHA. SEARCH METHODS Our research librarian searched MEDLINE and Cochrane Central Registry of Controlled Trials from October 2006 through February 2017 using terms for racial groups and disparities. SELECTION CRITERIA We included studies if they compared mortality between any racial/ethnic minority and nonminority veteran groups or between different minority groups in the VHA (PROSPERO# CRD42015015974). We made study selection decisions on the basis of prespecified eligibility criteria. They were first made by 1 reviewer and checked by a second and disagreements were resolved by consensus (sequential review). DATA COLLECTION AND ANALYSIS Two reviewers sequentially abstracted data on prespecified population, outcome, setting, and study design characteristics. Two reviewers sequentially graded the strength of evidence using prespecified criteria on the basis of 5 key domains: study limitations (study design and internal validity), consistency, directness, precision of the evidence, and reporting biases. We synthesized the evidence qualitatively by grouping studies first by racial/ethnic minority group and then by clinical area. For areas with multiple studies in the same population and outcome, we pooled their reported hazard ratios (HRs) using random effects models (StatsDirect version 2.8.0; StatsDirect Ltd., Altrincham, England). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: odds ratio or HR of mortality for racial/ethnic minority group versus Whites, clinical area, strength of evidence, statistical significance, and racial group. MAIN RESULTS From 2840 citations, we included 25 studies. Studies were large (n ≥ 10 000) and involved nationally representative cohorts, and the majority were of fair quality. Most studies compared mortality between Black and White veterans and found similar or lower mortality for Black veterans. However, we found modest mortality disparities (HR or OR = 1.07, 1.52) for Black veterans with stage 4 chronic kidney disease, colon cancer, diabetes, HIV, rectal cancer, or stroke; for American Indian and Alaska Native veterans undergoing noncardiac major surgery; and for Hispanic veterans with HIV or traumatic brain injury (most low strength). AUTHOR'S CONCLUSIONS Although the VHA's equal access health care system has reduced many racial/ethnic mortality disparities present in the private sector, our review identified mortality disparities that have persisted mainly for Black veterans in several clinical areas. However, because most mortality disparities were supported by single studies with imprecise findings, we could not draw strong conclusions about this evidence. More disparities research is needed for American Indian and Alaska Native, Asian, and Hispanic veterans overall and for more of the largest life expectancy gaps. Public Health Implications. Because of the relatively high prevalence of diabetes in Black veterans, further research to better understand and reduce this mortality disparity may be prioritized as having the greatest potential impact. However, other mortality disparities affect thousands of veterans and cannot be ignored.
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Affiliation(s)
- Kim Peterson
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
| | - Johanna Anderson
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
| | - Erin Boundy
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
| | - Lauren Ferguson
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
| | - Ellen McCleery
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
| | - Kallie Waldrip
- Kim Peterson, Johanna Anderson, Erin Boundy, Lauren Ferguson, Ellen McCleery, Kallie Waldrip, are with the Department of Veterans Affairs, VA Portland Health Care System, Evidence-Based Synthesis Program Coordinating Center, Portland, OR
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Kokkinos P, Faselis C, Narayan P, Myers J, Nylen E, Sui X, Zhang J, Lavie CJ. Cardiorespiratory Fitness and Incidence of Type 2 Diabetes in United States Veterans on Statin Therapy. Am J Med 2017; 130:1192-1198. [PMID: 28552431 DOI: 10.1016/j.amjmed.2017.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/30/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Impact of cardiorespiratory fitness on statin-related incidence of type 2 diabetes has not been assessed. We assessed the cardiorespiratory fitness and diabetes incidence association in dyslipidemic patients on statins. METHODS We identified dyslipidemic patients with a normal exercise test performed during 1986 and 2014 at the Veterans Affairs Medical Centers in Washington, DC or Palo Alto, Calif. The statin-treated patients (n = 4092; age = 58.8 ± 10.9 years) consisted of 2701 Blacks and 1391 Whites. None had evidence of type 2 diabetes prior to statin therapy. We formed 4 fitness categories based on age and peak metabolic equivalents achieved: Least-fit (n = 954), Low-fit (n = 1201), Moderate-fit (n = 1242), and High-fit (n = 695). The non-statin-treated cohort (n = 3001; age = 57.2 ± 11.2 years) with no evidence of type 2 diabetes prior to the exercise test served as controls. RESULTS Diabetes incidence was 24% higher in statin-treated compared with non-statin-treated patients (P <.001). In the statin-treated cohort, 1075 (26.3%) developed diabetes (average annual incidence rate of 30.6 events/1000 person-years). Compared with the Least-fit, adjusted risk decreased progressively with increasing fitness and was 34% lower for High-fit patients (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.53-0.82; P <.001). Compared with the nonstatin cohort, elevated risk was evident only in the Least-fit (HR 1.50; 95% CI, 1.30-1.73; P <.001) and Low-fit patients (HR 1.22; 95% CI, 1.06-1.41; P = .006). CONCLUSIONS Risk of diabetes in statin-treated dyslipidemic patients was inversely and independently associated with cardiorespiratory fitness. The increased risk was evident only in relatively low-fitness patients. Improving fitness may modulate the potential diabetogenic effects of statins.
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Affiliation(s)
- Peter Kokkinos
- Department of Cardiology, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Georgetown University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Charles Faselis
- George Washington University School of Medicine, Washington, DC; Veterans Affairs Medical Center, Washington, DC
| | | | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Calif; Stanford University, Calif
| | - Eric Nylen
- George Washington University School of Medicine, Washington, DC; Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, La
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Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The Interaction of Cardiorespiratory Fitness With Obesity and the Obesity Paradox in Cardiovascular Disease. Prog Cardiovasc Dis 2017; 60:30-44. [DOI: 10.1016/j.pcad.2017.05.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Baktir M, Ceran Y, Myers J. EXERCISE CAPACITY AND MORTALITY IN VETERANS WITH AND WITHOUT TYPE-2 DIABETES: AN ANALYSIS USING PROPENSITY MATCHING. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2017; 13:378-384. [PMID: 31149205 PMCID: PMC6516575 DOI: 10.4183/aeb.2017.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Recent studies have demonstrated a strong association between cardiorespiratory fitness (CRF) and mortality, but bias due to differences in the distribution of baseline variables has not been adequately considered. We studied a cohort of veterans with and without Type-2 diabetes using a propensity score matching method. METHODS Males with (n=592) and without (n= 6,167) Type-2 diabetes were studied. Propensity scores were used to balance covariate distributions between groups with and without Type-2 diabetes. All-cause mortality was the end point. RESULTS Predictors of mortality included hypertension, smoking, Type-2 diabetes, BMI and CRF. For each 1 MET increase in CRF in the unmatched group, the adjusted HR was 0.83 in those with diabetes (95% CI 0.77-0.89; p<0.0001) compared to 0.87 in those without diabetes (95% CI 0.86-0.89; p<0.0001). Similar trends were observed for the matched dataset: the adjusted HRs were 0.83 (95% CI 0.77-0.90; p<0.0001) and 0.88 (95% CI 0.82-0.94; p<0.0001) for those with and without diabetes, respectively. CONCLUSIONS CRF is a strong predictor of mortality in veterans with and without Type-2 diabetes. Although the trend in the association between CRF and all-cause-mortality was similar for matched and unmatched data, the mortality risks were relatively inflated when using unmatched data.
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Affiliation(s)
- M.A. Baktir
- Erciyes University School of Medicine, Department of Physiology, Kayseri, Turkey
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Y. Ceran
- Santa Clara University, School of Business, Santa Clara, CA, United States of America
| | - J. Myers
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
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Balducci S, D’Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Di Biase N, Bollanti L, Conti F, Zanuso S, Nicolucci A, Pugliese G, Italian Diabetes and Exercise Study 2 (IDES_2) Investigators. Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: A cross-sectional analysis of the Italian Diabetes and Exercise Study_2. PLoS One 2017; 12:e0173337. [PMID: 28291838 PMCID: PMC5349668 DOI: 10.1371/journal.pone.0173337] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/20/2017] [Indexed: 12/28/2022] Open
Abstract
Objective Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study_2 (IDES_2). Methods Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES_2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care. At baseline, LPA, moderate-to-vigorous-intensity PA (MVPA), and SED-time were measured by accelerometer. Physical fitness and cardiovascular risk factors and scores were also assessed. Results LPA was 3.93±1.35 hours∙day-1, MVPA was 12.4±4.6 min∙day-1, and SED-time was 11.6±1.2 hours∙day-1, with a large range of values (0.89–7.11 hours∙day-1, 0.6–21.0 min∙day-1, and 9.14–15.28 hours∙day-1, respectively). At bivariate analysis, LPA and MVPA correlated with better cardiovascular risk profile and fitness parameters, whereas the opposite was observed for SED-time. Likewise, values of LPA, MVPA, and SED-time falling in the best tertile were associated with optimal or acceptable levels of cardiovascular risk factors and scores. At multivariate analysis, age, female gender, HbA1c, BMI or waist circumference, and high-sensitivity C reactive protein (for LPA and SED-time only) were negatively associated with LPA and MPA and positively associated with SED-time in an independent manner. Conclusions Physically inactive and sedentary patients with type 2 diabetes from the IDES_2 show a low level of PA, though values of LPA, MVPA, and SED-time vary largely. Furthermore, there is a strong correlation of these measures with glycemic control, adiposity and inflammation, thus suggesting that even small improvements in LPA, MVPA, and SED-time might be associated with significant improvement in cardiovascular risk profile. Trial registration ClinicalTrials.gov NCT01600937
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D’Errico
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, ‘‘Foro Italico” University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, ‘‘Foro Italico” University, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Laboratory of Clinical Chemistry, Sant’Andrea Hospital, Rome, Italy
| | | | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
| | - Silvano Zanuso
- Centre for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, ‘‘La Sapienza” University, Rome, Italy
- Diabetes Unit, Sant’Andrea Hospital, Rome, Italy
- * E-mail:
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Kokkinos PF, Faselis C, Myers J, Narayan P, Sui X, Zhang J, Lavie CJ, Moore H, Karasik P, Fletcher R. Cardiorespiratory Fitness and Incidence of Major Adverse Cardiovascular Events in US Veterans: A Cohort Study. Mayo Clin Proc 2017; 92:39-48. [PMID: 27876315 DOI: 10.1016/j.mayocp.2016.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/27/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of major adverse cardiovascular events (MACEs). PATIENTS AND METHODS A symptom-limited exercise tolerance test was performed to assess exercise capacity in 20,590 US veterans (12,975 blacks and 7615 whites; mean ± SD age, 58.2±11.0 years) from the Veterans Affairs medical centers in Washington, District of Columbia, and Palo Alto, California. None had a history of MACE or evidence of ischemia at the time of or before their exercise tolerance test. We established quintiles of cardiorespiratory fitness (CRF) categories based on age-specific peak metabolic equivalents (METs) achieved. We also defined the age-specific MET level associated with no risk for MACE (hazard ratio [HR], 1.0) and formed 4 additional CRF categories based on METs achieved below (least fit and low fit) and above (moderately fit and highly fit) that level. Multivariate Cox models were used to estimate HR and 95% CIs for mortality across fitness categories. RESULTS During follow-up (median, 11.3 years; range, 0.3-33.0 years), 2846 individuals experienced MACEs. The CRF-MACE association was inverse and graded. The risk for MACE declined precipitously for those with a CRF level of 6.0 METs or higher. When considering CFR categories based on the age-specific MET threshold, the risk increased for those in the 2 CFR categories below that threshold (HR, 1.95; 95% CI, 1.73-2.21 and HR, 1.41; 95% CI, 1.27-1.56 for the least-fit and low-fit individuals, respectively) and decreased for those above it (HR, 0.77; 95% CI, 0.68-0.87 and HR, 0.57; 95% CI, 0.48-0.67 for moderately fit and highly fit, respectively). CONCLUSION Increased CRF is inversely and independently associated with the risk for MACE. When an age-specific MET threshold was defined, the risk for MACE increased significantly for those below that threshold and decreased for those above it (P<.001).
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Affiliation(s)
- Peter F Kokkinos
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Charles Faselis
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Puneet Narayan
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Hans Moore
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Pamela Karasik
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ross Fletcher
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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Pattanakuhar S, Pongchaidecha A, Chattipakorn N, Chattipakorn SC. The effect of exercise on skeletal muscle fibre type distribution in obesity: From cellular levels to clinical application. Obes Res Clin Pract 2016; 11:112-132. [PMID: 27756527 DOI: 10.1016/j.orcp.2016.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/18/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022]
Abstract
Skeletal muscles play important roles in metabolism, energy expenditure, physical strength, and locomotive activity. Skeletal muscle fibre types in the body are heterogeneous. They can be classified as oxidative types and glycolytic types with oxidative-type are fatigue-resistant and use oxidative metabolism, while fibres with glycolytic-type are fatigue-sensitive and prefer glycolytic metabolism. Several studies demonstrated that an obese condition with abnormal metabolic parameters has been negatively correlated with the distribution of oxidative-type skeletal muscle fibres, but positively associated with that of glycolytic-type muscle fibres. However, some studies demonstrated otherwise. In addition, several studies demonstrated that an exercise training programme caused the redistribution of oxidative-type skeletal muscle fibres in obesity. In contrast, some studies showed inconsistent findings. Therefore, the present review comprehensively summarizes and discusses those consistent and inconsistent findings from clinical studies, regarding the association among the distribution of skeletal muscle fibre types, obese condition, and exercise training programmes. Furthermore, the possible underlying mechanisms and clinical application of the alterations in muscle fibre type following obesity are presented and discussed.
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Affiliation(s)
- Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Anchalee Pongchaidecha
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand.
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Faselis C, Kokkinos P, Tsimploulis A, Pittaras A, Myers J, Lavie CJ, Kyritsi F, Lovic D, Karasik P, Moore H. Exercise Capacity and Atrial Fibrillation Risk in Veterans: A Cohort Study. Mayo Clin Proc 2016; 91:558-66. [PMID: 27068670 DOI: 10.1016/j.mayocp.2016.03.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of developing atrial fibrillation (AF). PATIENTS AND METHODS A symptom-limited exercise tolerance test was conducted to assess exercise capacity in 5962 veterans (mean age, 56.8±11.0 years) from the Veterans Affairs Medical Center, Washington, DC. None had evidence of AF or ischemia at the time of or before undergoing their exercise tolerance test. We established 4 fitness categories based on age-stratified quartiles of peak metabolic equivalent task (MET) achieved: least fit (4.9±1.10 METs; n=1446); moderately fit (6.7±1.0 METs; n=1490); fit (7.9±1.0 METs; n=1585), and highly fit (9.3±1.2 METs; n=1441). Multivariable Cox proportional hazards regression models were used to compare the AF-exercise capacity association between fitness categories. RESULTS During a median follow-up period of 8.3 years, 722 (12.1%) individuals developed AF (14.5 per 1000 person-years; 95% CI, 13.9-15.9 per 1000 person-years). Exercise capacity was inversely related to AF incidence. The risk was 21% lower (hazard ratio, 0.79; 95% CI, 0.76-0.82) for each 1-MET increase in exercise capacity. Compared with the least fit individuals, hazard ratios were 0.80 (95% CI, 0.67-0.97) for moderately fit individuals, 0.55 (95% CI, 0.45-0.68) for fit individuals, and 0.37 (95% CI, 0.29-0.47) for highly fit individuals. Similar trends were observed in those younger than 65 years and those 65 years or older. CONCLUSION Increased fitness is inversely and independently associated with the reduced risk of developing AF. The decrease in risk was graded and precipitous with only modest increases in exercise capacity. These findings counter previous suggestions that even moderate increases in physical activity, as recommended by national and international guidelines, increase the risk of AF, with marked protection against AF noted with increasing levels of fitness.
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Affiliation(s)
- Charles Faselis
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Peter Kokkinos
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | | | - Andreas Pittaras
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo Alto, CA; Stanford University, Stanford, CA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University Queensland School of Medicine, New Orleans, LA
| | - Fiorina Kyritsi
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC
| | - Dragan Lovic
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC
| | - Pamela Karasik
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Hans Moore
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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Zafrir B, Azencot M, Dobrecky-Mery I, Lewis BS, Flugelman MY, Halon DA. Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes. Eur J Prev Cardiol 2015; 23:1298-306. [PMID: 26701872 DOI: 10.1177/2047487315624747] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes. METHODS We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke. RESULTS Resting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute <18 beats/minute in 35%. Over 79 ± 16 months, there were 72 (12%) events. Each parameter was significantly associated with event risk in an adjusted multivariate analysis: chronotropic incompetence (hazard ratio 1.89, 95% confidence interval 1.18-3.01; P = 0.008), resting heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute <18 beats (hazard ratio 1.77, 95% confidence interval 1.12-2.81; P = 0.015). A progressive relationship between the number of abnormal parameters and event risk was observed (log rank P < 0.001). CONCLUSIONS Chronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Mali Azencot
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | | | - Basil S Lewis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
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Balducci S, Sacchetti M, Haxhi J, Orlando G, Zanuso S, Cardelli P, Cavallo S, D'Errico V, Ribaudo MC, Di Biase N, Salvi L, Vitale M, Bollanti L, Conti FG, Nicolucci A, Pugliese G. The Italian Diabetes and Exercise Study 2 (IDES-2): a long-term behavioral intervention for adoption and maintenance of a physically active lifestyle. Trials 2015; 16:569. [PMID: 26651484 PMCID: PMC4676117 DOI: 10.1186/s13063-015-1088-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA)/exercise have become an integral part of the management of type 2 diabetes mellitus (T2DM). However, current guidelines are difficult to put into action in this population due to a number of barriers, especially the lack of acceptable, feasible, and validated behavioral intervention strategies. The present manuscript reports the rationale, study design and methods, and design considerations of the Italian Diabetes and Exercise Study (IDES)-2, a randomized controlled trial testing the efficacy of a behavior change strategy in increasing total daily PA and reducing sedentary time (SED-time) in patients with T2DM. METHODS/DESIGN Starting 7 January 2014, the IDES_2 began enrolling 300 patients with known T2DM of at least 1-year duration in three tertiary referral outpatient Diabetes Clinics in Rome. Additional requirements are age 40 to 80 years, body mass index 27 to 40 kg/m(2), sedentary lifestyle, and physically inactive for at least 6 months, ability to walk 1.6 km without assistance, and eligibility after cardiovascular evaluation. Patients are randomized by center and within each center, by age and type of diabetes treatment to either the intervention or the control group. Patients in the intervention (INT) group (n = 150) receive theoretical and practical exercise counseling consisting of aggregated behavior change techniques (one individual theoretical counseling session plus eight twice-a-week individual theoretical and practical exercise counseling sessions) once a year for 3 years. Patients in the control (CON) group (n = 150), receive standard care, including general physician recommendations for daily PA. The primary outcomes are total daily PA and SED-time, as measured objectively by the use of an accelerometer. Secondary outcomes include physical fitness, modifiable cardiovascular risk factors, musculoskeletal disturbances, well-being/depression, and health-related quality of life. DISCUSSION The behavioral intervention strategy tested in the IDES_2 is based on solid theoretical grounds and uses several behavioral change techniques, two factors which were found to improve effectiveness of behavioral intervention. In addition, physicians and exercise specialists have been specifically trained for counselling/prescribing and supervising PA/exercise, respectively, in subjects suffering from metabolic disorders. Finally, the large sample size, the long study duration, and the objective measurement of PA allow statistically significant and scientifically robust conclusions to be drawn on the feasibility and efficacy of this intervention in T2DM patients. TRIAL REGISTRATION ClinicalTrials.gov; NCT01600937 ; 10 October 2012.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Jonida Haxhi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | | | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Stefano Cavallo
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Valeria D'Errico
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | | | | | - Laura Salvi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | | | | | - Francesco G Conti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy.
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
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Andersen E, Ekelund U, Anderssen SA. Effects of reducing sedentary time on glucose metabolism in immigrant Pakistani men. Med Sci Sports Exerc 2015; 47:775-81. [PMID: 25058329 PMCID: PMC5642350 DOI: 10.1249/mss.0000000000000460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose This study aimed to examine the association between changes in objectively measured overall physical activity (PA) and changes in fasting and postprandial plasma insulin, C-peptide, and glucose concentrations in type 2 diabetes-prone immigrant Pakistani men living in Norway and to examine whether this association is explained by changes in moderate and vigorous PA (MVPA) or changes in sedentary time. Methods The current study is a secondary cohort analysis on data collected from the Physical Activity and Minority Health study, a randomized controlled trial aimed at increasing the PA level, and not sedentary time per se, in a group of sedentary immigrant Pakistani men (n = 150). For the present analyses, the two groups were merged and a cohort analysis was performed. Overall PA (counts per minute) and its subcomponents, sedentary time and MVPA, were measured with accelerometry. Outcome variables were measured after a 2-h standardized glucose tolerance test. Results Change in overall PA was significantly associated with postprandial log-transformed plasma insulin (β = −0.002; 95% confidence interval (CI), −0.003 to 0.000; P = 0.008), C-peptide (β = −2.7; 95% CI, −4.9 to −0.5; P = 0.01), and glucose concentration (β = −0.006; 95% CI, −0.01 to −0.002; P = 0.002). Change in sedentary time was significantly and beneficially associated with changes in postprandial log-transformed plasma insulin (β = 0.002; 95% CI, 0.001–0.003; P = 0.001), C-peptide (β = 3.7; 95% CI, 1.5–6.0; P = 0.001), and glucose concentration (β = 0.006; 95% CI, 0.002–0.1; P = 0.002), independent of changes in MVPA, waist circumference, and other confounders. Conclusions Increasing overall PA by reducing sedentary time seems as important as increasing time spent at MVPA in relation to postprandial plasma insulin and glucose levels in diabetes-prone immigrant men.
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Affiliation(s)
- Eivind Andersen
- 1Department of Practical, Physical and Aesthetic Education, Buskerud and Vestfold University College, Tønsberg, NORWAY; and 2Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
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Nylen ES, Gandhi SM, Kheirbek R, Kokkinos P. Enhanced fitness and renal function in Type 2 diabetes. Diabet Med 2015; 32:1342-5. [PMID: 25943475 DOI: 10.1111/dme.12789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/14/2022]
Abstract
AIMS To investigate the renal effects of fitness in people with diabetes with mild renal dysfunction. METHODS The effect of a 12-week exercise programme on estimated GFR in 128 people with diabetes was evaluated. RESULTS All cardiometabolic variables improved after 12 weeks of supervised exercise. Although there was a modest 3.9% increase in estimated GFR from baseline in the 128 people who completed the study, those with baseline chronic kidney disease stages 2 and 3 were found to have significant (6 and 12%, respectively; p < 0.01) improvements in post-exercise estimated GFR. Moreover, 42% of the people with chronic kidney disease stage 3 improved to chronic kidney disease stage 2 after the intervention. CONCLUSION Short-term exercise improves renal function in those with more moderate baseline chronic kidney disease. Thus, renal function appears to be responsive to enhanced physical fitness. Being a strong and modifiable risk factor, enhanced fitness should be considered a non-pharmacological adjunct in the management of diabetic kidney disease.
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Affiliation(s)
- E S Nylen
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - S M Gandhi
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - R Kheirbek
- Department of Geriatrics, Veterans Affairs Medical Center, Washington, DC, USA
| | - P Kokkinos
- Department of Cardiology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Cardiology, Georgetown University School of Medicine, Washington, DC, USA
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Glenn KR, Slaughter JC, Fowke JH, Buchowski MS, Matthews CE, Signorello LB, Blot WJ, Lipworth L. Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes. Ann Epidemiol 2015; 25:649-55. [PMID: 26141652 PMCID: PMC4602000 DOI: 10.1016/j.annepidem.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 03/30/2015] [Accepted: 04/08/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE The study objective was to examine the role of physical activity (PA) and sedentary time (ST) on mortality risk among a population of low-income adults with diabetes. METHODS Black (n = 11,137) and white (n = 4508) men and women with diabetes from the Southern Community Cohort Study self-reported total PA levels and total ST. Participants were categorized into quartiles of total PA and total ST. Hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent mortality risk were estimated from Cox proportional hazards analysis with adjustment for potential confounders. RESULTS During follow-up, 2370 participants died. The multivariable risk of mortality was lower among participants in the highest quartile of PA compared with those in the lowest quartile (HR, 0.64; 95% CI: 0.57-0.73). Mortality risk was significantly increased among participants in the highest compared with the lowest quartile of ST after adjusting for PA (HR, 1.21; 95% CI: 1.08-1.37). Across sex and race groups, similar trends of decreasing mortality with rising PA and increasing mortality with rising ST were observed. CONCLUSIONS Although causality cannot be established from these observational data, the current findings suggest that increasing PA and decreasing ST may help extend survival among individuals with diabetes irrespective of race and sex.
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Affiliation(s)
- Kimberly R Glenn
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN.
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jay H Fowke
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Maciej S Buchowski
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Charles E Matthews
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Lisa B Signorello
- Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School, Boston, MA; Dana-Farber/Harvard Cancer Center, Boston, MA
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN; International Epidemiology Institute, Rockville, MD
| | - Loren Lipworth
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN
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48
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Byrkjeland R, Njerve IU, Anderssen S, Arnesen H, Seljeflot I, Solheim S. Effects of exercise training on HbA1c and VO2peak in patients with type 2 diabetes and coronary artery disease: A randomised clinical trial. Diab Vasc Dis Res 2015; 12:325-33. [PMID: 26092822 DOI: 10.1177/1479164115590552] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Few exercise trials have focused on patients with both type 2 diabetes and coronary artery disease. We investigated the effects of 1 year of exercise training on HbA1c and VO(2peak) in these patients. METHODS Patients with type 2 diabetes and coronary artery disease (n = 137) were randomised to combined exercise training or control group. HbA(1c) was measured at the beginning and end of the study. Changes in VO(2peak), and also ventilatory threshold and time to exhaustion, were assessed by cardiopulmonary exercise testing. RESULTS No differences in changes between the randomised groups were observed in HbA1c and VO(2peak), whereas ventilatory threshold and time to exhaustion increased significantly in the exercise group compared with the controls (p = 0.046 and p = 0.034). In patients without previous acute myocardial infarction and diabetes microvascular complications (n = 46), the exercise group did improve HbA1c and VO(2peak) compared with the controls (p = 0.052 and p = 0.035). CONCLUSION No significant effects of exercise training on HbA(1c) or VO(2peak) were observed in patients with type 2 diabetes and coronary artery disease, although improvements were seen in patients without vascular complications beyond coronary artery disease, implying that the degree of vascular disease may influence exercise responses. Ventilatory threshold and time to exhaustion did increase significantly, indicating improved exercise performance despite the minor change in VO(2peak).
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Affiliation(s)
- Rune Byrkjeland
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida U Njerve
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigmund Anderssen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
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Zafrir B, Azaiza M, Gaspar T, Dobrecky-Mery I, Azencot M, Lewis BS, Rubinshtein R, Halon DA. Low cardiorespiratory fitness and coronary artery calcification: Complementary cardiovascular risk predictors in asymptomatic type 2 diabetics. Atherosclerosis 2015; 241:634-40. [PMID: 26117400 DOI: 10.1016/j.atherosclerosis.2015.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/01/2015] [Accepted: 06/16/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite its well-established prognostic value, cardiorespiratory fitness (CRF) is not incorporated routinely in risk assessment tools. Whether low CRF provides additional predictive information in asymptomatic type 2 diabetics beyond conventional risk scores and coronary artery calcification (CAC) is unclear. METHODS We studied 600 type 2 diabetics aged 55-74 years without known coronary heart disease. CRF was quantified in metabolic equivalents (METs) by maximal treadmill testing and categorized as tertiles of percent predicted METs (ppMETs) achieved. CAC was calculated by non-enhanced computed tomography scans. The individual and joint association of both measures with an outcome event of all-cause mortality, myocardial infarction or stroke, was determined over a mean follow-up period of 80 ± 16 months. RESULTS There were 72 (12%) events during follow-up. Low CRF was independently associated with event risk after adjustment for traditional risk factors and CAC (HR 2.25, 95% CI 1.41-3.57, p = 0.001). CRF (unfit/fit) allowed further outcome discrimination both amongst diabetics with low CAC scores (9.5% versus 2.0% event rate), and amongst diabetics with high CAC scores (23.5% versus 12.4% event rate), p < 0.001. The addition of CRF to a model comprising UKPDS and CAC scores improved the area under the curve for event prediction from 0.66 to 0.71, p = 0.03, with a positive continuous net reclassification improvement (NRI) of 0.451, p = 0.002. CONCLUSIONS CRF, quantified by ppMETs, provided independent prognostic information which was additive to CAC. Low CRF may identify asymptomatic diabetic subjects at higher risk for all-cause mortality, myocardial infarction or stroke, despite low CAC.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Mohanad Azaiza
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Gaspar
- Department of Radiology, Lady Davis Carmel Medical Center, Israel
| | - Idit Dobrecky-Mery
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mali Azencot
- Department of Radiology, Lady Davis Carmel Medical Center, Israel
| | - Basil S Lewis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Rubinshtein
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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50
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Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Tsimploulis A, Chawla L, Palant C. Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study. Mayo Clin Proc 2015; 90:461-8. [PMID: 25792243 DOI: 10.1016/j.mayocp.2015.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD). PATIENTS AND METHODS Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.5 years) from the Veterans Affairs Medical Center, Washington, DC. Study participants had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or more 6 months before exercise testing and no evidence of CKD. Those who developed CKD during follow-up were initially identified by the International Classification of Diseases, Ninth Revision and further verified by at least 2 consecutive estimated glomerular filtration rate values of less than 60 mL/min per 1.73 m(2) 3 months or more apart. Normal kidney function for CKD-free individuals was confirmed by sequential normal eGFR levels. We established 4 fitness categories on the basis of age-stratified quartiles of peak metabolic equivalents (METs) achieved: least-fit (≤25%; 4.8±0.90 METs; n=1258); low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and high-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the association between exercise capacity and CKD. RESULTS During a median follow-up period of 7.9 years, 1010 developed CKD (20.4/1000 person-years). Exercise capacity was inversely related to CKD incidence. The risk was 22% lower (hazard ratio, 0.78; 95% CI, 0.75-0.82; P<.001) for every 1-MET increase in exercise capacity. Compared with the least-fit individuals, hazard ratios were 0.87 (95% CI, 0.74-1.03) for low-fit, 0.55 (95% CI, 0.47-0.65) for moderate-fit, and 0.42 (95% CI, 0.33-0.52) for high-fit individuals. CONCLUSION Higher exercise capacity attenuated the risk of developing CKD. The association was independent and graded.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Charles Faselis
- George Washington University School of Medicine, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | | | - Lakhmir Chawla
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
| | - Carlos Palant
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
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