Objective. To identify the effects of a one-year exercise intervention on myocardial dysfunction in patients with type 2 diabetes (T2DM).
Design. Randomised control trial – The Diabetes Lifestyle Intervention Study.
Setting. University Hospital.
Patients. 223 T2DM patients without occult coronary artery disease, aged 18-75 were randomised to an exercise training (n=111) or a usual care group (n=112). Complete follow-up data was available in 176 (88 exercise, 88 usual care).
Interventions. Exercise training consisted of gym- followed by telephone-monitored home-based exercise training.
Main Outcome Measures. Tissue Doppler-derived myocardial velocities, strain-rate and strain, body composition, glycated haemoglobin (HbA1c), maximum oxygen consumption (VO2max) and physical activity.
Results. Changes in myocardial function were not different between groups despite improvements in waist circumference, fat mass, blood glucose, HbA1c, insulin sensitivity, VO2max and 6 minute walk distance in the intervention group (p<0.05). The latter also spent significantly more time in vigorous activity (p<0.05). Intervention patients who spent more time in both moderate and vigorous activity showed a significant improvement in myocardial tissue velocity (p<0.01), HbA1c (p=0.03) and VO2max (p=0.03) compared to controls. Myocardial strain rate (p=0.03) and HbA1c improved in intervention patients with the greatest increase in moderate activity (p=0.03).
Conclusions. In patients with T2DM, current exercise recommendations led to an improvement in metabolic function, but failed to improve myocardial function. Patients with increases in both moderate and vigorous activity showed improvements in myocardial function, glycaemic control and cardiorespiratory fitness.
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