The relationship between cardiovascular risk factors and cardiovascular fitness and physical activity in patients with T2DM and prediabetes

Abstract Introduction Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are known to be associated with several adverse cardiovascular disease (CVD) risk factors, including hypertension, obesity, central obesity, hyperinsulinemia and serum lipid and lipoprotein abnormalities. Despite reduced exercise capacity is a strong predictor of CVD mortality in subjects with T2DM, there is limited evidence about the relation between CVD risk, exercise capacity and physical activity (PA). Objective The aim of the study was to investigate CVD risk factors and cardiovascular fitness and physical activity (PA) in patients with T2DM and prediabetes. Methods Prediabetes is defined as IGT. Patients with heart failure and history of CVD events last two years were excluded. The total number of coronary artery disease (CAD) risk factors was defined as the number of the following that were present: advanced age (45 for men, 55 for women), hypercholesterolemia, hypertension, diabetes mellitus (DM), family history of CAD, and tobacco use. SCORE2 that is a new algorithm validated to predict 10-year risk of first-onset CVD in European populations was also used. Cardiovascular fitness was determined by cardiopulmonary exercise test (CPET) and incremental shuttle walking test (ISWT). PA and energy consumption (metabolic equivalent-METs) during PA and exercise tests were measured using SenseWear Armband activity monitor. Results Twenty-six patients (T2DM: 16 patients, prediabetes: 10 patients) were included in the study. The median age of participants were 49.5 (39-58) years. The median CAD risk factors were 3 (2-6), the median 10 year CVD risk were 3 (1-8) according to SCORE2 algorithm. The number CAD risk factors was significantly related with mean METs during ISWT (r=-0.469, p=0.032), mean METs during one-week (r=-0.476, p=0.022), ∆glucose during ISWT (r=0.532, p=0.011), time to reach anaerobic threshold during CPET (r=-0.442, p=0.024). Conclusion As the CAD risk factors increase, energy consumption during maximal exercise performance and daily PA decrease, resulting greater decline in glucose levels and early transition to anaerobic metabolism in patients with T2DM and prediabetes. These findings express the importance of individualized exercise training for decreasing CVD risk in these patient population during cardiac rehabilitation programmes.