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The Effects of Chronic Aerobic Exercise on Cardiovascular Risk Factors in Persons with Diabetes Mellitus

  • Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (B Conway and H Keenan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Aerobic exercise training is a component of diabetes mellitus (DM) care guidelines due to its favorable effects on glycemic control and cardiovascular disease (CVD) risk factors. The purpose of this review is to outline the recent evidence regarding the clinical effects of chronic aerobic exercise on CVD risk factors in persons with DM and to compare the effects of varying intensities and types of exercise.

Recent Findings

Among individuals with DM, all types of aerobic exercise training can impact positively on some traditional and non-traditional risk factors for CVD. Training programs with a higher volume or intensity induce greater improvements in vascular function, cardiorespiratory fitness (CRF), and lipid profiles.

Summary

The beneficial outcomes of aerobic training include improvements in glycemic control, endothelial function, oxidative stress, dyslipidemia, myocardial function, adiposity, and CRF. Findings regarding markers of inflammation are discrepant and further research should focus on the role of exercise to impact upon the chronic inflammation associated with DM.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. International Diabetes Federation. IDF Diabetes Atlas. 7th ed; 2015. p. 144. Retrieved from diabetesatlas.org.

  2. The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22. doi:10.1016/S0140-6736(10)60484-9.

    Article  PubMed Central  Google Scholar 

  3. Schramm TK, Gislason GH, Køber L, Rasmussen S, Rasmussen JN, Abildstrøm SZ, et al. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117(15):1945–54.

    Article  CAS  PubMed  Google Scholar 

  4. Association AD. American Diabetes Association standards of medical care in diabetes—2017. J Clin Appl Res Educ. 2017;40:1–142.

    Google Scholar 

  5. Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia. 2003;46(8):1071–81.

    Article  PubMed  Google Scholar 

  6. ACSM. ACSM’s guidelines for exercise testing and prescription. 10th ed. Philadelphia, PA: Walters Kluwer; 2017. p. 268–275.

  7. • Mitranun W, Deerochanawong C, Tanaka H, Suksom D. Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sport. 2014;24(2):69–76. This study assessed a vast range of CVD risk factors in response to aerobic training in addition to comparing the effects of HIIT and MICT programs.

    Article  Google Scholar 

  8. Church TS, Blair SN, Cocreham S, Johnson W, Kramer K, Mikus CR, et al. Effects of aerobic and resistance training on hemoglobin a1c levels in patients with type 2 diabetes. JAMA J Am Med Assoc. 2010;304(20):2253–62.

    Article  CAS  Google Scholar 

  9. Sigal RJ, Kenny GP, Boule NG, Wells GA, Prud D, Fortier M, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med. 2007;147(6):357–69.

    Article  PubMed  Google Scholar 

  10. De Lemos ET, Oliveira J, Pinheiro JP, Reis F. Regular physical exercise as a strategy to improve antioxidant and anti-inflammatory status: benefits in type 2 diabetes mellitus. Oxidative Med Cell Longev. 2012;2012:1–15.

  11. Petrofsky JS. The effect of type-2-diabetes-related vascular endothelial dysfunction on skin physiology and activities of daily living. J Diabetes Sci Technol. 2011;5(3):657–67.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Virdis A, Ghiadoni L, Giannarelli CTS. Endothelial dysfunction and vascular disease in later life. Maturitas. 2010;67(1):20–4.

    Article  CAS  PubMed  Google Scholar 

  13. Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P, et al. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus. Arch Intern Med. 2010;170(20):1794–803.

    Article  PubMed  Google Scholar 

  14. Dadgostar H, Firouuzinezhad S, Ansari M, Younespour S, Mahmoudpour A, Khamseh ME. Supervised group-exercise therapy versus home-based exercise therapy: their effects on quality of life and cardiovascular risk factors in women with type 2 diabetes. Diabetes Metab Syndr Clin Res Rev. 2016;10:30–6.

    Article  Google Scholar 

  15. Pandey A, Swift DL, McGuire DK, Ayers CR, Neeland IJ, Blair SN, et al. Metabolic effects of exercise training among fitness-nonresponsive patients with type 2 diabetes: the HART-D study. Diabetes Care. 2015;38(8):1494–501.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yardley JE, Hay J, Abou-Setta AM, Marks SD, McGavock J. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014;106(3):393–400.

    Article  PubMed  Google Scholar 

  17. Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993–1017.

    Article  CAS  PubMed  Google Scholar 

  18. Dos Santos JM, Moreli ML, Tewari S, Benite-Ribeiro SA. The effect of exercise on skeletal muscle glucose uptake in type 2 diabetes: an epigenetic perspective. Metabolism. 2015;64(12):1619–28.

    Article  CAS  PubMed  Google Scholar 

  19. Hollekim-Strand SM, Bjørgaas MR, Albrektsen G, Tjønna AE, Wisløff U, Ingul CB. High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: a randomized controlled trial. J Am Coll Cardiol. 2014;64(16):1758–60.

    Article  PubMed  Google Scholar 

  20. Fuchsjäger-Mayrl G, Pleiner J, Wiesinger GF, Sieder AE, Quittan M, Nuhr MJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25(10):1795–801.

    Article  PubMed  Google Scholar 

  21. Ma RC. Genetics of cardiovascular and renal complications in diabetes. J Diabetes Investig. 2016;7(2):139–54.

    Article  CAS  PubMed  Google Scholar 

  22. He ZH, Eon SAD, Tinsley LJ, Fitzgerald S, Hastings SM, Khamaisi M, et al. Cardiovascular disease protection in long-duration type 1 diabetes and sex differences. Diabetes Care. 2015;38:73–4.

    Article  Google Scholar 

  23. • De Moraes R, Bavel DV, Gomes MD, Tibirica E. Effects of non-supervised low intensity aerobic excise training on the microvascular endothelial function of patients with type 1 diabetes: a non-pharmacological interventional study. BMC Cardiovasc Disord. 2016;16(1):23. This is one of very few recent original research with T1DM subjects utilizing an aerobic exercise training protocol. It involved the assessment of vascular function and tissue perfusion.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kasumov T, Solomon TPJ, Hwang C, Huang H, Haus JM, Zhang R, et al. Improved insulin sensitivity after exercise training is linked to reduced plasma C14:0 ceramide in obesity and type 2 diabetes. Obesity. 2015;23(7):1414–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Haus JM, Kashyap SR, Kasumov T, Zhang R, Kelly KR, Defronzo RA, et al. Plasma ceramides are elevated in obese subjects with type 2 diabetes and correlate with the severity of insulin resistance. Diabetes. 2009;58(2):337–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Revdal A, Hollekim-strand SM, Ingul CB. Can time efficient exercise improve cardiometabolic risk factors in type 2 diabetes? A pilot study. J Sport Sci Med. 2016;15(2):308–13.

    Google Scholar 

  27. Myers J, Tan SY, Abella J, Aleti VFV. Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil. 2007;14(2):215–21.

    Article  PubMed  Google Scholar 

  28. Herder C, Illig T, Rathmann W, Martin S, Haastert B, Müller-Scholze S, et al. Inflammation and type 2 diabetes: results from KORA Augsburg. Das Gesundheitswes. 2005;67(S 01):115–21.

    Article  Google Scholar 

  29. Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011;11:98–107.

    Article  CAS  PubMed  Google Scholar 

  30. Pesta D, Roden M. The Janus head of oxidative stress in metabolic diseases and during physical exercise. Curr Diab Rep. 2017;17(6):41.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Karstoft K, Pedersen BK. Exercise and type 2 diabetes: focus on metabolism and inflammation. Immunol Cell Biol. 2016;94(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  32. Kadoglou NPE, Fotiadis G, Kapelouzou A, Kostakis A, Liapis CD, Vrabas IS. The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with type 2 diabetes. Diabet Med. 2013;30(2):41–51.

    Article  Google Scholar 

  33. Hayashino Y, Jackson JL, Hirata T, Fukumori N, Nakamura F, Fukuhara S, et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism. 2014;63(3):431–40.

    Article  CAS  PubMed  Google Scholar 

  34. Mallard AR, Hollekim-Strand SM, Coombes JS, Ingul CB. Exercise intensity, redox homeostasis and inflammation in type 2 diabetes mellitus. J Sci Med Sport. 2017; 20:893–898.

    Article  PubMed  Google Scholar 

  35. Krause M, Rodrigues-Krause J, O’Hagan C, Medlow P, Davison G, Susta D, et al. The effects of aerobic exercise training at two different intensities in obesity and type 2 diabetes: implications for oxidative stress, low-grade inflammation and nitric oxide production. Eur J Appl Physiol. 2014;114(2):251–60.

    Article  CAS  PubMed  Google Scholar 

  36. Melo LC, Dativo-Medeiros J, Menezes-Silva CE, Barbosa FT, de Sousa-Rodrigues CF, Rabelo LA. Physical exercise on inflammatory markers in type 2 diabetes patients: a systematic review of randomized controlled trials. Oxidative Med Cell Longev. 2017;2017:8523728.

    Article  Google Scholar 

  37. Daousi C, Casson IF, Gill GV, MacFarlane IA, Wilding JPH, Pinkney JH. Prevalence of obesity in type 2 diabetes in secondary care: association with cardiovascular risk factors. Postgrad Med J. 2006;82(966):280–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Keane KN, Cruzat VF, Carlessi R, Ivo P, De Bittencourt H, Newsholme P. Molecular events linking oxidative stress and inflammation to insulin resistance and B-cell dysfunction. 2015;2015.

  39. Yavari A, Najafipoor F, Aliasgarzadeh A, Niafar M, Mobasseri M. Effect of aerobic exercise, resistance training or combined training on glycaemic control and cardio-vascular risk factors in patients with type 2 diabetes. Biol Sport. 2012;29(2):135–43.

    Article  Google Scholar 

  40. Cassidy S, Thoma C, Hallsworth K, Parikh J, Hollingsworth KG, Taylor R, et al. High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial. Diabetologia. 2016;59(1):56–66.

    Article  CAS  PubMed  Google Scholar 

  41. Karstoft K, Winding K, Knudsen SH, Nielsen JS, Thomsen C, Pedersen BK, et al. The effects of free-living interval- walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients. Diabetes Care. 2013;36:228–36.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Shakil-ur-Rehman S, Karimi H, Gillani SA. Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus. Pak J Med Sci. 2017;33(1):96–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60.

    Article  CAS  PubMed  Google Scholar 

  44. Sixt S, Beer S, Blüher M, Korff N, Peschel T, Sonnabend M, et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Heart J. 2010;31(1):112–9.

    Article  CAS  PubMed  Google Scholar 

  45. Laaksonen DE, Atalay M, Niskanen LK, Mustonen J, Sen CK, Lakka TA, et al. Aerobic exercise and the lipid profile in type 1 diabetic men: a randomized controlled trial. Med Sci Sports Exerc. 2000;32(9):1541–8.

    Article  CAS  PubMed  Google Scholar 

  46. Nuhu JM, Maharaj SS. Influence of a mini trampoline rebound exercise program on insulin resistance, lipid profile and central obesity in individuals with type 2 diabetes. J Sports Med Phys Fitness. 2017. doi:10.23736/S0022-4707.17.07120-1.

  47. Wilson LC, Peebles KC, Hoye NA, Manning P, Sheat C, Williams MJA, et al. Resting heart rate variability and exercise capacity in type 1 diabetes. Physiol Rep. 2017;5(8):e13248.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Turinese I, Marinelli P, Bonini M, Rossetti M, Statuto G, Filardi T, et al. Metabolic and cardiovascular response to exercise in patients with type 1 diabetes. J Endocrinol Invest. 2017;40(9):999–1005.

    Article  Google Scholar 

  49. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood A. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.

    Article  PubMed  Google Scholar 

  50. Schreuder THA, Maessen MFH, Tack CJ, Thijssen DHJ, Hopman MTE. Life-long physical activity restores metabolic and cardiovascular function in type 2 diabetes. Eur J Appl Physiol. 2014;114(3):619–27.

    Article  CAS  PubMed  Google Scholar 

  51. Johannsen NM, Swift DL, Lavie CJ, Earnest CP, Blair SN, Timothy SC. Categorical analysis of the impact of aerobic and resistance exercise training, alone and in combination, on cardiorespiratory fitness levels in patients with type 2 diabetes. Diabetes Care. 2013;36:3305–12.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Cooper AJM, Brage S, Ekelund U, Wareham NJ, Griffin SJ, Simmons RK. Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. Diabetologia. 2014;57(1):73–82.

    Article  CAS  PubMed  Google Scholar 

  53. Umpierre D, Kramer CK, Leita CB, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA 1c levels in type 2 diabetes. JAMA J Am Med Assoc. 2011;305:1790–9.

    Article  CAS  Google Scholar 

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  1. Exercise Science and Sport Studies, Springfield College, 263 Alden St, Springfield, MA, 01119, USA

    Emily M. Miele & Samuel A. E. Headley

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Emily M. Miele and Samuel A. E. Headley declare that they have no conflict of interest.

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This article is part of the Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk

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Miele, E.M., Headley, S.A.E. The Effects of Chronic Aerobic Exercise on Cardiovascular Risk Factors in Persons with Diabetes Mellitus. Curr Diab Rep 17, 97 (2017). https://doi.org/10.1007/s11892-017-0927-7

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