Effect of Exercise Intervention on Cardiac Function in Type 2 Diabetes Mellitus: A Systematic Review

• Published in: Sports medicine (Auckland) Vol. 49; no. 2; pp. 255 - 268
• Main Authors: Verboven, Maxim, Van Ryckeghem, Lisa, Belkhouribchia, Jamal, Dendale, Paul, Eijnde, Bert O., Hansen, Dominique, Bito, Virginie
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2019; Springer Nature B.V
• Subjects: Animal models; Animals; Cardiac function; Cardiomyopathy; Cardiovascular disease; Cardiovascular Physiological Phenomena; Clinical Trials as Topic; Collagen; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - therapy; Endurance; Endurance Training; Exercise; Exercise Therapy; Fitness training programs; Heart; Heart - physiology; Humans; Hyperglycemia; Hypertension; Intervention; Literature reviews; Medicine; Medicine & Public Health; Metabolism; Patients; Physical fitness; Resistance Training; Sports Medicine; Structure-function relationships; Systematic Review; Ventricle
• ISSN: 0112-1642; 1179-2035
• DOI: 10.1007/s40279-018-1003-4

Background
The effect of exercise on cardiac function/structure in type 2 diabetes mellitus (T2DM) with or without diabetic cardiomyopathy (DCM) is not yet completely understood. To date, results of studies have been controversial with variable outcomes due to the variety of exercise modalities.
Objectives
The aim of the present review was to examine the impact of exercise intervention, and different types of exercise, on cardiac function and structure in T2DM through a systematic literature review, combining both pre-clinical and clinical studies.
Methods
A systematic literature search was performed on PubMed, Web of Science, and PEDro to identify studies up to 2 April 2018. Articles were included when well-defined exercise protocols were provided, and cardiac function in T2DM patients or validated animal models was examined.
Results
In diabetic animals, improvements in both diastolic and systolic function through exercise therapy were mainly attributed to reduced collagen deposition. In T2DM patients, improvements were observed in diastolic function, but not consistently in systolic function, after endurance (and combined resistance) exercise training. Different exercise intervention modalities and exercise types seemed equally effective in improving cardiac structure and function.
Conclusion
Exercise training elicits significant improvements in diastolic function and beneficial remodeling in T2DM and DCM animal models, but not necessarily improvements in systolic function and left ventricular structure, regardless of exercise type. Therefore, exercise intervention should be a cornerstone in the treatment of T2DM patients not only to improve glycemic control but also to specifically enhance cardiac function.