Preventive cardiology
Effect of Long-Term Endurance and Strength Training on Metabolic Control and Arterial Elasticity in Patients With Type 2 Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2008.12.026Get rights and content

Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 ± 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. All exercise sessions were controlled by heart rate and intensity. Glycated hemoglobin A1c, insulin, leptin, blood lipids, blood pressure, maximal oxygen consumption in spiroergometry, and muscle strength were measured every 6 months. Arterial stiffness was assessed by measuring pulse wave velocity. Maximal oxygen consumption in spiroergometry (E 31.9 to 34.8 vs C 32.6 to 31.8 ml/kg/min; p = 0.003), muscle strength (sit-up test, E 12.7 to 20.8 vs C 14.6 to 13.1 times; p <0.001), hemoglobin A1c (E 8.2% to 7.6% vs C 8.0% to 8.3%; p = 0.006), and leptin (E 7.4 to 6.7 vs C 7.4 to 7.9 μg/L; p = 0.013) improved significantly in the E group, but no change or worsening in these variables occurred in the C group. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.

Section snippets

Methods

The study was a randomized controlled trial with 50 men recruited to assess the effect of exercise on PWV and baroreflex sensitivity, as described previously.15 One subject in the exercise-training (E) group withdrew from the study because of lack of time, and 1 from the control (C) group withdrew because of poor motivation. Our hypothesis was that baroreflex sensitivity may improve after 1 year of training, whereas arterial elasticity required a longer period. None of the patients was on

Results

Forty-eight subjects completed the 24-month intervention successfully. Their baseline characteristics are listed in Table 1. The E group met the requirements for minimum duration and intensity of training sessions. Mean adherence to controlled training sessions was 75% of sessions. Table 2 lists exercise and other results in the study groups at baseline and 24 months. Vo2max improved significantly in the E group (E +9% vs C −2%), and muscle strength parameters (sit-up test, E +64% vs C −10%)

Discussion

This is the first randomized controlled study evaluating the impact of 2 years of exercise training on arterial stiffness in patients with DM. Our main finding was that large-artery elasticity was not improved, although training resulted in an improved cardiovascular risk profile and significantly better hemoglobin A1c for 15 months. Figure 1, Figure 2 show the rapid changes in risk factors, and Figure 2 shows the end-point measure. Thus, arterial stiffening seemed to progress in men with DM. A

Acknowledgment

We thank Dr. Tiit Kööbi, MD, at Tampere University Hospital, Tampere, Finland, for the impedance cardiography method.

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    This work was supported by grants from the Finnish Ministry of Education, Helsinki, Finland; the Pirkanmaa Regional Fund under the auspices of the Finnish Cultural Fund, Tampere, Finland; the Medical Research Fund of the Tampere University Hospital, Tampere, Finland; and Finska Läkarsällskapet, Helsinki, Finland.

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