Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease.

Description

This study was conducted to investigate the effects of a multifactorial intervention with focus on exercise training on coronary endothelial function, vascular structure, and inflammation in serum and skeletal muscle biopsies, including mRNA expression of diabetes candidate genes. Twenty-three patients with coronary artery disease and type 2 diabetes were randomized to an intervention program (n=11) or to a control group (n=12). The intervention included 4 weeks in-hospital exercise training (6 x 15 min bicycle/day, 5 days/week) and a hypocaloric diet, followed by a 5-month ambulatory program (30 min ergometer/day, 5 days/week, plus 1-h group exercise/week). After 6 months of intervention, the coronary endothelial function was improved in patients with type 2 diabetes, but no regression was observed for the intramural coronary lesions of less than 25%. A significant improvement was observed after only 4 weeks for fasting plasma glucose, high-sensitive C-reactive protein and HbA1c levels, but a return to their baseline levels was observed after 6 months which could be explained by the slight regain in weight. The expression of oxidative stress-related genes measured in skeletal muscle was increased after 4 weeks of exercise training and showed a decline in expression after 6 months; similar results were observed for PPAR-a; and g. Moreover, mRNA expression of AdipoR1, AdipoR2, IL-6, eNOS, and PGC-1a increased after 4 weeks of intervention and were even higher after 6 months. These findings show the beneficial effects of exercise on endothelial function as well as on markers of hyperglycemia and inflammation in both serum and skeletal muscle of patients with type 2 diabetes.