Abstract
(1) Background: Physical activity is recommended in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to reduce hyperglycemia and cardiovascular risk. Effective aerobic exercise intensity, however, is not well defined. (2) Methods: 60 consecutive patients performed cardiopulmonary exercise testing (CPX) of 30 min duration targeting a respiratory exchange ratio (RER) between 0.85 and 0.95, being strictly aerobic. Plasma glucose (PG) was measured before and after CPX as well as one and two h after exercise. Maximum exercise intensity was evaluated using a standard bicycle exercise test. (3) Results: 50 patients completed the protocol (62 ± 10 years, BMI (body mass index) 30.5 ± 4.9 kg/m2, HbA1c (glycated haemoglobin) 6.9 ± 0.8%, left ventricular ejection fraction 55 ± 8%). Aerobic exercise capacity averaged at 32 ± 21 Watt (range 4–76 Watt) representing 29.8% of the maximum exercise intensity reached. PG before and after CPX was 9.3 ± 2.2 and 7.6 ± 1.7 mmol/L, respectively (p < 0.0001). PG was further decreased significantly at one and two h after exercise to 7.5 ± 1.6 mmol/L and 6.0 ± 1.0 mmol/L, respectively (p < 0.0001 for both as compared to PG before CPX). (4) Conclusions: Aerobic exercise capacity is very low in patients with CAD and T2DM. Exercise at aerobic intensity allowed for significant reduction of plasma glucose. Individual and effective aerobic exercise prescription is possible by CPX.
Highlights
According to guidelines and position statements, patients with type 2 diabetes mellitus (T2DM) should be advised to be physically active in order to decrease both hyperglycemia and their cardiovascular risk [1,2,3]
Exercise intensity should be tailored to the individual patient as high-intensity physical activity is able to prevent metabolic syndrome in healthy elderly people [22] and to reduce fasting glucose in younger and very fit patients with T2DM [18]
As to the best of our knowledge, aerobic exercise intensity has not been evaluated in patients with T2DM and concomitant coronary artery disease (CAD)
Summary
According to guidelines and position statements, patients with type 2 diabetes mellitus (T2DM) should be advised to be physically active in order to decrease both hyperglycemia and their cardiovascular risk [1,2,3]. A moderate- to vigorous-intensity aerobic activity is recommended [1,2,3] It is proposed, that “greater exercise intensities tend to yield even greater benefits in HbA1c and aerobic capacity” [4] or that “higher levels of exercise intensity are associated with greater improvements in A1C and fitness” [1,5]. That “greater exercise intensities tend to yield even greater benefits in HbA1c and aerobic capacity” [4] or that “higher levels of exercise intensity are associated with greater improvements in A1C and fitness” [1,5] These recommendations are given for patients with T2DM without known coronary artery disease (CAD) [1,4,5]. Did not reduce PG in this small cohort [6]
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