Exercise Recommendations to Decrease Mortality Risk in Diabetes and Cardiovascular Disease Patients

Patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) may lengthen their lifespans by adding physical activity to their routine for a variety of reasons, a new study has found. While this has been long reported, the present study provides physical activity guidelines for patients.

The study, published in the European Journal of Preventative Cardiology, was conducted on behalf of the European Association of Preventive Cardiology (EAPC). According to the EAPC researchers, T2DM patients are at an increased risk of numerous cardiovascular outcomes, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity, and reduced cardiorespiratory fitness (CRF). Patients with T2DM and cardiovascular comorbidities are especially at risk of mortality, and exercise can help with insulin sensitivity, lipid profile, vascular reactivity, and CRF.

“Sedentary lifestyles and unhealthy diets are the most important drivers of the increasing number of patients with type 2 diabetes and cardiovascular problems such as heart attacks,” said study author Dr. Hareld Kemps, a cardiologist at Máxima Medical Centre, Veldhoven, the Netherlands, in a press release. “Diabetes doubles the risk of mortality but the fitter patients become, the more that risk declines. Unfortunately, the majority of patients do not engage in exercise [programs].”

The Centers for Disease Control and Prevention (CDC) reports that as of 2015, more than 30 million Americans have diabetes—about 9.4% of the total population—and an additional 84.1 million have prediabetes, which, per the CDC, could become type 2 diabetes in as little as five years. And according to data from the American Heart Association and American Stroke Association, “Cardiovascular disease is the leading global cause of death, accounting for 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030.” An estimated 85.6 million people in the U.S. have some form of CVD or live with the after-effects of a stroke.

Among the report’s recommendations are:

Increased CRF. “Optimal exercise intensity to improve CRF and improve glycaemic control is essential,” according to the researchers. “Assessment of CRF is therefore recommended for risk stratification, exercise prescription and effect monitoring, preferably by cardiopulmonary exercise testing.”

Glycemic control. This should be considered “a key target … of exercise training in these patients,” the study authors state.

Optimal blood pressure control through exercise and medication. The authors called for future research to evaluate what type and duration of exercise is best for blood pressure control.

Parameters of various exercise trainings—aerobic endurance and resistance training—should be personalized for each patient. According to Dr. Kemps, these goals should also be motivational to everyday living.

“For an elderly person this could be climbing the stairs in their home or walking to the supermarket—achievements that will really improve their quality of life,” said Dr. Kemps, naming glycemic control through reduced medication as another incentive.

For T2DM and CVD patients, small changes can add up to big results.

“Interrupting sitting with brief bouts of walking improves glucose control, while two hours of brisk walking per week reduces the risk of further heart problems,” said Dr. Kemps.

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Sources: European Society of Cardiology, European Journal of Preventative Cardiology