Diabetes Metab J.  2014 Dec;38(6):439-448. 10.4093/dmj.2014.38.6.439.

Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes

• Jung JY
• Min KW
• Ahn HJ
• Kwon HR
• Lee JH
• Park KS
• Han KA

• KMID: 2174081
• DOI: http://doi.org/10.4093/dmj.2014.38.6.439

Abstract

BACKGROUND
Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication.
METHODS
A total of 35 women with type 2 diabetes (body mass index, 26.6+/-2.8 kg/m2; age, 56.4+/-1.9 years; duration of diabetes, 4.7+/-4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K(ITT)), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program.
RESULTS
The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA.
CONCLUSION
Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.

Keyword

Abdominal fat; Augmentation index; Diabetes mellitus, type 2; Moderate aerobic exercise; Vascular stiffness

MeSH Terms

Abdominal Fat
Atherosclerosis
Diabetes Complications
Diabetes Mellitus, Type 2
Energy Intake
Energy Metabolism*
Exercise*
Female
Humans
Insulin
Insulin Resistance*
Intra-Abdominal Fat
Metabolic Equivalent
Motor Activity*
Subcutaneous Fat
Vascular Stiffness*
Insulin

Figure

• 

  Fig. 1 Change in body weight and abdominal fat after 3 months intervention among two groups. BMI, body mass index; TFA, total fat area; VFA, visceral fat area; SFA, subcutaneous fat area; CG, control group; AEG, aerobic exercise group. aP<0.05 from independent t-test.

• 

  Fig. 2 Change in augmentation index 75% (AIx@75), aerobic capacity and physical activity energy expenditure (PAEE) after 3 months intervention among two groups. AEG, aerobic exercise group; CG, control group; AC, aerobic capacity. aP<0.05 from independent t-test.

• 

  Fig. 3 Correlation between physical activity energy expenditure (PAEE), aerobic capacity (AC), and augmentation index 75% (AIx@75).

Reference

1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M. Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 27 million participants. Lancet. 2011; 378:31–40.

2. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001; 44:Suppl 2. S14–S21.

3. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993; 16:434–444.

4. Alexander CM, Landsman PB, Teutsch SM, Haffner SM. Third National Health and Nutrition Examination Survey (NHANES III). National Cholesterol Education Program (NCEP). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003; 52:1210–1214.

5. O'Brien MJ, Alos VA, Davey A, Bueno A, Whitaker RC. Acculturation and the prevalence of diabetes in US Latino Adults, National Health and Nutrition Examination Survey 2007-2010. Prev Chronic Dis. 2014; 11:E176.

6. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002; 106:2085–2090.

7. Hope SA, Tay DB, Meredith IT, Cameron JD. Use of arterial transfer functions for the derivation of aortic waveform characteristics. J Hypertens. 2003; 21:1299–1305.

8. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M. CAFE Investigators. Anglo-Scandinavian Cardiac Outcomes Trial Investigators. CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006; 113:1213–1225.

9. Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, Giugliano D. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003; 289:1799–1804.

10. Kingwell BA, Cameron JD, Gillies KJ, Jennings GL, Dart AM. Arterial compliance may influence baroreflex function in athletes and hypertensives. Am J Physiol. 1995; 268(1 Pt 2):H411–H418.

11. DeSouza CA, Shapiro LF, Clevenger CM, Dinenno FA, Monahan KD, Tanaka H, Seals DR. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation. 2000; 102:1351–1357.

12. Bonora E, Moghetti P, Zancanaro C, Cigolini M, Querena M, Cacciatori V, Corgnati A, Muggeo M. Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies. J Clin Endocrinol Metab. 1989; 68:374–378.

13. Izzo JL Jr. Pulse contour analysis and augmentation index: it's time to move beyond cuff blood pressure measurement. Am J Hypertens. 2005; 18(1 Pt 2):1S–2S.

14. Kumahara H, Schutz Y, Ayabe M, Yoshioka M, Yoshitake Y, Shindo M, Ishii K, Tanaka H. The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry. Br J Nutr. 2004; 91:235–243.

15. Borkan GA, Gerzof SG, Robbins AH, Hults DE, Silbert CK, Silbert JE. Assessment of abdominal fat content by computed tomography. Am J Clin Nutr. 1982; 36:172–177.

16. Lee JH, Hwang BY, Nam SN. The change of post treadmill exercise on blood pressure and vascular compliance in essential hypertension patients. Korean J Phys Educ. 2004; 43:511–520.

17. Lee JH. Effects of aerobic exercise on arterial pulse wave velocity and vessel pressure in patients with anti-hypertensives agents [master's thesis]. Seoul: Hanyang University;2005.

18. Mustata S, Groeneveld S, Davidson W, Ford G, Kiland K, Manns B. Effects of exercise training on physical impairment, arterial stiffness and health-related quality of life in patients with chronic kidney disease: a pilot study. Int Urol Nephrol. 2011; 43:1133–1141.

19. Stewart KJ, Sung J, Silber HA, Fleg JL, Kelemen MD, Turner KL, Bacher AC, Dobrosielski DA, DeRegis JR, Shapiro EP, Ouyang P. Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens. 2004; 17:314–320.

20. Gielen S, Schuler G, Adams V. Cardiovascular effects of exercise training: molecular mechanisms. Circulation. 2010; 122:1221–1238.

21. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006; 27:2588–2605.

22. Lee JI, Sohn TS, Kwon HS, Lee JM, Chang SA, Cha BY, Son HS. The changes of central aortic pulse wave analysis in metabolic syndrome. Korean Diabetes J. 2008; 32:522–528.

23. Wilkinson IB, MacCallum H, Rooijmans DF, Murray GD, Cockcroft JR, McKnight JA, Webb DJ. Increased augmentation index and systolic stress in type 1 diabetes mellitus. QJM. 2000; 93:441–448.

24. Jung JY, Han KA, Ahn HJ, Kwon HR, Lee JH, Park KS, Min KW. Effects of aerobic exercise intensity on abdominal and thigh adipose tissue and skeletal muscle attenuation in over-weight women with type 2 diabetes mellitus. Diabetes Metab J. 2012; 36:211–221.

25. Short KR, Vittone JL, Bigelow ML, Proctor DN, Rizza RA, Coenen-Schimke JM, Nair KS. Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes. 2003; 52:1888–1896.

26. DiPietro L, Dziura J, Yeckel CW, Neufer PD. Exercise and improved insulin sensitivity in older women: evidence of the enduring benefits of higher intensity training. J Appl Physiol (1985). 2006; 100:142–149.

27. Ka SH. The impact of aquarobics on the body composition and vascular compliance of middle-aged obese women [dissertation]. Daejeon: Chungnam National University;2006.

28. Kim TS, Seo YY, Lee SH, Hong YH, Kim DY, Won HS, Yang MS, Shin HH. Correlation between pulse wave velocity and cardiovascular risk factors in Korean women. J Korean Soc Lipidol Atheroscler. 2008; 18:239–246.

29. Mackey RH, Sutton-Tyrrell K, Vaitkevicius PV, Sakkinen PA, Lyles MF, Spurgeon HA, Lakatta EG, Kuller LH. Correlates of aortic stiffness in elderly individuals: a subgroup of the Cardiovascular Health Study. Am J Hypertens. 2002; 15(1 Pt 1):16–23.

30. Despres JP. Abdominal obesity as important component of insulin-resistance syndrome. Nutrition. 1993; 9:452–459.

31. Dekker MJ, Lee S, Hudson R, Kilpatrick K, Graham TE, Ross R, Robinson LE. An exercise intervention without weight loss decreases circulating interleukin-6 in lean and obese men with and without type 2 diabetes mellitus. Metabolism. 2007; 56:332–338.

32. Vaitkevicius PV, Fleg JL, Engel JH, O'Connor FC, Wright JG, Lakatta LE, Yin FC, Lakatta EG. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation. 1993; 88(4 Pt 1):1456–1462.

33. Yoon ES, Jung SJ, Jae SY. Association between cardiorespiratory fitness and arterial stiffness in older women. Exerc Sci. 2009; 18:307–316.

34. Chandler MP, DiCarlo SE. Acute exercise and gender alter cardiac autonomic tonus differently in hypertensive and normotensive rats. Am J Physiol. 1998; 274(2 Pt 2):R510–R516.

35. Shen W, Zhang X, Zhao G, Wolin MS, Sessa W, Hintze TH. Nitric oxide production and NO synthase gene expression contribute to vascular regulation during exercise. Med Sci Sports Exerc. 1995; 27:1125–1134.

36. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000; 132:552–555.

37. Poirier P, Garneau C, Bogaty P, Nadeau A, Marois L, Brochu C, Gingras C, Fortin C, Jobin J, Dumesnil JG. Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol. 2000; 85:473–477.

38. Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG. American Diabetes Association. North American Association for the Study of Obesity. American Society for Clinical Nutrition. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care. 2004; 27:2067–2073.

39. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006; 29:1433–1438.