Neurovascular Dysregulation During Exercise in Type 2 Diabetes

Area of Science:

• Cardiovascular Physiology
• Exercise Science
• Endocrinology

Background:

• Type 2 diabetes (T2D) is associated with altered circulatory adjustments during physical activity.
• Previous studies report elevated blood pressure (BP) and reduced skeletal muscle blood flow (BF) during exercise in individuals with T2D.

Purpose of the Study:

• To review the current understanding of abnormal exercise circulatory responses in T2D.
• To explore potential underlying mechanisms, focusing on sympathetic nervous system regulation.
• To discuss the roles of the exercise pressor reflex and central command.

Main Methods:

• Literature review synthesizing existing research on T2D and exercise physiology.
• Analysis of studies investigating sympathetic nervous system activity, BP, and BF during exercise.
• Examination of evidence related to functional sympatholysis, exercise pressor reflex, and central command.

Main Results:

• Evidence supports augmented sympathetic activation and heightened BP during exercise in T2D.
• Reduced skeletal muscle BF and impaired ability to attenuate sympathetically mediated vasoconstriction (functional sympatholysis) are observed.
• The exercise pressor reflex and central command may also contribute to neurovascular dysregulation.

Conclusions:

• Neurovascular dysregulation, driven by sympathetic overactivity and impaired functional sympatholysis, significantly impacts exercise responses in T2D.
• Altered exercise pressor reflex and central command further contribute to these circulatory impairments.
• Further research is needed to fully elucidate these mechanisms and inform therapeutic strategies.