Assessing the evidence: Exploring the effects of exercise on diabetic microcirculation
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Helena Lenasi1, Markos Klonizakis2
1Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia.
Abstract:
Diabetes mellitus (DM) is associated with cardiovascular complications. Impairment of glycemic control induces noxious glycations, an increase in oxydative stress and dearangement of various metabolic pathways. DM leads to dysfunction of micro- and macrovessels, connected to metabolic, endothelial and autonomic nervous system. Thus, assessing vascular reactivity might be one of the clinical tools to evaluate the impact of harmful effects of DM and potential benefit of treatment; skin and skeletal muscle microcirculation have usually been tested. Physical exercise improves vascular dysfunction through various mechanisms, and is regarded as an additional effective treatment strategy of DM as it positively impacts glycemic control, improves insulin sensitivity and glucose uptake in the target tissues, thus affecting glucose and lipid metabolism, and increases the endothelium dependent vasodilation. Yet, not all patients respond in the same way so titrating the exercise type individualy would be desirable. Resistance training has, apart from aerobic one, been shown to positively correlate to glycemic control, and improve vascular reactivity. It has been prescribed in various forms or in combination with aerobic training. This review would assess the impact of different modes of exercise, the mechanisms involved, and its potential positive and negative effects on treating patients with Type I and Type II DM, focusing on the recent literature.
Insights
Physical exercise, including resistance training, improves vascular function and glycemic control in diabetes mellitus (DM). Individualized exercise prescriptions are recommended for optimal treatment benefits in Type I and Type II DM patients.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Exercise Physiology
Background:
- Diabetes mellitus (DM) is linked to cardiovascular complications due to impaired glycemic control, leading to oxidative stress and metabolic dysregulation.
- DM causes micro- and macrovascular dysfunction, affecting metabolic, endothelial, and autonomic nervous systems.
- Vascular reactivity assessment is a clinical tool to evaluate DM's impact and treatment efficacy, often focusing on skin and skeletal muscle microcirculation.
Purpose of the Study:
- To review the impact of different exercise modalities on vascular function in patients with Type I and Type II diabetes mellitus.
- To elucidate the underlying mechanisms by which exercise influences vascular health and glycemic control in diabetic individuals.
- To assess the potential benefits and drawbacks of various exercise interventions for managing diabetes-related vascular complications.
Main Methods:
- Systematic review of recent literature on physical exercise interventions for diabetes mellitus.
- Analysis of studies investigating aerobic and resistance training effects on vascular reactivity, glycemic control, and metabolic parameters.
- Evaluation of mechanisms including insulin sensitivity, glucose uptake, lipid metabolism, and endothelial function.
Main Results:
- Physical exercise, encompassing both aerobic and resistance training, demonstrates positive effects on glycemic control and vascular function in DM.
- Exercise improves insulin sensitivity, enhances glucose uptake, positively influences glucose and lipid metabolism, and promotes endothelium-dependent vasodilation.
- Individual patient responses to exercise vary, highlighting the need for tailored exercise prescriptions.
Conclusions:
- Exercise is a crucial adjunct therapy for diabetes mellitus, improving vascular health and metabolic control.
- Resistance training, alongside aerobic exercise, offers significant benefits for patients with Type I and Type II DM.
- Personalized exercise regimens are essential for maximizing therapeutic outcomes and mitigating risks in diabetes management.
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