Advertisement

Exercise training improves hemodynamic recovery to isometric exercise in obese men with type 2 diabetes but not in obese women

      Abstract

      Objectives

      Women with type 2 diabetes (T2D) show greater rates of mortality due to ischemic heart disease than men with T2D. We aimed to examine cardiovascular and autonomic function responses to isometric handgrip (IHG) exercise between men and women with T2D, before and after an exercise training program.

      Materials/Methods

      Hemodynamic responses were measured in 22 men and women with T2D during and following a 3-min IHG test, and before and after 16 wks of aerobic exercise training.

      Results

      Women had a smaller decrease in mean arterial pressure (MAP) and systolic blood pressure (BP) during recovery from IHG (ΔMAPREC) than men pre- and post-training (P<0.05). Men showed a greater reduction in diastolic BP during recovery from IHG (P<0.05), and exercise training improved this response in men but not in women (men, pre-training: −13.9±1.8, post-training: −20.5±5.3 mmHg vs. women, pre-training: −10.7±1.7, post-training: −4.1±4.9 mmHg; P<0.05). Men had a greater reduction in sympathetic modulation of vasomotor tone (P<0.05), as estimated by blood pressure variability, following IHG. This response was accentuated after training, while this training effect was not seen in women. Post-training ΔMAPREC was correlated with recovery of low frequency component of the BP spectrum (ΔLFSBPrec, r=0.52, P<0.05).

      Conclusions

      Differences in BP recovery immediately following IHG may be attributed to gender differences in cardiovascular autonomic modulation. An improvement in these responses occurs following aerobic exercise training in obese men, but not in obese women with T2D which reflects a better adaptive autonomic response to exercise training.

      Abbreviations:

      T2D (type 2 diabetes), IHG (isometric handgrip), MAP (mean arterial pressure), SBP (systolic blood pressure), Δ (change), ΔMAPREC (recovery from IHG), ΔLFSBPrec (low frequency component of the BP spectrum), HR (heart rate), DBP (diastolic blood pressure), MSNA (muscle sympathetic nerve activity), HF (high frequency), HFRRI (index of cardiac parasympathetic modulation, component of HR spectrum), OGTT (oral glucose tolerance test), VO2 peak (aerobic capacity, peak oxygen consumption), MVC (maximal voluntary contraction), CO (cardiac output), HFRRI (HR variability spectrum), Nu (normalized units), LFRRI (low frequency), HbA1c (Hemoglobin A1C), QUICKI (quantitative insulin sensitivity check index), HOMA-IR (homeostatic model assessment for insulin resistance), ln (logarithmic transformation), TPR (Total peripheral resistance), HRIHG (HR response to IHG), HRREC (HR response following IHG)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Metabolism - Clinical and Experimental
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Grassi G.
        • Seravalle G.
        • Cattaneo B.M.
        • Bolla G.B.
        • Lanfranchi A.
        • Colombo M.
        • et al.
        Sympathetic activation in obese normotensive subjects.
        Hypertension. 1995; 25 ([Epub 1995/04/01]): 560-563
        • Grassi G.
        • Seravalle G.
        • Colombo M.
        • Bolla G.
        • Cattaneo B.M.
        • Cavagnini F.
        • et al.
        Body weight reduction, sympathetic nerve traffic, and arterial baroreflex in obese normotensive humans.
        Circulation. 1998; 97: 2037-2042
        • Vaz M.
        • Jennings G.
        • Turner A.
        • Cox H.
        • Lambert G.
        • Esler M.
        Regional sympathetic nervous activity and oxygen consumption in obese normotensive human subjects.
        Circulation. 1997; 96 ([Epub 1997/12/13]): 3423-3429
        • Jarvis S.S.
        • VanGundy T.B.
        • Galbreath M.M.
        • Shibata S.
        • Okazaki K.
        • Reelick M.F.
        • et al.
        Sex differences in the modulation of vasomotor sympathetic outflow during static handgrip exercise in healthy young humans.
        Am J Physiol Regul Integr Comp Physiol. 2011; 301 ([Epub 2011/04/22]): R193-R200
        • Dipla K.
        • Zafeiridis A.
        • Koidou I.
        • Geladas N.
        • Vrabas I.S.
        Altered hemodynamic regulation and reflex control during exercise and recovery in obese boys.
        Am J Physiol Heart Circ Physiol. 2010; 299 ([Epub 2010/10/19]): H2090-H2096
        • Ettinger S.M.
        • Silber D.H.
        • Collins B.G.
        • Gray K.S.
        • Sutliff G.
        • Whisler S.K.
        • et al.
        Influences of gender on sympathetic nerve responses to static exercise.
        J Appl Physiol. 1996; 80 ([Epub 1996/01/01]): 245-251
        • Valensi P.
        • Ngoc P.T.B.
        • Idriss S.
        • Paries J.
        • Cazes P.
        • Lormeau B.
        • et al.
        Haemodynamic response to an isometric exercise test in obese patients: influence of autonomic dysfunction.
        Int J Obes Relat Metab Disord. 1999; 23: 543-549
        • Ewing D.J.
        • Irving J.B.
        • Kerr F.
        • Wildsmith J.A.
        • Clarke B.F.
        Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function.
        Clin Sci Mol Med. 1974; 46 ([Epub 1974/03/01]): 295-306
        • Davis S.N.
        • Galassetti P.
        • Wasserman D.H.
        • Tate D.
        Effects of gender on neuroendocrine and metabolic counterregulatory responses to exercise in normal man.
        J Clin Endocrinol Metab. 2000; 85 ([Epub 2000/01/14]): 224-230
        • Nolan R.P.
        • Barry-Bianchi S.M.
        • Mechetiuc A.E.
        • Chen M.H.
        Sex-based differences in the association between duration of type 2 diabetes and heart rate variability.
        Diab Vasc Dis Res. 2009; 6 ([Epub 2010/04/07]): 276-282
        • Christou D.D.
        • Jones P.P.
        • Jordan J.
        • Diedrich A.
        • Robertson D.
        • Seals D.R.
        Women have lower tonic autonomic support of arterial blood pressure and less effective baroreflex buffering than men.
        Circulation. 2005; 111 ([Epub 2005/02/03]): 494-498
        • Sanchez J.
        • Pequignot J.M.
        • Peyrin L.
        • Monod H.
        Sex differences in the sympatho-adrenal response to isometric exercise.
        Eur J Appl Physiol Occup Physiol. 1980; 45 ([Epub 1980/01/01]): 147-154
        • Jones P.P.
        • Spraul M.
        • Matt K.S.
        • Seals D.R.
        • Skinner J.S.
        • Ravussin E.
        Gender does not influence sympathetic neural reactivity to stress in healthy humans.
        Am J Physiol. 1996; 270 ([Epub 1996/01/01]): H350-H357
        • Kawamura Y.
        Assessment of autonomic nerve activity: approach to gender differences in cardiovascular events in patients with diabetes.
        Circ J: Official J Jpn Circ Soc. 2011; 75 ([Epub 2011/04/12]): 1320-1321
        • Maser R.E.
        • Mitchell B.D.
        • Vinik A.I.
        • Freeman R.
        The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis.
        Diabetes Care. 2003; 26: 1895-1901
        • Fernhall B.
        • Figueroa A.
        • Collier S.
        • Baynard T.
        • Giannopoulou I.
        • Goulopoulou S.
        Blunted heart rate response to upright tilt in people with Down syndrome.
        Arch Phys Med Rehabil. 2005; 86 ([Epub 2005/04/14]): 813-818
        • Figueroa A.
        • Baynard T.
        • Fernhall B.
        • Carhart R.
        • Kanaley J.A.
        Impaired postexercise cardiovascular autonomic modulation in middle-aged women with type 2 diabetes.
        Eur J Cardiovasc Prev Rehabil. 2007; 14 ([Epub 2007/04/21]): 237-243
        • Figueroa A.
        • Collier S.R.
        • Baynard T.
        • Giannopoulou I.
        • Goulopoulou S.
        • Fernhall B.
        Impaired vagal modulation of heart rate in individuals with Down syndrome.
        Clin Auton Res. 2005; 15 ([Epub 2005/03/16]): 45-50
        • Heffernan K.S.
        • Sosnoff J.J.
        • Ofori E.
        • Jae S.Y.
        • Baynard T.
        • Collier S.R.
        • et al.
        Complexity of force output during static exercise in individuals with Down syndrome.
        J Appl Physiol. 2009; 106 ([Epub 2009/01/24]): 1227-1233
        • Goulopoulou S.
        • Baynard T.
        • Franklin R.M.
        • Fernhall B.
        • Carhart Jr., R.
        • Weinstock R.
        • et al.
        Exercise training improves cardiovascular autonomic modulation in response to glucose ingestion in obese adults with and without type 2 diabetes mellitus.
        Metabolism. 2010; 59 ([Epub 2009/12/18]): 901-910
        • Kanaley J.A.
        • Shadid S.
        • Sheehan M.T.
        • Guo Z.
        • Jensen M.D.
        Relationship between plasma free fatty acid, intramyocellular triglycerides and long-chain acylcarnitines in resting humans.
        J Physiol. 2009; 587 ([Epub 2009/10/28]): 5939-5950
        • Loimaala A.
        • Huikuri K.
        • Kööbi T.
        • Rinne M.
        • Vuori I.
        Exercise training improves baroreflex sensitivity in type 2 diabetes.
        Diabetes. 2003; 52: 1837-1842
        • Kanaley J.A.
        • Goulopoulou S.
        • Franklin R.M.
        • Baynard T.
        • Holmstrup M.E.
        • Carhart Jr., R.
        • et al.
        Plasticity of heart rate signalling and complexity with exercise training in obese individuals with and without type 2 diabetes.
        Int J Obes (Lond). 2009; 33 ([Epub 2009/08/05]): 1198-1206
        • McArdle W.D.
        • Katch F.I.
        • Katch V.L.
        Exercise physiology: energy, nutrition, and human performance.
        4th ed. Williams & Wilkins, Philadelphia2001
        • Franklin R.M.
        • Baynard T.
        • Weinstock R.S.
        • Goulopoulou S.
        • Carhart Jr., R.
        • Ploutz-Snyder R.
        • et al.
        Autonomic responses to physiological stressors in women with type 2 diabetes.
        Clin Auton Res. 2008; 18 ([Epub 2008/04/10]): 66-73
        • Huikuri H.V.
        • Valkama J.O.
        • Airaksinen K.E.
        • Seppanen T.
        • Kessler K.M.
        • Takkunen J.T.
        • et al.
        Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease.
        Circulation. 1993; 87: 1220-1228
        • Huikuri H.V.
        • Linnaluoto M.K.
        • Seppanen T.
        • Airaksinen K.E.
        • Kessler K.M.
        • Takkunen J.T.
        • et al.
        Circadian rhythm of heart rate variability in survivors of cardiac arrest.
        Am J Cardiol. 1992; 70: 610-615
      1. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.
        Eur Heart J. 1996; 17: 354-381
        • Akselrod S.
        • Gordon D.
        • Madved J.
        • Snidman N.
        • Shannon D.
        • Cohen R.
        Hemodynamic regulation: investigation by spectral analysis.
        Am J Physiol. 1985; 249: H867-H875
        • Kanaley J.A.
        • Baynard T.
        • Franklin R.M.
        • Weinstock R.S.
        • Goulopoulou S.
        • Carhart Jr., R.
        • et al.
        The effects of a glucose load and sympathetic challenge on autonomic function in obese women with and without type 2 diabetes mellitus.
        Metabolism. 2007; 56 ([Epub 2007/05/22]): 778-785
        • Katz A.
        • Nambi S.S.
        • Mather K.
        • Baron A.D.
        • Follmann D.A.
        • Sullivan G.
        • et al.
        Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans.
        J Clin Endocrinol Metab. 2000; 85 ([Epub 2000/07/21]): 2402-2410
        • Mari A.
        • Pacini G.
        • Murphy E.
        • Ludvik B.
        • Nolan J.J.
        A model-based method for assessing insulin sensitivity from the oral glucose tolerance test.
        Diabetes Care. 2001; 24 ([Epub 2001/04/06]): 539-548
        • Clark B.C.
        • Collier S.R.
        • Manini T.M.
        • Ploutz-Snyder L.L.
        Sex differences in muscle fatigability and activation patterns of the human quadriceps femoris.
        Eur J Appl Physiol. 2005; 94 ([Epub 2005/03/26]): 196-206
        • Coote J.H.
        • Hilton S.M.
        • Perez-Gonzalez J.F.
        The reflex nature of the pressor response to muscular exercise.
        J Physiol. 1971; 215 ([Epub 1971/07/01]): 789-804
        • McCloskey D.I.
        • Mitchell J.H.
        Reflex cardiovascular and respiratory responses originating in exercising muscle.
        J Physiol. 1972; 224 ([Epub 1972/07/01]): 173-186
        • Hicks A.L.
        • Kent-Braun J.
        • Ditor D.S.
        Sex differences in human skeletal muscle fatigue.
        Exerc Sport Sci Rev. 2001; 29 ([Epub 2001/07/28]): 109-112
        • Kagaya A.
        • Homma S.
        Brachial arterial blood flow during static handgrip exercise of short duration at varying intensities studied by a Doppler ultrasound method.
        Acta Physiol Scand. 1997; 160 ([Epub 1997/07/01]): 257-265
        • Momen A.
        • Handly B.
        • Kunselman A.
        • Leuenberger U.A.
        • Sinoway L.I.
        Influence of sex and active muscle mass on renal vascular responses during static exercise.
        Am J Physiol Heart Circ Physiol. 2006; 291 ([Epub 2006/02/08]): H121-H126
        • MacDonald J.R.
        Potential causes, mechanisms, and implications of post exercise hypotension.
        J Hum Hypertens. 2002; 16 ([Epub 2002/04/23]): 225-236
        • Chrysant S.G.
        Current evidence on the hemodynamic and blood pressure effects of isometric exercise in normotensive and hypertensive persons.
        J Clin Hypertens (Greenwich). 2010; 12 ([Epub 2010/10/05]): 721-726
        • Gouni-Berthold I.
        • Berthold H.K.
        • Mantzoros C.S.
        • Bohm M.
        • Krone W.
        Sex disparities in the treatment and control of cardiovascular risk factors in type 2 diabetes.
        Diabetes Care. 2008; 31 ([Epub 2008/04/01]): 1389-1391