What is the clinical evidence from this study?

Study design: RCT. Population: Type 2 diabetes mellitus (n=48). Intervention: Supervised exercise training vs. Standard treatment. Primary outcome: Myocardial early diastolic tissue velocity (Ea) (p=0.85).

September 26, 2007Open Access

Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes

Key Result

A 12-month supervised exercise training program did not significantly improve myocardial early diastolic tissue velocities in men with Type 2 diabetes compared to standard care (p = 0.85), despite improvements in exercise capacity and glycemic control.

Study Design

Type

RCT (n=48)

Blinding

Single-blind

Randomization

Randomized

Structured PICO

Does supervised exercise training improve myocardial diastolic function in men with Type 2 diabetes without ischemic heart disease?

Population

48 middle-aged men with recently diagnosed Type 2 diabetes and no ischemic heart disease, randomized to a 12-month supervised exercise program or standard care.

Intervention

Supervised exercise training four times a week added to standard therapy for 12 months.

Comparator

Standard treatment alone for 12 months.

Outcome

Myocardial diastolic function assessed by Tissue Doppler Imaging (TDI), specifically average maximal mitral annular early (Ea) diastolic velocity.surrogate

A 12-month supervised exercise training program in men with Type 2 diabetes improved exercise capacity, glycemic control, and blood pressure, but did not significantly improve myocardial diastolic tissue velocities.

Main Result

Absolute Event Rate: 7.9% vs 7.8%

p-value: p=0.85

Limitations

The change in systolic blood pressure was moderate and smaller than typically achieved by medical therapy.
Food diaries were not used and consumption of saturated fats was not known.
The 12-month training period may have been too short to reverse structural diastolic impairment.

Abstract

BACKGROUND: Myocardial diastolic tissue velocities are reduced already in newly onset Type 2 diabetes mellitus (T2D). Poor disease control may lead to left ventricular (LV) systolic dysfunction and heart failure. The aim of this study was to assess the effects of exercise training on myocardial diastolic function in T2D patients without ischemic heart disease. METHODS: 48 men (52.3 +/- 5.6 yrs) with T2D were randomized to supervised training four times a week and standard therapy (E), or standard treatment alone (C) for 12 months. Glycated hemoglobin (HbA1c), oxygen consumption (VO2max), and muscle strength (Sit-up) were measured. Tissue Doppler Imaging (TDI) was used to determine the average maximal mitral annular early (Ea) and late (Aa) diastolic as well as systolic (Sa) velocities, systolic strain (epsilon) and strain rate (epsilon) from the septum, and an estimation of left ventricular end diastolic pressure (E/Ea). RESULTS: Exercise capacity (VO2max, E 32.0 to 34.7 vs. C 32.6 to 31.5 ml/kg/min, p = .001), muscle strength (E 12.7 to 18.3 times vs. C 14.6 to 14.7 times, p < .001), and HbA1c (E 8.2 to 7.5% vs. C 8.0 to 8.4%, p = .006) improved significantly in the exercise group compared to the controls (ANOVA). Systolic blood pressure decreased in the E group (E 144 to 138 mmHg vs. C 146 to 144 mmHg, p = .04). Contrary to risk factor changes diastolic long axis relaxation did not improve significantly, early diastolic velocity Ea from 8.1 to 7.9 cm/s for the E group vs. C 7.4 to 7.8 cm/s (p = .85, ANOVA). Likewise, after 12 months the mitral annular systolic velocity, systolic strain and strain rate, as well as E/Ea were unchanged. CONCLUSION: Exercise training improves endurance and muscle fitness in T2D, resulting in better glycemic control and reduced blood pressure. However, myocardial diastolic tissue velocities did not change significantly. Our data suggest that a much longer exercise intervention may be needed in order to reverse diastolic impairment in diabetics, if at all possible.

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