Sustained increase in physical fitness independently predicts improvements in cardiometabolic risk profile in type 2 diabetes

Stefano Balducci; Jonida Haxhi; Martina Vitale; Lorenza Mattia; Massimo Sacchetti; Giorgio Orlando; Patrizia Cardelli; Carla Iacobini; Lucilla Bollanti; Francesco Conti; Silvano Zanuso; Antonio Nicolucci; Giuseppe Pugliese; Italian Diabetes and Exercise Study 2 (IDES_2) Investigators

doi:10.1002/dmrr.3671

Sustained increase in physical fitness independently predicts improvements in cardiometabolic risk profile in type 2 diabetes

Diabetes Metab Res Rev. 2023 Sep;39(6):e3671. doi: 10.1002/dmrr.3671. Epub 2023 Jun 14.

Authors

Stefano Balducci^{1

2

3}, Jonida Haxhi^{1

2

3}, Martina Vitale^{1

2}, Lorenza Mattia^{1

2}, Massimo Sacchetti⁴, Giorgio Orlando⁵, Patrizia Cardelli^{1

6}, Carla Iacobini^{1

2}, Lucilla Bollanti^{1

2}, Francesco Conti^{1

2}, Silvano Zanuso⁷, Antonio Nicolucci⁸, Giuseppe Pugliese^{1

2}; Italian Diabetes and Exercise Study 2 (IDES_2) Investigators

Affiliations

¹ Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.
² Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.
³ Metabolic Fitness Association, Rome, Italy.
⁴ Department of Human Movement and Sport Sciences, University of Rome 'Foro Italico', Rome, Italy.
⁵ Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
⁶ Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy.
⁷ Center for Applied Biological and Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK.
⁸ Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.

PMID: 37312666
DOI: 10.1002/dmrr.3671

Abstract

Aims: To investigate the relationship between changes in physical fitness and cardiovascular risk factors and scores in patients with type 2 diabetes receiving either a behavioural counselling intervention to increase moderate-to-vigorous-intensity physical activity (MVPA) and decrease sedentary-time (SED-time) or standard care.

Materials and methods: This is a pre-specified ancillary analysis of the Italian Diabetes and Exercise Study_2, a 3-year randomized clinical trial in which 300 physically inactive and sedentary patients were randomized 1:1 to receive either a one-month theoretical and practical counselling each year or standard care. Mean changes from baseline throughout the 3-year period in MVPA, SED-time, cardiorespiratory fitness (VO_2max ), muscle strength, flexibility, cardiovascular risk factors and scores were calculated for study completers (n = 267) and considered irrespective of study arm.

Results: Haemoglobin (Hb) A_1c and coronary heart disease (CHD) risk scores decreased with quartiles of VO_2max and lower body muscle strength changes. Multivariable linear regression analysis showed that increases in VO_2max independently predicted decreases in HbA_1c , blood glucose, diastolic blood pressure (BP), CHD and total stroke 10-year risk and increases in HDL cholesterol, whereas increases in lower body muscle strength independently predicted decreases in body mass index (BMI), waist circumference, triglycerides, systolic BP, CHD and fatal stroke 10-year risk. These associations remained after including changes in BMI, waist circumference, fat mass and fat-free mass, or MVPA and SED-time as covariates.

Conclusions: Improvement in physical fitness predicts favourable changes in cardiometabolic risk profile, independent of changes not only in (central) adiposity or body composition but also in MVPA and SED-time.

Trial registration: ClinicalTrials.gov; NCT01600937; URL https://clinicaltrials.gov/ct2/show/NCT01600937.

Keywords: cardiovascular risk; physical activity; physical fitness; sedentary behaviour; type 2 diabetes.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / prevention & control
Diabetes Mellitus, Type 2* / complications
Exercise / physiology
Glycated Hemoglobin
Humans
Physical Fitness
Risk Factors
Waist Circumference

Substances

Glycated Hemoglobin

Associated data

ClinicalTrials.gov/NCT01600937