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Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial

Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Increased blood pressure (BP) in type 2 diabetes (T2DM) markedly increases cardiovascular disease morbidity and mortality risk compared to having increased BP alone.

OBJECTIVE

To investigate whether exercise reduces suboptimal levels of untreated suboptimal BP or treated hypertension.

DESIGN

Prospective, randomized controlled trial for 6 months.

SETTING

Single center in Baltimore, MD, USA.

PATIENTS

140 participants with T2DM not requiring insulin and untreated SBP of 120–159 or DBP of 85–99 mmHg, or, if being treated for hypertension, any SBP <159 mmHg or DBP < 99 mmHg; 114 completed the study.

INTERVENTION

Supervised exercise, 3 times per week for 6 months compared with general advice about physical activity.

MEASUREMENTS

Resting SBP and DBP (primary outcome); diabetes status, arterial stiffness assessed as carotid-femoral pulse-wave velocity (PWV), body composition and fitness (secondary outcomes).

RESULTS

Overall baseline BP was 126.8 ± 13.5 / 71.7 ± 9.0 mmHg, with no group differences. At 6 months, BP was unchanged from baseline in either group, BP 125.8 ± 13.2 / 70.7 ± 8.8 mmHg in controls; and 126.0 ± 14.2 / 70.3 ± 9.0 mmHg in exercisers, despite attaining a training effects as evidenced by increased aerobic and strength fitness and lean mass and reduced fat mass (all p < 0.05), Overall baseline PWV was 959.9 ± 333.1 cm/s, with no group difference. At 6-months, PWV did not change and was not different between group; exercisers, 923.7 ± 319.8 cm/s, 905.5 ± 344.7, controls.

LIMITATIONS

A completion rate of 81 %.

CONCLUSIONS

Though exercisers improve fitness and body composition, there were no reductions in BP. The lack of change in arterial stiffness suggests a resistance to exercise-induced BP reduction in persons with T2DM.

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References

  1. Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NR. Cardiovascular outcomes in Framingham participants with diabetes: the importance of blood pressure. Hypertension. 2011;57(5):891–7.

    Article  PubMed  CAS  Google Scholar 

  2. Kannel WB, Wilson PW, Zhang TJ. The epidemiology of impaired glucose tolerance and hypertension. Am Heart J. 1991;121(4 Pt 2):1268–73.

    Article  PubMed  CAS  Google Scholar 

  3. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med. 1993;153(5):598–615.

    Article  PubMed  CAS  Google Scholar 

  4. Bangalore S, Kumar S, Lobach I, Messerli FH. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. Circulation. 2011;123(24):2799–810.

    Article  PubMed  CAS  Google Scholar 

  5. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36(3):533–53.

    Article  PubMed  Google Scholar 

  6. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33(12):2692–6.

    Article  PubMed  Google Scholar 

  7. Whaley MH, Brubaker PH, Otto RM. ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Baltimore: Lippincott Williams & Wilkins; 2006.

    Google Scholar 

  8. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402–7.

    Article  PubMed  CAS  Google Scholar 

  9. Program NHBPE. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2003:03–5233.

  10. Stewart KJ, Bacher AC, Turner KL, Fleg JL, Hees PS, Shapiro EP, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med. 2005;165(7):756–62.

    Article  PubMed  Google Scholar 

  11. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, et al. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2000;32(7):1345–60.

    Article  PubMed  CAS  Google Scholar 

  12. Stewart KJ, Sung J, Silber HA, Fleg JL, Kelemen MD, Turner KL, et al. Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens. 2004;17(4):314–20.

    Article  PubMed  Google Scholar 

  13. Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.

    Google Scholar 

  14. Sigal RJ, Kenny GP, Boule NG, Wells GA, Prud'homme D, Fortier M, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147(6):357–69.

    PubMed  Google Scholar 

  15. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287(19):2570–81.

    Article  PubMed  CAS  Google Scholar 

  16. Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103(7):972–7.

    Article  PubMed  Google Scholar 

  17. Stewart KJ. Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension: plausible mechanisms for improving cardiovascular health. JAMA. 2002;288(13):1622–31.

    Article  PubMed  Google Scholar 

  18. London GM, Asmar RG, O'Rourke MF, Safar ME, Investigators RP. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. J Am Coll Cardiol. 2004;43(1):92–9.

    Article  PubMed  CAS  Google Scholar 

  19. Safar ME. Can antihypertensive treatment reverse large-artery stiffening? Curr Hypertens Rep. 2010;12(1):47–51.

    Article  PubMed  Google Scholar 

  20. Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.

    Article  PubMed  CAS  Google Scholar 

  21. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassai B, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011;343:d4169.

    Article  PubMed  Google Scholar 

  22. Chudyk A, Petrella RJ. Effects of Exercise on Cardiovascular Risk Factors in Type 2 Diabetes. Diabetes Care. 2011;34(5):1228–37.

    Article  PubMed  Google Scholar 

  23. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.

    Article  PubMed  CAS  Google Scholar 

  24. Lewis GF, Carpentier A, Adeli K, Giacca A. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocr Rev. 2002;23(2):201–29.

    Article  PubMed  CAS  Google Scholar 

  25. Giannopoulou I, Ploutz-Snyder LL, Carhart R, Weinstock RS, Fernhall B, Goulopoulou S, et al. Exercise is required for visceral fat loss in postmenopausal women with type 2 diabetes. J Clin Endocrinol Metab. 2005;90(3):1511–8.

    Article  PubMed  CAS  Google Scholar 

  26. Mourier A, Gautier J-F, Kerviler ED, Bigard AX, Villette J-M, Garnier J-P, et al. Mobilization of Visceral Adipose Tissue Related to the Improvement in Insulin Sensitivity in Response to Physical Training in NIDDM: Effects of branched-chain amino acid supplements. Diabetes Care. 1997;20(3):385–91.

    Article  PubMed  CAS  Google Scholar 

  27. Bennett WL, Ouyang P, Wu AW, Barone BB, Stewart KJ. Fatness and fitness: how do they influence health-related quality of life in type 2 diabetes mellitus? Health Qual Life Outcomes. 2008;6:110.

    Article  PubMed  Google Scholar 

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Acknowledgements

Funding Support

This study was supported by grant R01DK62368 from the National Institute of Diabetes and Digestive and Kidney Diseases (Dr. Stewart); and by Grant Number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp."

Prior Presentations

American Heart Association Annual Meeting 2011, Orlando FL.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors

Corresponding author

Correspondence to Devon A. Dobrosielski PhD.

Additional information

Trials Registration clinicaltrials.gov Identifier: NCT00212303

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Dobrosielski, D.A., Gibbs, B.B., Ouyang, P. et al. Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial. J GEN INTERN MED 27, 1453–1459 (2012). https://doi.org/10.1007/s11606-012-2103-8

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  • DOI: https://doi.org/10.1007/s11606-012-2103-8

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