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How do I adjust my exercise prescription when my cardiac patient also suffers from type 2 diabetes mellitus?

Dominique Hansen, Hasselt university, Faculty of Rehabilitation Sciences, Hasselt, Belgium



Introduction

It is well established that physical activity and exercise training is, as part of a multidisciplinary rehabilitation program, key to optimise health and prognosis in patients with cardiovascular disease (CVD).1 It will contribute to greater improvements in body composition, lipid profile, blood pressure, exercise capacity and muscle strength, inflammation, vascular function and even cardiac function.2 These effects may help to explain why exercise training and physical activity is independently related to enhanced survival rates and lowered risk for adverse cardiovascular events in patients with coronary artery disease, and lower hospitalisation rates in heart failure patients.3,4

However, type 2 diabetes mellitus (T2DM) is very often co-existent in CVD patients, which may clearly affect the clinical outcome (e.g. prognosis). For example, increased prevalence rates of diabetes have been reported in patients with coronary artery disease, such as in the Framingham Heart Study5 and the Multiple Risk Factor Intervention Trial6. From these studies, the prevalence of diabetes in patients with coronary artery disease varied from 14 to 26%. These prevalence rates can be even higher in heart failure patients.7 As a result, clinicians should be aware of the potential presence of T2DM in every patient with CVD at entry of a rehabilitation program, even when it is not diagnosed yet. 

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References

1. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-2381.
2. Pinckard K, Baskin KK, Stanford KI. Effects of Exercise to Improve Cardiovascular Health. Front Cardiovasc Med. 2019;6:69.
3. Rauch B, Davos CH, Doherty P, et al. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol. 2016;23(18):1914-1939.
4. Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1:CD003331.
5. Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation. 1979;59: 8-13.
6. Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434-44.
7. Stevens AL, Hansen D, Vandoren V, et al. Mandatory oral glucose tolerance tests identify more diabetics in stable patients with chronic heart failure: a prospective observational study. Diabetol Metab Syndr. 2014;6(1):44.