Cardiorespiratory capacity is associated with favourable cardiovascular risk profile in patients with Type 2 diabetes.

OBJECTIVE: The aim of this study was to examine the interaction between cardiorespiratory capacity and cardiovascular risk factors in patients with Type 2 diabetes mellitus (T2DM). RESEARCH DESIGN/METHODS: A total of 92 patients with T2DM (40 men, 52 women) performed a symptom-limited exercise test on ergocycle, with continuous gas exchange measurement. All patients were overweight or obese (body mass index >25 kg/m(2)), with poor glycemic control (hemoglobin A(1c) >7%), but free from overt diabetic vascular complications. Anthropometric parameters, blood pressure (BP), cardiorespiratory fitness, glycemic and lipid profile, fibrinogen, plasminogen activator inhibitor-1, high-sensitivity C-reactive protein (hsCRP), insulin resistance, and 24-h urinary albumin excretion (UAE) were measured. Based on the median Vo(2) peak value, participants were placed into low fitness (LF, n=46) or moderate fitness group (MF, n=46). RESULTS: In univariate analysis, exercise capacity correlated with systolic (r=-0.349) and diastolic BP (r=-0.441), waist circumference (r=-0.345), total cholesterol (r=-0.348), high-density lipoprotein (HDL) (r=0.362), UAE (r=-0.486), homeostasis model assessment (HOMA-IR) (r=-0.467), uric acid (r=-0.316), and hsCRP (r=-0.217, only in women subgroup) (P<.05). With the exception of the latter three variables, the above associations remained significant after controlling for age and sex in multiple regression analysis (P<.05). Compared to LF group, patients in MF group showed significantly higher levels of HDL and lower levels of BP, waist circumference, hsCRP, and HOMA-IR (P<.05). In addition to this, UAE tended to be lower in fit patients (P=.054). CONCLUSIONS: Low cardiorespiratory fitness seems to be independently associated with most traditional and emerging cardiovascular risk factors in patients with T2DM. Even a moderate increase of cardiorespiratory fitness exerts beneficial effects on cardiovascular risk profile.

The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) and chronic inflammation are strongly related to increased cardiovascular risk. The purpose of this study was to evaluate whether an aerobic training programme would ameliorate inflammatory and anti-inflammatory markers in patients with type 2 DM. DESIGN: Interventional study. METHODS: A total of 60 overweight individuals with type 2 DM, but without vascular complications, were randomly assigned to either a 6-month aerobic exercise training programme (four times/week, 45-60 min/session), designated as exercise group, or to the control group. All participants were on an oral antidiabetic regimen and none was receiving lipid-lowering medications. Anthropometric parameters, cardiorespiratory fitness, glycaemic and lipid profiles, high sensitivity C-reactive protein (hs CRP), adiponectin, interleukin (IL)-10, IL-18, tumour necrosis factor (TNF)-alpha, insulin, reciprocal index of homoeostasis model assessment (HOMA-IR), body fat and blood pressure (BP) were measured at baseline and at the end of the study. RESULTS: In comparison with baseline and control group, exercise-treated patients improved glucose control, lipid profile, exercise capacity (VO2 peak) and exhibited decreased insulin resistance and systolic BP considerably (P<0.05). Plasma adiponectin, TNF-alpha and body weight changed slightly across treatment (P>0.05), whereas diastolic BP and fat mass tended to decrease (P=0.071 and 0.061, respectively). Exercise training reduced hs CRP (from 0.48+/-0.16 to 0.29+/-0.2 mg/dl; P=0.04) and IL-18 (from 315.19+/-122.76 to 203.77+/-96.02 pg/ml; P=0.02). Moreover, exercise provided anti-inflammatory protection through IL-10 increment (P=0.039) and IL-18/IL-10 ratio downregulation (P=0.014). In multiple regression analysis, alteration in IL-18 was independently correlated with hs CRP and VO2 peak changes (P<0.05). CONCLUSION: Aerobic exercise training without significant weight loss improves metabolic profile and exerts anti-inflammatory effects in patients with type 2 DM.