Acute effect of healthy walking on arterial stiffness in patients with type 2 diabetes and differences by age and sex: a pre-post intervention study (original) (raw)
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Walking may be related to less vascular stiffness in the Activity Counseling Trial (ACT)
American Heart Journal, 2005
Background The ACT was a clinical trial of various patient education and counseling interventions to increase physical activity in sedentary primary care populations. It provided the opportunity to measure the effect of increasing physical activity on aortic pulse wave velocity (APWV), a measure of vascular stiffness, in a relatively healthy middle-aged population. The effects of the interventions, as well as the impact of walking and correlates such as older age and maximal oxygen uptake (V˙o 2 max), on APWV were assessed.
Diabetologia, 2020
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 V O 2peak ≥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 intimamedia 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 PWVof 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).
Deterioration of the structure and function of the vascular system is the underlying feature in cardiovascular disease (CVD), which is the highest cause of mortality in type 2 diabetes (T2D). Studies assessing the effect of exercise on vascular function and stiffness have used different measurement techniques and small cohorts, making it difficult to conclude on the overall efficacy of exercise on these outcomes. The aim of this study was to assess the effect of exercise on vascular function and stiffness in T2D. Electronic database searches were performed in AMED, MEDLINE, MEDLINE Daily Update, PREMEDLINE, SPORTDiscus, CINAHL, EMBASE and Web of Science. The effect size (ES), and 95% confidence intervals (CIs) of eligible studies were calculated. Pooled estimates of the effect of aerobic exercise (AEx) on vascular function and stiffness, using ES, were obtained. Results show that AEx led to a near-significant reduction in PWV (ES = -0.472; 95% CI: -0.949 to 0.005; P = 0.052), a significant reduction in EID (ES = 0.416, 95% CI: 0.062 to 0.769; P= 0.021), and a non-significant benefit in FMD measures. There were limited studies using resistance training or in combination with aerobic exercise, to assess a pooled effect on vascular function or stiffness. These data suggest that aerobic exercise training should be used as a primary treatment strategy for improving vascular smooth muscle function as measured by EID in individuals with T2D. There is currently insufficient evidence concerning the efficacy of regular exercise for improving vascular function and stiffness as measured by FMD and PWV.
Individuals with type 2 diabetes (T2D) have a two to four-fold greater risk of cardiovascular disease (CVD). This is due to vascular maladaptations resulting from chronic hyperglycaemia and hyperinsulinaemia, along with comorbid hypertension, proinflammatory cytokines, and the presence of excess free fatty acids. To date, the primary treatment for vascular dysfunction is pharmacological interventions. Regular exercise has been shown to produce physiological changes in the cardiovascular system and reduce risk factors associated with CVD, leading to overall reductions in cardiovascular morbidity and mortality in T2D. Current studies assessing the effect of exercise on vascular function have used different techniques usually on vessel structure, or endothelial function, making it difficult to conclude on the efficacy of exercise in vascular function. PURPOSE: The aim of this study was to assess the effect of exercise on vascular function in T2D. METHODS: Electronic database searches were performed in AMED, MEDLINE, MEDLINE Daily Update, PREMEDLINE, SPORTDiscus, CINAHL, EMBASE and Web of Science. Studies that were eligible for this review performed controlled trials (CTs) and completed an exercise intervention of ≥ 4 weeks in individuals with T2D. The effect size (ES), and 95% confidence intervals (CIs) of eligible studies were calculated. RESULTS: Of the studies employing an aerobic exercise (AEx) intervention alone, three used pulse wave velocity (PWV), three used endothelial-independent dilation (EID), and three used flow-mediated dilation (FMD), and had sufficient data for calculation of ES and 95% CIs for the purpose of meta-analyses. Results found that AEx had a significant effect in vascular stiffness (PWV: ES = -0.402, 95% CI: -0.716 to -0.088; P = 0.012) and a non-significant benefit in endothelial function measures (EID: ES =-0.262, 95% CI: -0.615 to 0.091; FMD: ES =-0.029, 95% CI: -0.384 to 0.326; P= 0.873). There were limited studies using resistance training, or in combination with aerobic exercise, to assess a pooled effect. CONCLUSIONS: Exercise therapy may be considered as a primary intervention to treat vascular stiffness as it targets the pathology associated with vascular maladaptation. Future research is needed in controlled trials targeting aerobic, resistance or combined exercise to provide guidelines in exercise prescription to manage vascular health in T2D.
Hypertension Research, 2012
Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7 ± 3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (Po0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern.
Short-term aerobic exercise improves arterial stiffness in type 2 diabetes
Diabetes Research and Clinical Practice, 2004
Objective: To investigate whether: (1) aerobic exercise decreases arterial stiffness and (2) reduction in arterial stiffness is associated with improvement in insulin resistance in type 2 diabetes. Methods: Common carotid and femoral arterial stiffness was ultrasonographically evaluated using stiffness index β in 23 type 2 diabetic subjects before and after a 3-week exercise protocol including ergometer and walking. Insulin sensitivity (Clamp-IR) was assessed using euglycemic-hyperinsulinemic clamp before and after the protocol. Arterial stiffness was also examined in steady hyperinsulinemic state during clamp. Results: Anthropometrical factors did not change following exercise. Clamp-IR tended to increase after exercise protocol (P = 0.061). Stiffness index β decreased following exercise in both common carotid and femoral arteries (P = 0.020 and P < 0.001, respectively). Clamp-IR was significantly correlated with the changes in stiffness index β of both common carotid (P = 0.040) and femoral artery (P = 0.016). Divided into tertiles according to Clamp-IR, decreases in stiffness index β for both common carotid (P = 0.009) and femoral (P = 0.037) arteries was greater in tertile group with a higher Clamp-IR. Hyperinsulinemia during clamp decreased stiffness index β in both common carotid (P = 0.031) and femoral (P = 0.025) arteries before exercise, but these effects disappeared after the exercise protocol. Conclusions: Short-term aerobic exercise significantly decreased arterial stiffness in both common carotid and femoral arteries, and the reduction of stiffness was associated with improvement of insulin resistance in type 2 diabetes.
Current Research in Diabetes & Obesity Journal
Cardiovascular disease (CVD) is common occur in type 2 diabetes mellitus (T2DM) patients. We aim to evaluate the association of cardioankle vascular index (CAVI) with the CVD risk factors. Anthropometric and CAVI measurements, blood pressure (BP) and biochemical variables were measured. One hundred and eighty seven women were allocated to 2 groups. Group (Gr)-1; 56T2DM patients with CAVI>0.9 were significantly higher in age, BP, mean arterial pressure (MAP), fasting blood sugar (Glu), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), hs-CRP, insulin, insulin resistance (HOMA-IR) and significantly lower in BMI, high density lipoprotein (HDL-C)levels than Gr-2; 131 non-T2DM subjects with CAVI<0.9. In bivariate correlation, CAVI was significantly correlated with Age, BMI, MAP, TC, HDL-C and hs-CRP (p<0.05). Multiple forward stepwise linear regression analyses of the significant variables showed that the independent predictors of CAVI were Age (b=0.448, R 2 =0.406, p<0.001), hs-CRP (b=0.220, R 2 =0.507, p<0.001), BMI (b=-0.383, R 2 =0.545, p<0.001), HDL-C (b=-0.350, R 2 =0.484, p<0.001), TC (b=0.256, R 2 =0.508, p<0.001) and MAP (b=0.248, R 2 =0.524, p<0.001). CAVI was associated with CVD risk factors and can be used as a CVD risk factor in T2DM patients. CAVI measurement is a useful tool to assess arterial stiffness and evaluate for subclinical coronary atherosclerosis in asymptomatic patients.
Effect of Foot Exercise and Care on Peripheral Vascular Status in Patients with Diabetes Mellitus
Jurnal Ners, 2019
Introduction: Diabetes mellitus is a cause of health problems which occurs in most countries. Approximately 13 - 15% of all patients with diabetes mellitus will experience peripheral circulatory disorders. Foot exercise and foot care are interventions that can be implemented to prevent foot ulcers.Methods: This study employed a pre-post-test quasi-experimental design with a control group. The sample consisted of 94 patients with diabetes mellitus who were assigned to the intervention group (n=47) and the control group (n=47) respectively. Consecutive sampling was used to recruit the samples. The instruments used to collect the data included 10-g monofilament for the diabetic neuropathy test, a HbA1c test and a sphygmomanometer. The collected data was analyzed using a paired t-test.Results: The results of this study showed there to be significant effects from foot exercise and foot care on the HbA1c test, in relation to the frequency of the dorsalis pedis artery and diabetic neuropat...
Jurnal Ners
Introduction: Hyperglycemia is one of the typical symptoms of patients with diabetes mellitus. This systematic review aims to systematically review the research evidence related to the effects of leg exercise on increasing the value of the ankle-brachial index in patients with diabetes mellitus.Methods: This study used a systematic review with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We identified 85 articles from Scopus, 34 from Pubmed and 401 from ProQuest. The keywords used in the search were "Foot Exercise", "Buerger Allen Exercise" and "Diabetes Mellitus". The inclusion criteria for this study were 1) Interventions with a focus on the Buerger Allen Exercise and 2) papers published in English. The deadline for publication was between 2014 and 2019.Results: After going through the selection process, 8 articles were deemed to be relevant for inclusion in this systematic review. One effort to overcome ...