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Diabetes T2 – Reduces risk of cardiovascular complications

Evidence summary (Updated 2022)

Those with type 2 diabetes have lower fitness levels than those without [1]. Observational studies have shown that regular exercise is associated with improved fitness and lower risk of all-cause and CV mortality in those with type 2 diabetes ?[2-5].
A more recent systematic review which analysed 10 randomised controlled trials showed that high intensity interval training can improve cardiovascular fitness, however, caution is advised to avoid a sudden increase in level of physical activity due to increased risk of cardiovascular death [6]. HIIT training has showed a cardiac protective role in diabetic patients by reducing cardiac output by 21%, stroke volume by 13%, heart rate by 9% and improves left ventricular function by improving left ventricular filling and emptying during exercise [7]. Aerobic exercise and/or a higher intensity exercise will lead to improvement in the quality of life of heart failure patients with T2DM [8]. Exercise also improves inflammatory profile, helps to lower LDL cholesterol and can prevent deterioration in LDL and total cholesterol profile [9].

Quality of Evidence
Grade A – High Quality

Strength of recommendation
Grade 1 – Strong recommendation

Recent evidence review has strengthened the evidence that physical activity in particular high intensity exercise such as HIIT has shown an overall improvement in cardiac function in diabetic patients, thereby reducing complications related to the heart. However, caution is advised to avoid a sudden increase in level of physical activity due to increased risk of cardiovascular death.

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[2] Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus. Diabetologia. 2003 Aug;46(8):1071-81.
[3] Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis Diabetes Care. 2011 May;34(5):1228-37.
[4] Gregg EW, Gerzoff RB, Caspersen CJ, Williamson DF, Narayan KM. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med. 2003 Jun 23;163(12):1440-7.
[5] Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, Tjønneland A, Overvad K, Ostergaard JN, Amiano P, Ardanaz E, Bendinelli B, Pala V, Tumino R, Ricceri F, Mattiello A, Spijkerman AM, Monninkhof EM, May AM, Franks PW, Nilsson PM, Wennberg P, Rolandsson O, Fagherazzi G, Boutron-Ruault MC, Clavel-Chapelon F, Castaño JM, Gallo V, Boeing H, Nöthlings U. Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis. Arch Intern Med. 2012 Sep 24;172(17):1285-95.
[6] Lora-Pozo I, Lucena-Anton D, Salazar A, Galán-Mercant A, Moral-Munoz JA. Anthropometric, Cardiopulmonary and Metabolic Benefits of the High-Intensity Interval Training Versus Moderate, Low-Intensity or Control for Type 2 Diabetes: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Nov 15;16(22):4524. doi: 10.3390/ijerph16224524. PMID: 31731764; PMCID: PMC6887993.
[7] Suryanegara J, Cassidy S, Ninkovic V, Popovic D, Grbovic M, Okwose N, Trenell MI, Mac- Gowan GG, Jakovljevic DG. High intensity interval training protects the heart during increase metabolic demand in patients with type 2 diabetes: a randomised controlled trial. Acta Diabetol. 2019 Mar;56(3):321-329. doi: 10.1007/s00592-018-1245-5. Epub 2018 Nov 1. PMID: 30387015; PMCID: PMC6394729

[8] Sargeant, J.A., Yates, T., McCann, G.P., Lawson, C.A., Davies, M.J., Gulsin, G.S. and Hen- son, J., 2018. Physical activity and structured exercise in patients with type 2 diabetes mellitus and heart failure. Practical Diabetes, 35(4), pp.131-138b.

[9] Magalhaes JP, Santos DA, Correia IR, Hetherington-Rauth M, Ribeiro R, Raposo JF, Matos A, Bicho MD, Sardinha LB: Impact of combined training with different exercise intensities on inflammatory and lipid markers in type 2 diabetes; a secondary analysis from a 1-year randomised con- trolled trial. Cardiovasc Diabetol (2020) 19:169.