两年抗阻运动对糖尿病前期患者心血管疾病风险的影响

目的:探讨2年的抗阻运动和有氧运动对糖尿病前期患者心血管疾病风险的影响。方法:选取2014年1—4月在南京中医药大学附属中西医结合医院以及2014年5—12月在丹阳市人民医院和广西医科大学第一附属医院就诊的糖尿病前期患者共248例,随机数字表法将248例患者随机分为3组:抗阻运动组(RT组)82例,有氧运动组(AT组)83例和对照组83例。AT组、RT组干预24个月后,比较各组患者在基线以及第12个月和第24个月时的血糖、血脂等指标。结果:随着干预时间的延长,RT组和AT组患者糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、血压和稳态模型2胰岛素抵抗指数(HOMA2-IR)趋于降低,稳态模型2β细胞功能指数(HOMA2-β)趋于增高。24个月时,RT组和AT组患者HbA1c[5.80(5.43,6.20)%、5.70(5.50,6.00)%比6.20(5.70,6.60)%,P值均≤0.01],LDL-C[3.07(2.69,3.58)mmol/L、2.97(2.62,3.95)mmol/L比3.21(2.54,3.78)mmol/L,P值均<0.05]和HOMA2-IR[0.96(0.82,1.47)、1.20(0.99,1.43)比1.34.(1.09,1.51),P值均<0.05]均明显低于对照组,而HOMA2-β[84.50(60.55,107.33)、93.00(78.60,119.75)比53.40(37.70,80.40),P值均=0.001]则高于对照组,而甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)运动干预组与对照组之间差异无统计学意义(P值均>0.05)。校正年龄、性别、血压后,干预后RT组(P=0.017)和AT组(P=0.018)的糖尿病前期心血管风险显著降低。校正年龄、性别、他汀类药物治疗、体重指数、腰臀围比后,Cox回归显示抗阻运动(HR=0.419,95%CI=0.415~0.942,P=0.037)和有氧运动(HR=0.310,95%CI=0.447~0.866,P=0.026)为糖尿病前期心血管疾病保护因子,分别降低了糖尿病前期患者58.1%和69.0%的心血管疾病风险。结论:24个月有氧和抗阻运动可改善血糖控制和糖尿病前期患者HOMA2-IR。抗阻运动能够降低心血管疾病风险,对于没有明显运动禁忌证的糖尿病前期患者,抗阻运动是值得推荐的运动方式。     

Comparing the effects of 12 months aerobic exercise and resistance training on glucose metabolism among prediabetes phenotype: A explorative randomized controlled trial

AimsThe pathophysiology of each phenotype of prediabetes is unique that promotes different levels of diabetes and cardiovascular disease risks. Exercise guidelines for individuals with prediabetes including both aerobic and resistance training could improve metabolic control, but its effects on different prediabetes subtypes are unclear. The aim of this explorative randomized controlled trial was to evaluate the effects of aerobic training (AT) or resistance training (RT) on glucose metabolism and lipid profile by different prediabetes subtypes with.MethodsA randomized controlled trial in which 128 individuals with isolated impaired fasting glucose (i-IFG; n = 39), isolated impaired glucose tolerance (i-IGT; n = 29), combined glucose tolerance (CGI; n = 27) and isolated elevated HbA_1c (n = 33) were randomly assigned to the control group, AT group and RT group, respectively. Supervised exercise training, including AT and RT were completed at moderate intensity for 60 min per day, three non-consecutive days per week for 12 months. The primary outcome was improvement in glucose metabolism. Secondary outcomes included measure of lipid profile and if these effects were moderated by the prediabetes phenotype.ResultsOf the initial 128 participants, 118 finished the study, but all participants were included in the intention-to-treat analyses. The improvement in 2 h postprandial plasma glucose (2 hPG) between group difference (AT vs. RT) at 12 months was 0.87 (95% CI, -1.59 to-0.16; p < 0.05). Compared with RT group, AT significantly decreased the 2hPG in participants with i-IGT at 12 months (-1.66, 95% CI -3.04 to -0.28; p < 0.05).ConclusionsAT program conferred benefits in improving 2 h PG and HbA_1c compared with RT for prediabetes. These findings may moderate by prediabetes phenotype, and AT appeared more effective in i-IGT. A future trial with large sample size and long time follow up of prediabetes phenotype groups are needed.     

Effects of a digital diabetes prevention program on cardiovascular risk among individuals with prediabetes

ObjectiveTo examine changes in cardiovascular disease (CVD) risk outcomes of overweight/obese adults with prediabetes.MethodsUsing data from a randomized control trial of digital diabetes prevention program (d‐DPP) with 599 participants. We applied the atherosclerotic CVD (ASCVD) risk calculator to predict 10-year CVD risk for d‐DPP and small education (comparison) groups. Between-group risk changes at 4 and 12 months were compared using a repeated measures linear mixed-effect model. We examined within-group differences in proportion of participants over time for specific CVD risk factors using generalized estimating equations.ResultsWe found no differences between baseline 10-year ASCVD risk. Relative to the comparison group, the d‐DPP group experienced greater reductions in predicted 10-year ASCVD risk at each follow-up visit and a significant group difference at 4 months (−0.96%; 95% confidence interval: −1.58%, −0.34%) (but not at 12 months). Additionally, we observed that the d‐DPP group experienced a decreased proportion of individuals with hyperlipidemia (18% and 16% from baseline to 4 and 12 months), high-risk total cholesterol (8% from baseline to 12 months), and being insufficiently active (26% and 22% from baseline to 4 and 12 months at follow-up time points.ConclusionsOur findings suggest that a digitally adapted DPP may promote the prevention of cardiometabolic disease among overweight/obese individuals with prediabetes. However, given the lack of maintenance of effect on ASCVD risk at 12 months, there may also be a need for additional interventions to sustain the effect detected at 4 months.     

Sex disparities in cardiovascular disease outcomes among geriatric patients with prediabetes

AimsTo analyze the sex-based differences in the prevalence of cardiovascular disease risk factors and outcomes in older patients with prediabetes using demographically matched national cohorts of hospitalized patients aged ≥65 years.MethodsWe queried the 2007–2014 National Inpatient Database to identify older patients (>65 years) admitted with prediabetes using ICD-9 Clinical Modification codes. The older patients were then subcategorized based on sex. Comparative analyses of their baseline characteristics, the prevalence of cardiovascular(CV) disease comorbidities, hospitalization outcomes, and mortality rates were performed on propensity-matched cohorts for demographics.ResultsA total of 1,197,978 older patients with prediabetes (599,223 males; mean age 75years and 598,755 females; mean age 76years) were identified. Higher admission rates were found commonly among older white males (84.1%) and females (81.7%). Prediabetic older males showed a higher frequency of cardiovascular comorbidities compared to females. Prediabetic older males had higher all-cause in-hospital mortality (4.2% vs. 3.6%, p < 0.001), acute myocardial infarction (7.0% vs. 4.7%, p < 0.001), arrhythmia (36.3% vs. 30.5%, p < 0.001), stroke (4.8% vs. 4.6%, p < 0.001), venous thromboembolism (3.3% vs. 3.0%, p < 0.001) and percutaneous coronary intervention (3.1% vs. 1.5%, p < 0.001) compared to females.ConclusionsOur analysis revealed that among older patients hospitalized with prediabetes, males suffered worse in-hospital CV outcomes and survival rates compared to females.     

Effects of resistance training on sarcopenic obesity index in older women: A randomized controlled trial

The purpose of this study was to examine the effects of resistance training (RT) on sarcopenic obesity (SO) in older women. 243 older women underwent body composition measurement using dual-energy X-ray absorptiometry, and the SO index was calculated. This randomized controlled trial adopted from the baseline sample, 113 volunteers (67.0 ± 5.2 years) were randomly assigned to a control group (CG, n = 64) or an experimental group (EG, n = 69). The EG took part in a 24-week RT program, conducted three times per week. Body composition measurements were repeated at the end of the training program. RT induced a significant increase in fat-free mass (P < 0.01), but not decrease in fat mass in the EG. Moreover, the SO index was also significantly improved in the EG (P < 0.01), while it decreased significantly in the CG (P < 0.01). It is concluded that RT is an effective approach to promote body composition alterations in older women, and it might improve SO-related phenotypes.     

Effects of aerobic or resistance exercise training on cardiovascular autonomic function of subjects with type 2 diabetes: A pilot study

Background and aims

Both aerobic (AER) and resistance (RES) training improve metabolic control in patients with type 2 diabetes (T2DM). However, information on the effects of these training modalities on cardiovascular autonomic control is limited. Our aim was to compare the effects of AER and RES training on cardiovascular autonomic function in these subjects.

Association of myeloperoxidase with cardiovascular disease risk factors in prediabetic subjects

IntroductionPrediabetes is a chronic low-grade inflammatory disease and considered as a risk factor for the development of diabetes mellitus and cardiovascular disease. Myeloperoxidase (MPO) is a leukocyte-derived enzyme, linked to both oxidative stress and inflammation and has been proposed as a possible mediator of atherosclerosis, the major cause of cardiovascular disease. The objective of the present study was to evaluate the level of MPO in prediabetic subjects and correlate it with other cardiovascular disease risk factors.Materials and methodsIn this cross-sectional study, a total of 400 subjects were recruited. Of them, 200 were prediabetic subjects and 200 were age and gender-matched controls. For each subject, blood pressure, weight, height, waist circumference, hip circumference and lipid parameters were measured. In addition, MPO was determined.ResultsMPO was significantly increased in prediabetic subjects as compared to controls. In correlation analysis, MPO was found to be significantly and positively correlated with all the cardiovascular disease risk factors i.e. age, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure [both systolic blood pressure (SBP) and diastolic blood pressure (DBP)], lipid parameters except high density lipoprotein (HDL) to which it was negatively correlated.ConclusionIn conclusion, MPO is well correlated with cardiovascular disease risk factors in prediabetes. Hence, MPO could be used to detect cardiovascular risk among prediabetic subjects and also can be used as an early biomarker of oxidative stress and inflammation in prediabetes.     

Exercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial

AimsTo test the Diabetes College Brazil Study feasibility, the acceptability of study interventions and their preliminary effectiveness, and describe the study protocol modifications due to the COVID-19 pandemic.MethodsSingle-center, double-blinded pilot randomized trial with two parallel groups, Exercise and Lifestyle Education (ExLE; 12-week exercise and educational interventions) and Exercise (Ex; 12-week exercise intervention only) involving patients with prediabetes or diabetes. Feasibility (eligibility, recruitment, retention, completeness of variables measures and participation rates), acceptability (satisfaction), and preliminary effectiveness of interventions (variables: functional capacity, physical activity (PA), exercise self-efficacy, diabetes knowledge, health literacy, adherence to Mediterranean food pattern, glycated hemoglobin (HbA1c), anthropometric measures, cardiac autonomic control, depression, and quality of life (QofL)).ResultsEligibility, recruitment, retention, participation in exercise sessions, and education classes rates were 17%, 93%,82%, 76%, and 71%, respectively. Missing data in the post-intervention assessment (PA, HbA1c, cardiac autonomic control, anthropometric measures, depression, and QofL) were mainly related to research procedure modifications. The interventions were highly acceptable, and most variables improved farther in the ExLE, with moderate effect sizes for PA, diabetes knowledge, health literacy, cardiac autonomic control, and QofL.ConclusionsThe Diabetes College Brazil Study is feasible, and the ExLE may benefit Brazilians living with prediabetes and diabetes.     

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AimAim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes.Data synthesisThis metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing ‘no exercise’ as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (?0.3 [-0.1;-0.4]%, ?1.44 [-2.22, ?0.66]%, and ?5.6 [-9.5, ?1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, ?0.4 [-0.6;-0.3], ?0.2 [-0.4;-0.1], and ?0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise.ConclusionsPhysical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.     

Multiple-modality exercise and mind-motor training to improve cardiovascular health and fitness in older adults at risk for cognitive impairment: A randomized controlled trial

BackgroundThe effects of multiple-modality exercise on arterial stiffening and cardiovascular fitness has not been fully explored.ObjectivesTo explore the influence of a 24-week multiple-modality exercise program associated with a mind-motor training in cardiovascular health and fitness in community-dwelling older adults, compared to multiple-modality exercise (M2) alone.MethodsParticipants (n = 127, aged 67.5 [7.3] years, 71% females) were randomized to either M4 or M2 groups. Both groups received multiple-modality exercise intervention (60 min/day, 3 days/week for 24-weeks); however, the M4 group underwent additional 15 min of mind-motor training, whereas the M2 group received 15 min of balance training. Participants were assessed at 24-weeks and after a 28-week non-contact follow-up (52-weeks).Resultsat 52-weeks, the M4 group demonstrated a greater VO2max (ml/kg/min) compared to the M2 group (mean difference: 2.39, 95% CI: 0. 61 to 4.16, p = 0.009). Within-group analysis indicated that the M4 group demonstrated a positive change in VO2max at 24-weeks (mean change: 1.93, 95% CI: 0.82 to 3.05, p = 0.001) and 52-weeks (4.02, 95% CI: 2.71 to 5.32, p = 0.001). Similarly, the M2 group increased VO2max at 24-weeks (2.28, 95% CI: 1.23 to 3.32, p < 0.001) and 52-weeks (1.63, 95% CI: 0.43 to 2.83, p = 0.008). Additionally, the M2 group decreased 24 h SBP (mmHg) at 24-weeks (−2.31, 95% CI: −4.61 to −0.01, p = 0.049); whereas the M4 group improved 24 h DBP (−1.6, 95% CI: −3.03 to −0.17, p = 0.028) at 52-weeks.ConclusionMind-motor training associated with multiple-modality exercise can positively impact cardiovascular fitness to the same extent as multiple-modality exercise alone.     

Efficacy of IVRS-based mHealth intervention in reducing cardiovascular risk in metabolic syndrome: A cluster randomized trial

AimsEfficacy of mobile-phone based intervention for reducing cardiovascular risk in metabolic syndrome (MetSyn).MethodsWe screened adults 20–60 years in 10 villages in India for MetSyn using stratified cluster sampling. Lifestyle and biochemical risk factors were assessed. International Harmonized Criteria were used for diagnosis. Villages were randomized with 5 each in control and intervention groups. Interactive voice response system (IVRS) in Hindi was developed. In intervention clusters two messages for promotion of healthy lifestyle and medical treatment were broadcast daily over 12-months and risk factors reassessed.Results1012/1200(84%) persons were screened and MetSyn diagnosed in 286(28.3%). Villages were divided into 5 control(n = 136) and 5 intervention(n = 147) clusters. Baseline characteristics in both clusters were similar. Acceptability of intervention was >60% in 80% participants. At 12 months, significantly greater participants in intervention vs control clusters had healthier lifestyle (healthy diet 28.8vs14.7%, physical activity 25.9vs13.1%, tobacco 13.7vs32.5%), anthropometry (waist circumference 85.7 ± 6.3vs88.6 ± 14.0 cm, body mass index 21.9 ± 2.8vs23.1 ± 2.9 kg/m²), systolic BP 123.6 ± 7.7vs128.6 ± 14.1 mmHg, fasting glucose 95.6 ± 19.4vs109.4 ± 43.7 mg/dl, cholesterol 175.5 ± 36.5vs186.4 ± 43.3 mg/dl, and triglycerides 147.6 ± 48.3vs159.5 ± 60.7 mg/dl (p < 0.01). Prevalence of metabolic syndrome declined in intervention group by 22.3%vs3.9%, p < 0.001).ConclusionAn interactive voice response system based technology significantly reduced multiple cardiovascular risk factors and prevalence of metabolic syndrome.     

Concurrent resistance and aerobic training as protection against heart disease

Summary

This study was designed to compare the effects of aerobic and concurrent aerobic and resistance training on their ability to slow the rate of development and progression of coronary heart disease (CHD) in young adult males at low risk, as determined by the Framingham risk assessment (FRA) score. Subjects were assigned to 16 weeks of three-times weekly aerobic training (AT) (n = 13), concurrent aerobic and resistance training (CART) (n = 13) or no exercise (NO) (n = 12). Both AT and CART resulted in significant (p < 0.05) changes in total cholesterol (from 173.67 ± 29.93 to 161.75 ± 26.78 mg.dl^-1 and from 190.00 ± 38.20 to 164.31 ± 28.73 mg.dl^-1, respectively), smoking status (from 12.25 ± 5.08 to 10.33 ± 5.37 cigarettes per day and 12.00 ± 4.71 to 8.77 ± 5.10 cigarettes per day, respectively), high-density lipoprotein cholesterol (from 47.00 ± 11.85 to 57.50 ± 5.99 mg.dl^-1 and 34.00 ± 8.53 to 46.77 ± 14.32 mg.dl^-1, respectively), systolic blood pressure (from 126.17 ± 7.00 to 122.33 ± 3.17 mmHg and 131.54 ± 9.28 to 121.69 ± 7.87 mmHg, respectively) and therefore FRA score (from 3.58 ± 2.19 to 1.33 ± 2.27 and 5.77 ± 3.09 to 2.46 ± 2.90, respectively). Both modes of exercise were found to be equally effective in reducing CHD risk. These findings support the inclusion of resistance training into an aerobic training programme to lower CHD risk, which will afford subjects the unique benefits of each mode of exercise.     

Effects of endurance,circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake (V˙o2peak), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (−18 %), V˙o2peak (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (−11 %), V˙o2peak (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in V˙o2peak, mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.     

A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes

PURPOSE: To assess the efficacy of a pharmacist-led, primary care-based, disease management program to improve cardiovascular risk factors and glycated hemoglobin (A(1C)) levels in vulnerable patients with poorly controlled diabetes. METHODS: A randomized controlled trial of 217 patients with type 2 diabetes and poor glycemic control (A(1C) level >or=8.0%) was conducted at an academic general medicine practice from February 2001 to April 2003. Intervention patients received intensive management from clinical pharmacists, as well as from a diabetes care coordinator who provided diabetes education, applied algorithms for managing glucose control and decreasing cardiovascular risk factors, and addressed barriers to care. Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider. Outcomes were recorded at baseline and at 6 and 12 months. Primary outcomes included blood pressure, A(1C) level, cholesterol level, and aspirin use. Secondary outcomes included diabetes knowledge, satisfaction, use of clinical services, and adverse events. RESULTS: For the 194 patients (89%) with 12-month data, the intervention group had significantly greater improvement than did the control group for systolic blood pressure (-9 mm Hg; 95% confidence interval [CI]: -16 to -3 mm Hg) and A(1C) level (-0.8%; 95% CI: -1.7% to 0%). Change in total cholesterol level was not significant. At 12 months, aspirin use was 91% in the intervention group versus 58% among controls (P <0.0001). Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients. There were no significant differences in use of clinical services or adverse events. CONCLUSION: Our comprehensive disease management program reduced cardiovascular risk factors and A(1C) levels among vulnerable patients with type 2 diabetes and poor glycemic control.     

High protein diet leads to prediabetes remission and positive changes in incretins and cardiovascular risk factors

Background and aimsHigh Protein diets may be associated with endocrine responses that favor improved metabolic outcomes. We studied the response to High Protein (HP) versus High Carbohydrate (HC) Diets in terms of incretin hormones GLP-1 and GIP, the hunger hormone ghrelin and BNP, which is associated with cardiac function. We hypothesized that HP diets induce more pronounced release of glucose lowering hormones, suppress hunger and improve cardiac function.Methods and results24 obese women and men with prediabetes were recruited and randomized to either a High Protein (HP) (n = 12) or High Carbohydrate (HC) (n = 12) diet for 6 months with all food provided. OGTT and MTT were performed and GLP-1, GIP, Ghrelin, BNP, insulin and glucose were measured at baseline and 6 months on the respective diets.Our studies showed that subjects on the HP diet had 100% remission of prediabetes compared to only 33% on the HC diet with similar weight loss.HP diet subjects had a greater increase in (1) OGTT GLP-1 AUC(p = 0.001) and MTT GLP-1 AUC(p = 0.001), (2) OGTT GIP AUC(p = 0.005) and MTT GIP AUC(p = 0.005), and a greater decrease in OGTT ghrelin AUC(p = 0.005) and MTT ghrelin AUC(p = 0.001) and BNP(p = 0.001) compared to the HC diet at 6 months.ConclusionsThis study demonstrates that the HP diet increases GLP-1 and GIP which may be responsible in part for improved insulin sensitivity and β cell function compared to the HC diet. HP ghrelin results demonstrate the HP diet can reduce hunger more effectively than the HC diet. BNP and other CVRF, metabolic parameters and oxidative stress are significantly improved compared to the HC diet.Clinicaltrials.gov identifierNCT01642849.