Author Affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Md.
The coexistence of type 2 diabetes and hypertension is especially damaging
to cardiovascular health. Most trials of exercise training for these conditions
have focused on glycemic control and blood pressure reduction. Less is known
about the effects of exercise on the cardiovascular consequences of diabetes
and hypertension. This article reviews the available evidence and plausible
mechanisms by which exercise training may improve the cardiovascular health
of persons with type 2 diabetes and hypertension and provides practical guidelines
for exercise prescription. A MEDLINE search was performed for January 1985
to June 2002. Bibliographies from relevant articles, professional society
clinical practice guidelines, and books were also reviewed. Because few large,
randomized trials exist on these topics, meta-analyses, smaller trials, nonrandomized
trials, and animal studies were also considered. Data quality was determined
by publication in peer-reviewed journals or professional society literature.
Type 2 diabetes and hypertension result in abnormalities in central and peripheral
parameters of cardiovascular structure and function. Evidence for an exercise
training benefit is strongest for improvements in endothelial vasodilator
function and left ventricular diastolic function. The data for exercise training's
improvement of arterial stiffness and system inflammation and reduction of
left ventricular mass are less robust. However, this assertion is based more
on a lack of randomized controlled trials rather than data to the contrary.
Exercise training also reduces total and abdominal fat. These changes in body
composition mediate improvements in insulin sensitivity and blood pressure
and may improve endothelial vasodilator function. The current evidence, albeit
not fully confirmed in randomized trials, suggests that the benefits of exercise
training go beyond the recognized benefits of glycemic control and blood pressure
Stewart KJ. Exercise Training and the Cardiovascular Consequences of Type 2 Diabetes and Hypertension: Plausible Mechanisms for Improving Cardiovascular Health. JAMA. 2002;288(13):1622–1631. doi:10.1001/jama.288.13.1622
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