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CLINICAL STUDY: EXERCISE TRAINING

The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes

Andrew Maiorana, MSc^* , Gerard O’Driscoll, FRACP , Craig Cheetham, BSc^*, Lawrence Dembo, MB, BS^*, Kim Stanton, FRACP^||, Carmel Goodman, FRACSP^*, Roger Taylor, FRACP and Daniel Green, PhD^*

^* Department of Human Movement and Exercise Science, The University of Western Australia, Crawley, Western Australia, Australia
Department of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
Department of Cardiology, Royal Perth Hospital and West Australian Heart Research Institute, Crawley, Western Australia, Australia
Cardiac Transplant Unit, Royal Perth Hospital and West Australian Heart Research Institute, Crawley, Western Australia, Australia
^|| Endocrinology and Diabetic Unit, Royal Perth Hospital and West Australian Heart Research Institute, Crawley, Western Australia, Australia

Manuscript received August 7, 2000; revised manuscript received May 4, 2001, accepted May 21, 2001.

Reprint requests and correspondence: Dr. Daniel Green, The Department of Human Movement and Exercise Science, The University of Western Australia, Parkway Entrance No. 3, 35 Stirling Highway, Crawley, WA, 6009, Australia
brevis{at}cyllene.uwa.edu.au

OBJECTIVES

The purpose of this study was to examine whether exercise training stimulates a generalized improvement in vascular function in patients with type 2 diabetes mellitus.

BACKGROUND

Exercise is often recommended for patients with type 2 diabetes to improve physical conditioning and glycemic control. This study examined the effect of eight weeks of exercise training on conduit and resistance vessel function in patients with type 2 diabetes, using a randomized crossover design.

METHODS

Both resistance vessel endothelium-dependent and -independent functions were determined by forearm plethysmography and intrabrachial infusions of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, in 16 patients with type 2 diabetes. Conduit vessel endothelial function was assessed in 15 of these patients using high-resolution ultrasound and flow-mediated dilation of the brachial artery; glyceryl trinitrate (GTN) was used as an endothelium-independent dilator.

RESULTS

Flow-mediated dilation increased from 1.7 ± 0.5% to 5.0 ± 0.4% following training (p < 0.001). The forearm blood flow ratio to ACh was significantly improved (analysis of variance, p < 0.05). Responses to SNP and GTN were unchanged. Endothelium-dependent vasodilation was enhanced in both conduit and resistance vessels.

CONCLUSIONS

If endothelial dysfunction is an integral component of the pathogenesis of vascular disease, as currently believed, this study supports the value of an exercise program in the management of type 2 diabetes.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ACh = acetylcholine   ANOVA = analysis of variance   ECG = electrocardiogram   FBF = forearm blood flow   FMD = flow-mediated dilation   GTN = glyceryl trinitrate   HR = heart rate   L-NMMA = NG-monomethyl-L-arginine   MAP = mean arterial pressure   NO = nitric oxide   SNP = sodium nitroprusside

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