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Relationship Between Physical Activity and Autonomic Responses in Adults with Type 2 Diabetes
Michela Persiani1, Alessandra Laffi1, Alessandro Piras2
1Department of Biomedical and Neuromotor Sciences DIBINEM, Bologna University, 40126 Bologna, Italy.
International Journal of Environmental Research and Public Health
|November 27, 2025
Summary
Physical activity in type 2 diabetes (T2DM) is linked to better heart rate variability (HRV), a marker of autonomic function. Regular exercise may improve cardiac health, with SDNN showing promise as an early indicator.
Area of Science:
- Cardiology
- Endocrinology
- Exercise Physiology
Background:
- Cardiac autonomic dysfunction is common in type 2 diabetes (T2DM).
- Heart rate variability (HRV) is a sensitive biomarker for autonomic function.
- The link between physical activity and HRV in T2DM, considering metabolic factors, needs further exploration.
Purpose of the Study:
- To compare HRV indices between physically active and inactive adults with T2DM.
- To assess the association between physical activity and clinical variables in T2DM.
- To investigate the independent association of physical activity with HRV after adjusting for covariates.
Main Methods:
- Cross-sectional observational study of 41 T2DM adults, classified as active or inactive using the IPAQ-S.
- Analysis of time- and frequency-domain HRV indices (RMSSD, SDNN, LF, HF, LF/HF) from resting recordings.
- Between-group comparisons and backward stepwise quantile regression to examine independent associations.
Main Results:
- Physically active T2DM participants showed significantly higher HRV indices (SDNN, RMSSD, LF, HF) compared to inactive individuals.
- Physical activity was positively associated with LF and independently associated with SDNN and RMSSD after adjusting for HbA1c.
- BMI negatively correlated with mean RR interval and positively with mean heart rate.
Conclusions:
- Habitual physical activity is independently associated with enhanced cardiac autonomic modulation in T2DM.
- SDNN emerged as an early marker of improved autonomic function related to physical activity.
- HRV can serve as a biomarker to guide exercise interventions for individuals with T2DM.
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