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Physical Activity, Cardiorespiratory Fitness, and the Diabetes Spectrum

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Cardiorespiratory Fitness in Cardiometabolic Diseases

Abstract

Physical activity and cardiorespiratory fitness greatly impact the diabetic spectrum of disorders such as prediabetes, gestational diabetes, and type 1 and type 2 diabetes. Epidemiologically, there is a strong and inverse association between fitness status and diabetes incidence. Randomized controlled trials have also shown that diabetes incidence is significantly reduced in individuals with prediabetes when a lifestyle intervention program is implemented and cardiorespiratory fitness improves. Although improvement in microvascular disease in these intervention trials has not been shown, mortality is decreased. Subjects with both DM1 and DM2 have reduced cardiorespiratory fitness. In those with early DM2, fitness strongly improves glycemic parameters in a dose-dependent manner to cardiorespiratory fitness. In more established diabetes, although the emphasis historically has been on the volume of the aerobic component of exercise, there is a bourgeoning additive benefit role for resistance training, and the consensus guidelines recommend a combination of aerobic and resistance activity as well as minimizing inactivity along with nutritional support. The role of high-intensity interval training, for those medically capable, has also been shown to increase cardiorespiratory fitness benefit with reduced investment in time.

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Abbreviations

ADA:

American Diabetes Association

CRF:

Cardiorespiratory fitness

CVD:

Cardiovascular disease

DM1:

Type 1 diabetes mellitus

DM2:

Type 2 diabetes mellitus

GDM:

Gestational diabetes mellitus

GLUT4:

Glucose transporter 4

HgbA1c:

Glycosylated hemoglobin A1c

HIIT:

High-intensity interval training

IGT:

Impaired glucose tolerance

IR:

Insulin resistance

VO2max:

maximal oxygen uptake

MVPA:

Moderate-vigorous physical activity

NNT:

Numbers needed to treat

RT:

Resistance training

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Authors and Affiliations

  1. Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, DC, USA

    Eric S. Nylén

  2. Veterans Affairs Medical Center, Department of Cardiology, Washington, DC, USA

    Peter Kokkinos

  3. Georgetown University School of Medicine, Washington, DC, USA

    Peter Kokkinos

  4. Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA

    Peter Kokkinos

  5. George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Kokkinos

  6. University of South Carolina, Department of Exercise Science, Arnold School of Public Health, Columbia, SC, USA

    Peter Kokkinos

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  1. Eric S. Nylén
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Correspondence to Peter Kokkinos .

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Editors and Affiliations

  1. Veterans Affairs Medical Center, Georgetown University School of Medicine, Rutgers University Department of Kinesiology and Health, University of South Carolina Arnold School of Public Health, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Kokkinos

  2. Clinical Research Institute of Northern Virginia, Burke, VA, USA

    Puneet Narayan

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Nylén, E.S., Kokkinos, P. (2019). Physical Activity, Cardiorespiratory Fitness, and the Diabetes Spectrum. In: Kokkinos, P., Narayan, P. (eds) Cardiorespiratory Fitness in Cardiometabolic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-04816-7_11

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