Zusammenfassung
Typ-2-Diabetiker mit Herzinsuffizienz stellen eine immer größer werdende Patientengruppe dar. Nachweislich profitieren diese Patienten von körperlichem Training. Die in zahlreichen Studien gezeigten positiven Veränderungen in Bezug auf kardiovaskuläre Risikofaktoren, Morbidität und Mortalität lassen sich nur durch langfristige Trainingsprogramme in Form einer Kombination aus Ausdauer- und Krafttraining erzielen. Dieses wirksame und kostengünstige Therapeutikum sollte möglichst vielen Patienten angeboten werden.
Abstract
Patients with type 2 diabetes mellitus and heart failure represent a relevant population in everyday practice. Several exercise training studies have documented numerous positive changes in cardiovascular risk factors, morbidity and mortality, that can only be achieved through long-term training programs of combined aerobic and strength training. This efficient and cost effective therapy should be offered to as many patients in need as possible.
Literatur
Rubler S, Dlugash J, Yuceoglu YZ et al (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30:595–602
Zarich SW, Nesto RW (1989) Diabetic cardiomyopathy. Am Heart J 118:1000–1012
Boudina S, Abel ED (2007) Diabetic cardiomyopathy revisited. Circulation 115:3213–3223
Fein FS (1990) Diabetic cardiomyopathy. Diabetes Care 13:1169–1179
Bell DS (1995) Diabetic cardiomyopathy. A unique entity or a complication of coronary artery disease? Diabetes Care 18:708–714
Poirier P, Bogaty P, Garneau C et al (2001) Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 24:5–10
Schannwell CM, Schneppenheim M, Perings S et al (2002) Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology 98:33–39
Resl M, Hulsmann M, Pacher R, Clodi M (2009) Heart failure in diabetes. Wien Med Wochenschr 159:134–140
Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 34:29–34
Nichols GA, Hillier TA, Erbey JR, Brown JB (2001) Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 24:1614–1619
Bertoni AG, Hundley WG, Massing MW et al (2004) Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care 27:699–703
Iribarren C, Karter AJ, Go AS et al (2001) Glycemic control and heart failure among adult patients with diabetes. Circulation 103:2668–2673
Bertoni AG, Tsai A, Kasper EK, Brancati FL (2003) Diabetes and idiopathic cardiomyopathy: a nationwide case-control study. Diabetes Care 26:2791–2795
Nichols GA, Gullion CM, Koro CE et al (2004) The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 27:1879–1884
Barzilay JI, Kronmal RA, Gottdiener JS et al (2004) The association of fasting glucose levels with congestive heart failure in diabetic adults > or = 65 years: the Cardiovascular Health Study. J Am Coll Cardiol 43:2236–2241
Carr AA, Kowey PR, Devereux RB et al (2005) Hospitalizations for new heart failure among subjects with diabetes mellitus in the RENAAL and LIFE studies. Am J Cardiol 96:1530–1536
Halon DA, Merdler A, Flugelman MY et al (2000) Late-onset heart failure as a mechanism for adverse long-term outcome in diabetic patients undergoing revascularization (a 13-year report from the Lady Davis Carmel Medical Center registry). Am J Cardiol 85:1420–1426
Greenberg BH, Abraham WT, Albert NM et al (2007) Influence of diabetes on characteristics and outcomes in patients hospitalized with heart failure: a report from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J 154:277.e1–e8
Murray AJ, Anderson RE, Watson GC et al (2004) Uncoupling proteins in human heart. Lancet 364:1786–1788
Swan JW, Anker SD, Walton C et al (1997) Insulin resistance in chronic heart failure: relation to severity and etiology of heart failure. J Am Coll Cardiol 30:527–532
Pogatsa G (2001) Metabolic energy metabolism in diabetes: therapeutic implications. Coron Artery Dis 12(Suppl 1):29–33
Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442
Von Bibra H, Thrainsdottir IS, Hansen A et al (2005) Tissue Doppler imaging for the detection and quantitation of myocardial dysfunction in patients with type 2 diabetes mellitus. Diab Vasc Dis Res 2:24–30
Epshteyn V, Morrison K, Krishnaswamy P et al (2003) Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes. Diabetes Care 26:2081–2087
Zannad F, Briancon S, Juilliere Y et al (1999) Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Epidemiologie de l’Insuffisance Cardiaque Avancee en Lorraine. J Am Coll Cardiol 33:734–742
Kristiansson K, Sigfusson N, Sigvaldason H, Thorgeirsson G (1995) Glucose tolerance and blood pressure in a population-based cohort study of males and females: the Reykjavik Study. J Hypertens 13:581–586
McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446
He J, Ogden LG, Bazzano LA et al (2001) Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 161:996–1002
Hu FB, Stampfer MJ, Haffner SM et al (2002) Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care 25:1129–1134
Ryden L, Standl E, Bartnik M et al (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136
Solang L, Malmberg K, Ryden L (1999) Diabetes mellitus and congestive heart failure. Further knowledge needed. Eur Heart J 20:789–795
(n a) (2012) Standards of medical care in diabetes – 2012. Diabetes Care 35(Suppl 1):S11–S63
Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10:933–989
Niederseer D, Thaler C, Niebauer J (2007) The failing heart. N Engl J Med 356:2545
Berger M, Berchtold P, Cuppers HJ et al (1977) Metabolic and hormonal effects of muscular exercise in juvenile type diabetics. Diabetologia 13:355–365
Poirier P, Tremblay A, Catellier C et al (2000) Impact of time interval from the last meal on glucose response to exercise in subjects with type 2 diabetes. J Clin Endocrinol Metab 85:2860–2864
Fang ZY, Sharman J, Prins JB, Marwick TH (2005) Determinants of exercise capacity in patients with type 2 diabetes. Diabetes Care 28:1643–1648
Devlin JT (1992) Effects of exercise on insulin sensitivity in humans. Diabetes Care 15:1690–1693
Schneider SH, Amorosa LF, Khachadurian AK, Ruderman NB (1984) Studies on the mechanism of improved glucose control during regular exercise in type 2 (non-insulin-dependent) diabetes. Diabetologia 26:355–360
Henriksson J (1992) Effects of physical training on the metabolism of skeletal muscle. Diabetes Care 15:1701–1711
Mayer-Davis EJ, D’Agostino R Jr, Karter AJ et al (1998) Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA 279:669–674
Boule NG, Haddad E, Kenny GP et al (2001) Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286:1218–1227
Snowling NJ, Hopkins WG (2006) Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 29:2518–2527
Umpierre D, Ribeiro PA, Kramer CK et al (2011) Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305:1790–1799
Chudyk A, Petrella RJ (2011) Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 34:1228–1237
Sigal RJ, Kenny GP, Boule NG et al (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 147:357–369
Church TS, Blair SN, Cocreham S et al (2010) Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 304:2253–2262
Gregg EW, Gerzoff RB, Caspersen CJ et al (2003) Relationship of walking to mortality among US adults with diabetes. Arch Intern Med 163:1440–1447
Tanasescu M, Leitzmann MF, Rimm EB, Hu FB (2003) Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation 107:2435–2439
Hu FB, Stampfer MJ, Solomon C et al (2001) Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med 134:96–105
Wei M, Gibbons LW, Kampert JB et al (2000) Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 132:605–611
O’Connor CM, Whellan DJ, Lee KL et al (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1439–1450
Davies EJ, Moxham T, Rees K et al (2010) Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev (4):CD003331
Flynn KE, Pina IL, Whellan DJ et al (2009) Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1451–1459
Haykowsky MJ, Liang Y, Pechter D et al (2007) A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. J Am Coll Cardiol 49:2329–2336
Hambrecht R, Gielen S, Linke A et al (2000) Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial. JAMA 283:3095–3101
(n a) (1998) Experience from controlled trials of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. European Heart Failure Training Group. Eur Heart J 19:466–475
Pina IL, Apstein CS, Balady GJ et al (2003) Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107:1210–1225
Rees K, Taylor RS, Singh S et al (2004) Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev (3):CD003331
Smart N, Marwick TH (2004) Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 116:693–706
Wisloff U, Stoylen A, Loennechen JP et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115:3086–3094
Kitzman DW, Hundley WG, Brubaker PH et al (2010) A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction: effects on exercise tolerance and arterial distensibility. Circ Heart Fail 3:477–485
McKelvie RS, Teo KK, McCartney N et al (1995) Effects of exercise training in patients with congestive heart failure: a critical review. J Am Coll Cardiol 25:789–796
Belardinelli R, Georgiou D, Cianci G, Purcaro A (1996) Effects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction. Am Heart J 132:61–70
Sixt S, Beer S, Bluher M et al (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 31:112–119
Edelmann F, Gelbrich G, Dungen HD et al (2011) Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 58:1780–1791
Liu JL, Irvine S, Reid IA et al (2000) Chronic exercise reduces sympathetic nerve activity in rabbits with pacing-induced heart failure: a role for angiotensin II. Circulation 102:1854–1862
Roveda F, Middlekauff HR, Rondon MU et al (2003) The effects of exercise training on sympathetic neural activation in advanced heart failure: a randomized controlled trial. J Am Coll Cardiol 42:854–860
Braith RW, Welsch MA, Feigenbaum MS et al (1999) Neuroendocrine activation in heart failure is modified by endurance exercise training. J Am Coll Cardiol 34:1170–1175
Hambrecht R, Fiehn E, Weigl C et al (1998) Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 98:2709–2715
Varin R, Mulder P, Richard V et al (1999) Exercise improves flow-mediated vasodilatation of skeletal muscle arteries in rats with chronic heart failure. Role of nitric oxide, prostanoids, and oxidant stress. Circulation 99:2951–2957
Sixt S, Rastan A, Desch S et al (2008) Exercise training but not rosiglitazone improves endothelial function in prediabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil 15:473–478
Desch S, Sonnabend M, Niebauer J et al (2010) Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetes. Diabetes Obes Metab 12:825–828
Hambrecht R, Hilbrich L, Erbs S et al (2000) Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation. J Am Coll Cardiol 35:706–713
Niebauer J, Clark AL, Webb-Peploe KM, Coats AJ (2005) Exercise training in chronic heart failure: effects on pro-inflammatory markers. Eur J Heart Fail 7:189–193
Niebauer J, Clark AL, Webb-Peploe KM et al (2005) Home-based exercise training modulates pro-oxidant substrates in patients with chronic heart failure. Eur J Heart Fail 7:183–188
Goodpaster BH, Park SW, Harris TB et al (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61:1059–1064
Nelson ME, Rejeski WJ, Blair SN et al (2007) Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 116:1094–1105
Niederseer D, Niebauer J (2010) Möglichkeiten und Risiken des Krafttrainings. Ärzte Woche 24:14
Weitgasser R, Brath H, Niebauer J (2009) Lebensstil: Diagnostik und Therapie. Wien Klin Wochenschr 121:10–12
Cauza E, Hanusch-Enserer U, Strasser B et al (2005) The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil 86:1527–1533
Dunstan DW, Daly RM, Owen N et al (2002) High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 25:1729–1736
Castaneda C, Layne JE, Munoz-Orians L et al (2002) A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 25:2335–2341
Sigal RJ, Kenny GP, Wasserman DH et al (2006) Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 29:1433–1438
Maron BJ, Araújo CGS, Thompson PD et al (2001) Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 103:327–334
Niebauer J (2008) Effects of exercise training on inflammatory markers in patients with heart failure. Heart Fail Rev 13:39–49
Lemaster JW, Reiber GE, Smith DG et al (2003) Daily weight-bearing activity does not increase the risk of diabetic foot ulcers. Med Sci Sports Exerc 35:1093–1099
Bjarnason-Wehrens B, Mayer-Berger W, Meister ER et al (2004) Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 11:352–361
Bjarnason-Wehrens B, Mayer-Berger W, Meister ER et al (2004) The stakes of force perseverance training and muscle structure training in rehabilitation. Recommendations of the German Federation for Prevention and Rehabilitation of Heart-Circulatory Diseases e.v. Z Kardiol 93:357–370
Niebauer J, Hambrecht R, Marburger C et al (1995) Impact of intensive physical exercise and low-fat diet on collateral vessel formation in stable angina pectoris and angiographically confirmed coronary artery disease. Am J Cardiol 76:771–775
Lewis JD, Ferrara A, Peng T et al (2011) Risk of bladder cancer among diabetic patients treated with pioglitazone: interim report of a longitudinal cohort study. Diabetes Care 34:916–922
Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31:2501–2555
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Niederseer, D., Niebauer, J. Ausdauer- und Krafttraining bei Patienten mit Diabetes mellitus Typ 2 und Herzinsuffizienz. Herz 37, 499–507 (2012). https://doi.org/10.1007/s00059-012-3635-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-012-3635-8