Effects of an adapted cardiac rehabilitation programme on arterial stiffness in patients with type 2 diabetes without cardiac disease diagnosis.

PURPOSE: To determine the effects of a 12-week cardiac rehabilitation programme of aerobic and resistance exercise training on arterial stiffness, peak calf vasodilatory reserve, and haemostatic markers in patients with type 2 diabetes. METHODS: Observational cohort study examining effects of 12 weeks of exercise training in 23 subjects (13 men, 10 women; mean age of 56.1 ± 10.1 years) with type 2 diabetes mellitus. Subjects performed exercise training for 12 weeks [aerobic training 5 days/week, 70%-75% peak cardiovascular fitness (VO2peak) and resistance training 2-3 days/week, 60% of one repetition maximum]. Vascular stiffness (pulse-wave velocity), augmentation index, peak calf vasodilatory reserve, and VO2peak were measured pre- and post-exercise training. Secondary outcomes included heart rate variability and haemostatic measures. RESULTS: VO2peak increased by 16% (20.1 ± 5.5 vs 23.2 ± 8.8 mL/kg/min, p = 0.002) and abdominal circumference was reduced (101.9 ± 13.3 vs 97.9 ± 12.7 cm, p < 0.03). Vascular function was improved including central arterial stiffness (central pulse-wave velocity: 8.44 ± 1.75 vs 8.02 ± 1.60 m/s, p = 0.026) and the aortic augmentation index (21.7 ± 10.6% vs 18.3 ± 12.6%, p = 0.005); peak calf vasodilatory reserve increased from 30.3 ± 10.6 mL/100 mL/min to 38.0 ± 15.3 mL/100 mL/min ( p = 0.04). No changes were seen in heart rate variability, blood lipids, glycated haemoglobin and C-reactive protein. CONCLUSION: A 12-week cardiac rehabilitation programme of aerobic and resistance training significantly reduces arterial stiffness and improves aerobic fitness in individuals with type 2 diabetes mellitus.

Dietary measures and exercise training contribute to improvement of endothelial function and atherosclerosis even in patients given intensive pharmacologic therapy.

PURPOSE: Atherosclerosis contributes to cardiovascular mortality and morbidity even with aggressive lipid management. Our objective is to determine whether a combined pharmacological and lifestyle intervention can improve atherosclerosis. METHODS: We conducted a 2-year observational study at a specialized clinic in a tertiary care hospital. One hundred fifty-six subjects with coronary disease were enrolled in an intensive pharmacological management and lifestyle measures (including counseling and exercise training) program designed to reach specific targets. The main outcome measures were carotid intima media thickness and plaque area; brachial artery flow-mediated dilation; nitroglycerin-mediated dilation; flow-mediated dilation-nitroglycerin-mediated dilation ratio; laboratory parameters including lipids, glucose, creatinine, and homocysteine; and physical fitness. RESULTS: At completion, there were improvements in lipids and physical fitness. There were no overall changes in flow-mediated dilation, nitroglycerin-mediated dilation, or carotid intima media thickness in the entire cohort. However, multivariate logistic regression showed that dietary and exercise variables, such as increasing fiber intake and reducing body weight and body fat percentage, were independent predictors of improvements in endothelial function and carotid plaque burden. CONCLUSIONS: Even in the setting of intensive pharmacological therapy, lifestyle interventions, including exercise training and dietary changes, are important determinants of improved endothelial function and atherosclerosis.