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Diabetologia

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Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention, irrespective of changes in cardiorespiratory fitness

  • Megan Hetherington-Rauth
  • João P. Magalhães
  • Pedro B. Júdice
  • Xavier Melo
  • Luís B. SardinhaEmail author
Article
First Online:

Abstract

Aims/hypothesis

Vascular changes in individuals with type 2 diabetes mellitus majorly contribute to the development of cardiovascular disease. Increased cardiorespiratory fitness (CRF) has been associated with improvements in vascular health. Although CRF tends to improve with exercise training, there remains a portion of participants with little or no improvement. Given the importance of vascular function in individuals with type 2 diabetes, we assessed whether individuals who failed to improve CRF following a 1 year exercise intervention also failed to improve arterial stiffness and structural indices.

Methods

Individuals with type 2 diabetes with no major micro- and macrovascular complications and aged between 30 and 75 years old (n = 63) participated in a three-arm, 1 year, randomised controlled exercise intervention in Lisbon, Portugal. The study involved a non-exercise control group, a moderate continuous training combined with resistance training (RT) group and a high-intensity interval training with RT group. Allocation of participants into the intervention and control groups was done using a computer-generated list of random numbers. An improvement in CRF was defined as a change in \( \dot{V}{\mathrm{O}}_{2\mathrm{peak}} \) ≥5%. Vascular stiffness and structural indices were measured using ultrasound imaging and applanation tonometry. Generalised estimating equations were used to compare changes in vascular measures across individuals in the control group (n = 22) and those in the exercise groups who either had improved CRF (CRF responders; n = 14) or whose CRF did not improve (CRF non-responders; n = 27) following 1 year of exercise training.

Results

Compared with the control group, exercisers, with and without improvements in CRF, had decreased carotid intima–media thickness (IMT) (CRF responders: β = −2.84 [95% CI −5.63, −0.04]; CRF non-responders: β = −5.89 [95% CI −9.38, −2.40]) and lower-limb pulse wave velocity (PWV) (CRF responders: β = −0.14 [95% CI −0.25, −0.03]; CRF non-responders: β = −0.14 [95% CI −0.25, −0.03]), the latter being an indicator of peripheral arterial stiffness. Only CRF responders had decreased PWV of the upper limb compared with control participants (β = −0.12 [95% CI −0.23, −0.01]). As for central stiffness, CRF non-responders had increased aortic PWV compared with CRF responders (β = 0.19 [95% CI 0.07, 0.31]), whereas only the CRF non-responders had altered carotid distensibility coefficient compared with the control group (β = 0.00 [95% CI 3.01 × 10−5, 0.00]). No interaction effects between the CRF responders and non-responders vs control group were found for the remaining stiffness or haemodynamic indices (p>0.05).

Conclusions/interpretation

Regardless of improvements in CRF, individuals with type 2 diabetes had significant improvements in carotid IMT and lower-limb arterial stiffness following a 1 year exercise intervention. Thus, a lack of improvement in CRF following exercise in people with type 2 diabetes does not necessarily entail a lack of improvement in vascular health.

Trial registration

ClinicalTrials.gov NCT03144505

Funding

This work was supported by fellowships from the Portuguese Foundation for Science and Technology. This work is also financed by a national grant through the Fundação para a Ciência e Tecnologia (FCT), within the unit I&D 472.

Keywords

Arterial stiffness Carotid intima–media thickness Exercise intervention Peak wave velocity Type 2 diabetes 

Abbreviations

CRF

Cardiorespiratory fitness

CVD

Cardiovascular disease

DBP

Diastolic BP

HIIT

High-intensity interval training

HRR

Heart rate reserve

IMT

Intima–media thickness

LIPA

Low intensity physical activity

MAP

Mean arterial pressure

MCT

Moderate continuous training

MVPA

Moderate-to-vigorous physical activity

NEPA

Non-exercise physical activity

PWV

Pulse wave velocity

RT

Resistance training

SBP

Systolic BP

TEM

Technical error of measurement

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Notes

Acknowledgements

The authors are grateful to all participants for their time and effort.

Contribution statement

LBS and JPM contributed to the conception and design of the study. JPM, PBJ and XM were responsible for data collection and acquisition. MHR was responsible for data analysis and interpretation. MHR drafted the manuscript. LBS, JPM, PBJ and XM contributed to reviewing and editing the manuscript. LBS and MHR gave approval of the final version of the manuscript and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This work was supported by fellowships from the Portuguese Foundation for Science and Technology (grant to JPM: SFRH/BD/85742/2012; grant to PBJ: SFRH/BPD/115977/2016). This work is also financed by a national grant through the Fundação para a Ciência e Tecnologia (FCT) within the unit I&D 472 (UID/DTP/00447/2019).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2020_5089_MOESM1_ESM.pdf (233 kb)
ESM Methods (PDF 233 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Exercise and Health Laboratory, CIPER, Faculdade de Motricidade HumanaUniversidade de LisboaCruz-QuebradaPortugal
  2. 2.Ginásio Clube Português, GCP LabLisbonPortugal

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