Skip to main content
Top
Published in: European Journal of Applied Physiology 3/2014

01-03-2014 | Original Article

Life-long physical activity restores metabolic and cardiovascular function in type 2 diabetes

Authors: Tim H. A. Schreuder, Martijn F. H. Maessen, Cees J. Tack, Dick H. J. Thijssen, Maria T. E. Hopman

Published in: European Journal of Applied Physiology | Issue 3/2014

Login to get access

Abstract

Purpose

Short-to-moderate duration exercise training improves fitness and lowers cardiovascular risk in type 2 diabetes (T2DM). However, the impact of long-term compliance to an active lifestyle of T2DM patients on cardiovascular risk factors has never been studied but could provide information on the maximal achievable health effect of physical activity in T2DM. This study examined the impact of a life-long active lifestyle by comparing physical fitness, cardiovascular risk and vascular function between long-term physically active T2DM patients versus sedentary T2DM patients and controls.

Methods

Fitness, HOMA-IR, brachial artery flow-mediated dilation (FMD) and lifetime risk for cardiovascular disease were assessed in 15 exercising T2DM patients, 12 age-, sex- and weight-matched sedentary T2DM patients and 9 sedentary men free of established cardiovascular and metabolic disease as controls. Long-term regular exercise was defined as self-reported participation of >2.5 h of (predominantly) endurance exercise per week, which was performed for 18–47 years.

Results

Sedentary T2DM patients showed lower fitness (21.8 ± 2.3, 32.6 ± 6.0 and 31.1 ± 3.2 ml O2/kg/min), higher HOMA-IR (8.3 ± 5.0, 2.0 ± 1.8 and 1.1 ± 0.5 100/%S) and higher lifetime risk scores (17.3 ± 5.4, 9.3 ± 5.0 and 8.9 ± 3.9 %) compared to active peers and controls, respectively. Brachial artery FMD was lower in sedentary T2DM patients compared with active peers, but not in controls (3.3 ± 1.2, 5.2 ± 2.1 and 3.8 ± 1.2 %).

Conclusions

Life-long active T2DM patients have superior fitness levels, HOMA-IR, cardiovascular risk and FMD compared to sedentary peers, whilst no differences were found when compared to controls. This study provides evidence that a life-long active lifestyle, even in T2DM, may be able to effectively normalize cardiovascular risk.
Literature
go back to reference Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, Keteyian SJ, Lavie CJ, Macko R, Mancini D, Milani RV, American Heart Association Exercise CR, Prevention Committee of the Council on Clinical C, Council on E, Prevention, Council on Peripheral Vascular D, Interdisciplinary Council on Quality of C, Outcomes R (2010) Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 122(2):191–225. doi:10.1161/CIR.0b013e3181e52e69 PubMedCrossRef Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, Keteyian SJ, Lavie CJ, Macko R, Mancini D, Milani RV, American Heart Association Exercise CR, Prevention Committee of the Council on Clinical C, Council on E, Prevention, Council on Peripheral Vascular D, Interdisciplinary Council on Quality of C, Outcomes R (2010) Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 122(2):191–225. doi:10.​1161/​CIR.​0b013e3181e52e69​ PubMedCrossRef
go back to reference Berry JD, Willis B, Gupta S, Barlow CE, Lakoski SG, Khera A, Rohatgi A, de Lemos JA, Haskell W, Lloyd-Jones DM (2011) Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men. The Cooper Center Longitudinal Study. J Am Coll Cardiol 57(15):1604–1610. doi:10.1016/j.jacc.2010.10.056 PubMedCentralPubMedCrossRef Berry JD, Willis B, Gupta S, Barlow CE, Lakoski SG, Khera A, Rohatgi A, de Lemos JA, Haskell W, Lloyd-Jones DM (2011) Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men. The Cooper Center Longitudinal Study. J Am Coll Cardiol 57(15):1604–1610. doi:10.​1016/​j.​jacc.​2010.​10.​056 PubMedCentralPubMedCrossRef
go back to reference Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ (2001) Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286(10):1218–1227PubMedCrossRef Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ (2001) Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286(10):1218–1227PubMedCrossRef
go back to reference Boule NG, Kenny GP, Haddad E, Wells GA, Sigal RJ (2003) Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia 46(8):1071–1081. doi:10.1007/s00125-003-1160-2 PubMedCrossRef Boule NG, Kenny GP, Haddad E, Wells GA, Sigal RJ (2003) Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia 46(8):1071–1081. doi:10.​1007/​s00125-003-1160-2 PubMedCrossRef
go back to reference Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ (2003) Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 26(11):2977–2982PubMedCrossRef Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ (2003) Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 26(11):2977–2982PubMedCrossRef
go back to reference Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG (1997) The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. A randomized controlled study. Diabetes Care 20(6):913–921PubMedCrossRef Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG (1997) The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. A randomized controlled study. Diabetes Care 20(6):913–921PubMedCrossRef
go back to reference Dunstan DW, Zimmet PZ, Welborn TA, Cameron AJ, Shaw J, de Courten M, Jolley D, McCarty DJ, Australian Diabetes, Obesity and Lifestyle Study (AusDiab) (2002) The Australian diabetes, obesity and lifestyle study (AusDiab)—methods and response rates. Diabetes Res Clin Pract 57(2):119–129PubMedCrossRef Dunstan DW, Zimmet PZ, Welborn TA, Cameron AJ, Shaw J, de Courten M, Jolley D, McCarty DJ, Australian Diabetes, Obesity and Lifestyle Study (AusDiab) (2002) The Australian diabetes, obesity and lifestyle study (AusDiab)—methods and response rates. Diabetes Res Clin Pract 57(2):119–129PubMedCrossRef
go back to reference Giugliano D, Marfella R, Acampora R, Giunta R, Coppola L, D’Onofrio F (1998) Effects of perindopril and carvedilol on endothelium-dependent vascular functions in patients with diabetes and hypertension. Diabetes Care 21(4):631–636PubMedCrossRef Giugliano D, Marfella R, Acampora R, Giunta R, Coppola L, D’Onofrio F (1998) Effects of perindopril and carvedilol on endothelium-dependent vascular functions in patients with diabetes and hypertension. Diabetes Care 21(4):631–636PubMedCrossRef
go back to reference Gupta S, Berry JD, Ayers CR, Peshock RM, Khera A, de Lemos JA, Patel PC, Markham DW, Drazner MH (2010) Left ventricular hypertrophy, aortic wall thickness, and lifetime predicted risk of cardiovascular disease: the Dallas Heart Study. JACC 3(6):605–613. doi:10.1016/j.jcmg.2010.03.005 PubMedCrossRef Gupta S, Berry JD, Ayers CR, Peshock RM, Khera A, de Lemos JA, Patel PC, Markham DW, Drazner MH (2010) Left ventricular hypertrophy, aortic wall thickness, and lifetime predicted risk of cardiovascular disease: the Dallas Heart Study. JACC 3(6):605–613. doi:10.​1016/​j.​jcmg.​2010.​03.​005 PubMedCrossRef
go back to reference Honkola A, Forsen T, Eriksson J (1997) Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol 34(4):245–248PubMedCrossRef Honkola A, Forsen T, Eriksson J (1997) Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol 34(4):245–248PubMedCrossRef
go back to reference Kim SH, Lee SJ, Kang ES, Kang S, Hur KY, Lee HJ, Ahn CW, Cha BS, Yoo JS, Lee HC (2006) Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus. Metabolism Clin Exp 55(8):1053–1059. doi:10.1016/j.metabol.2006.03.017 CrossRef Kim SH, Lee SJ, Kang ES, Kang S, Hur KY, Lee HJ, Ahn CW, Cha BS, Yoo JS, Lee HC (2006) Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus. Metabolism Clin Exp 55(8):1053–1059. doi:10.​1016/​j.​metabol.​2006.​03.​017 CrossRef
go back to reference Lopes-Virella MF, Carter RE, Gilbert GE, Klein RL, Jaffa M, Jenkins AJ, Lyons TJ, Garvey WT, Virella G, Diabetes C, Complications Trial/Epidemiology of Diabetes I, Complications Cohort Study G (2008) Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications. Diabetes Care 31(10):2006–2012. doi:10.2337/dc08-0659 PubMedCrossRef Lopes-Virella MF, Carter RE, Gilbert GE, Klein RL, Jaffa M, Jenkins AJ, Lyons TJ, Garvey WT, Virella G, Diabetes C, Complications Trial/Epidemiology of Diabetes I, Complications Cohort Study G (2008) Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications. Diabetes Care 31(10):2006–2012. doi:10.​2337/​dc08-0659 PubMedCrossRef
go back to reference Maiorana A, O’Driscoll G, Cheetham C, Dembo L, Stanton K, Goodman C, Taylor R, Green D (2001) The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol 38(3):860–866PubMedCrossRef Maiorana A, O’Driscoll G, Cheetham C, Dembo L, Stanton K, Goodman C, Taylor R, Green D (2001) The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol 38(3):860–866PubMedCrossRef
go back to reference Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56(2):115–123PubMedCrossRef Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56(2):115–123PubMedCrossRef
go back to reference Marwick TH, Hordern MD, Miller T, Chyun DA, Bertoni AG, Blumenthal RS, Philippides G, Rocchini A, Council on Clinical Cardiology AHAECR, Prevention C, Council on Cardiovascular Disease in the Y, Council on Cardiovascular N, Council on Nutrition PA, Metabolism, Interdisciplinary Council on Quality of C, Outcomes R (2009) Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation 119(25):3244–3262. doi:10.1161/CIRCULATIONAHA.109.192521 PubMedCrossRef Marwick TH, Hordern MD, Miller T, Chyun DA, Bertoni AG, Blumenthal RS, Philippides G, Rocchini A, Council on Clinical Cardiology AHAECR, Prevention C, Council on Cardiovascular Disease in the Y, Council on Cardiovascular N, Council on Nutrition PA, Metabolism, Interdisciplinary Council on Quality of C, Outcomes R (2009) Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation 119(25):3244–3262. doi:10.​1161/​CIRCULATIONAHA.​109.​192521 PubMedCrossRef
go back to reference Mather KJ, Verma S, Anderson TJ (2001) Improved endothelial function with metformin in type 2 diabetes mellitus. J Am Coll Cardiol 37(5):1344–1350PubMedCrossRef Mather KJ, Verma S, Anderson TJ (2001) Improved endothelial function with metformin in type 2 diabetes mellitus. J Am Coll Cardiol 37(5):1344–1350PubMedCrossRef
go back to reference O’Driscoll G, Green D, Taylor RR (1997) Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation 95(5):1126–1131PubMedCrossRef O’Driscoll G, Green D, Taylor RR (1997) Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation 95(5):1126–1131PubMedCrossRef
go back to reference Okada S, Hiuge A, Makino H, Nagumo A, Takaki H, Konishi H, Goto Y, Yoshimasa Y, Miyamoto Y (2010) Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb 17(8):828–833PubMedCrossRef Okada S, Hiuge A, Makino H, Nagumo A, Takaki H, Konishi H, Goto Y, Yoshimasa Y, Miyamoto Y (2010) Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb 17(8):828–833PubMedCrossRef
go back to reference Ozdirenc M, Biberoglu S, Ozcan A (2003) Evaluation of physical fitness in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 60(3):171–176PubMedCrossRef Ozdirenc M, Biberoglu S, Ozcan A (2003) Evaluation of physical fitness in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 60(3):171–176PubMedCrossRef
go back to reference Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, Teupser D, Thiery J, Adams V, Schuler G, Niebauer J (2010) 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 31(1):112–119. doi:10.1093/eurheartj/ehp398 PubMedCrossRef Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, Teupser D, Thiery J, Adams V, Schuler G, Niebauer J (2010) 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 31(1):112–119. doi:10.​1093/​eurheartj/​ehp398 PubMedCrossRef
go back to reference Watarai T, Yamasaki Y, Ikeda M, Kubota M, Kodama M, Tsujino T, Kishimoto M, Kawamori R, Hori M (1999) Insulin resistance contributes to carotid arterial wall thickness in patients with non-insulin-dependent-diabetes mellitus. Endocr J 46(5):629–638PubMedCrossRef Watarai T, Yamasaki Y, Ikeda M, Kubota M, Kodama M, Tsujino T, Kishimoto M, Kawamori R, Hori M (1999) Insulin resistance contributes to carotid arterial wall thickness in patients with non-insulin-dependent-diabetes mellitus. Endocr J 46(5):629–638PubMedCrossRef
go back to reference Woodman RJ, Playford DA, Watts GF, Cheetham C, Reed C, Taylor RR, Puddey IB, Beilin LJ, Burke V, Mori TA, Green D (2001) Improved analysis of brachial artery ultrasound using a novel edge-detection software system. J Appl Physiol 91(2):929–937PubMed Woodman RJ, Playford DA, Watts GF, Cheetham C, Reed C, Taylor RR, Puddey IB, Beilin LJ, Burke V, Mori TA, Green D (2001) Improved analysis of brachial artery ultrasound using a novel edge-detection software system. J Appl Physiol 91(2):929–937PubMed
Metadata
Title
Life-long physical activity restores metabolic and cardiovascular function in type 2 diabetes
Authors
Tim H. A. Schreuder
Martijn F. H. Maessen
Cees J. Tack
Dick H. J. Thijssen
Maria T. E. Hopman
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Applied Physiology / Issue 3/2014
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-013-2794-5

Other articles of this Issue 3/2014

European Journal of Applied Physiology 3/2014 Go to the issue