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Determinants of Exercise Capacity in Patients With Type 2 Diabetes

Department of Medicine, University of Queensland, Brisbane, Australia

Address correspondence and reprint requests to Prof. Thomas Marwick, MBBS, PhD, University of Queensland, Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4012, Australia. E-mail: tmarwick{at}soms.uq.edu.au

OBJECTIVE—Type 2 diabetes is associated with reduced exercise capacity, but the cause of this association is unclear. We sought the associations of impaired exercise capacity in type 2 diabetes.

RESEARCH DESIGN AND METHODS—Subclinical left ventricular (LV) dysfunction was sought from myocardial strain rate and the basal segmental diastolic velocity (Em) of each wall in 170 patients with type 2 diabetes (aged 56 ± 10 years, 91 men), good quality echocardiographic images, and negative exercise echocardiograms. The same measurements were made in 56 control subjects (aged 53 ± 10 years, 29 men). Exercise capacity was calculated in metabolic equivalents, and heart rate recovery (HRR) was measured as the heart rate difference between peak and 1 min after exercise. In subjects with type 2 diabetes, exercise capacity was correlated with clinical, therapeutic, biochemical, and echocardiographic variables, and significant independent associations were sought using a multiple linear regression model.

RESULTS—Exercise capacity, strain rate, Em, and HRR were significantly reduced in type 2 diabetes. Exercise capacity was associated with age (r = –0.37, P < 0.001), male sex (r = 0.26, P = 0.001), BMI (r = –0.19, P = 0.012), HbA_1c (A1C; r = –0.22, P = 0.009), Em (r = 0.43, P < 0.001), HRR (r = 0.42, P < 0.001), diabetes duration (r = –0.18, P = 0.021), and hypertension history (r = –0.28, P < 0.001). Age (P < 0.001), male sex (P = 0.007), BMI (P = 0.001), Em (P = 0.032), HRR (P = 0.013), and A1C (P = 0.0007) were independent predictors of exercise capacity.

CONCLUSIONS—Reduced exercise capacity in patients with type 2 diabetes is associated with diabetes control, subclinical LV dysfunction, and impaired HRR.

Abbreviations: HRR, heart rate recovery • LV, left ventricular

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