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April 8, 2026Healthcare0 citationsOpen Access

Complexity of Cardiovascular Regulation and Its Association with Physical and Cardiorespiratory Fitness in Men with Type 2 Diabetes Mellitus

ÉSÉtore De F. SigniniRARAPHAEL MARTINS DE ABREUACAlex Castro

Key Result

Physical and cardiorespiratory fitness variables correlated positively with cardiovascular regulation complexity in healthy controls (r=0.354-0.548, p≤0.047) but not in men with T2DM.

Key Points

  • To explore the relationship between cardiovascular regulation complexity (CRC) and physical and cardiorespiratory fitness in men, highlighting differences related to type 2 diabetes mellitus (T2DM).
  • Divided sixty-eight men into T2DM and control groups based on diabetes status.
  • Conducted cardiovascular data collection and cardiopulmonary exercise tests using a cycle ergometer.
  • Calculated peak oxygen consumption and relative peak power to analyze their correlation with CRC indices.
  • In the control group, significant positive correlations between relative peak oxygen consumption and CRC indices from heart period series were observed.
  • No significant correlations were found in the T2DM group.
  • Correlations with systolic arterial pressure series were not significant for either group, indicating differing cardiovascular behaviors.

Study Design

Type

Cross-Sectional (n=68)

Structured PICO

Does the relationship between physical and cardiorespiratory fitness and cardiovascular regulation complexity differ in men with type 2 diabetes mellitus compared to healthy controls?

P
Population
68 men, equally divided into a Type 2 Diabetes Mellitus group (n=34, mean age 57 ± 6 years, BMI 28.4 ± 3.1 kg/m2) and a control group (n=34, mean age 52 ± 5 years, BMI 25.1 ± 2.8 kg/m2).
I
Intervention
Assessment of physical and cardiorespiratory fitness (relative peak power and peak oxygen consumption) via cardiopulmonary exercise test on a cycle ergometer
C
Comparator
Healthy control group without Type 2 Diabetes Mellitus
O
Outcome
Correlation between physical/cardiorespiratory fitness (W/kgPEAK and VO2PEAK) and cardiovascular regulation complexity (CRC) indices (Shannon entropy, complexity index, normalized complexity index, and sample entropy from heart period and systolic arterial pressure series)surrogate

Type 2 diabetes mellitus appears to blunt the normal positive relationship between cardiorespiratory fitness and cardiovascular regulation complexity seen in healthy individuals.

Main Result

Effect estimate: r = 0.354 to 0.548

p-value: p=0.001 ≤ p ≤ 0.047

Limitations

  • Small sample size

Abstract

Background/Objectives: Cardiovascular regulation complexity (CRC) is an underexplored health marker in the context of type 2 diabetes mellitus (T2DM). Additionally, associating CRC with physical and cardiorespiratory fitness variables could provide greater insight into how physical conditioning impacts cardiovascular health in the context of T2DM. This study aims to investigate whether the relationship between physical and cardiorespiratory fitness and CRC differs according to the presence or absence of T2DM. Methods: Sixty-eight men were equally divided into the T2DM group (T2DMG; 57 ± 6 years old and 28.4 ± 3.1 kg/m2) and the control group (CG; 52 ± 5 years old and 25.1 ± 2.8 kg/m2). Participants underwent a resting cardiovascular data collection and a cardiopulmonary exercise test on a cycle ergometer. For each group, the relative peak power (W/kgPEAK) and peak oxygen consumption (VO2PEAK) were correlated with the CRC indices, namely, Shannon entropy, the complexity index, the normalized complexity index, and the sample entropy from heart period (HP) and systolic arterial pressure (SAP) series. A partial correlation was performed for each group, controlling for age, physical activity level, and metabolic cart. Results: Only the CG showed positive and significant correlations between relative VO2PEAK and W/kgPEAK and CRC indices derived from the HP series (0.354 ≤ r ≤ 0.548 and 0.001 ≤ p ≤ 0.047). Correlations with the SAP series were not significant, regardless of the groups. Conclusions: In this sample, there was no positive relationship between physical and cardiorespiratory fitness variables and CRC indices among individuals with T2DM. Further large sample studies are needed to elucidate the factors involved in T2DM that impact CRC.

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Cite This Study

Signini et al. (2026) conducted a cross-sectional in Type 2 Diabetes Mellitus (n=68). Physical and cardiorespiratory fitness vs. Control group (men without T2DM) was evaluated on Correlation between physical/cardiorespiratory fitness and cardiovascular regulation complexity (CRC) indices (r = 0.354 to 0.548, p=0.001 ≤ p ≤ 0.047). Physical and cardiorespiratory fitness variables correlated positively with cardiovascular regulation complexity in healthy controls (r=0.354-0.548, p≤0.047) but not in men with T2DM.

synapsesocial.com/papers/69d5f0d774eaea4b11a7a36bhttps://doi.org/10.3390/healthcare14070940
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