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Effects of 12 Week Regular Aerobic Exercise on ST-segment and QTc Interval in Type 2 Diabetes Mellitus Patients

12주 규칙적인 유산소 운동이 제 2형 당뇨환자의 ST 분절과 QTc 연장에 미치는 영향

  • Kim, Young-Il (Department of Physical Education, Yonsei University) ;
  • Paik, Il-Young (Department of Physical Education, Yonsei University) ;
  • Jin, Hwa-Eun (Department of Physical Education, Yonsei University) ;
  • Suh, Ah-Ram (Department of Golf, Hoseo University) ;
  • Kwak, Yi-Sub (Department of Physical Education, Dongeui University) ;
  • Woo, Jin-Hee (Department of Physical Education, Dong-A University)
  • Published : 2009.01.30

Abstract

The purpose of the present study was to examine effect of 12 week regular aerobic exercise on ST-segment and QTc interval in middle age type 2 diabetes mellitus (T2DM) patients. The subjects consist of 13 type 2 diabetes mellitus (T2DM) patients in middle age men and all of them had no other complications. Subjects participated in aerobic exercise training for 12 weeks. They started to exercise for $20{\sim}60$ min at $60{\sim}80%$ of $HR_{max}$, (exercise intensity has been increased gradually) per day, $3{\sim}5$ times a week. The results were compared before and after. Weight and BMI, % body fat, fasting glucose, HOMA-IR, $_{peak}DBP$ were significantly decreased and $_{peak}HR$, $_{peak}VO_2$, exercisre time were significantly increased after 12 week aerobic exercise. Also, QTc interval and ST-segment were significantly decreased during at rest, peak exercise after 12 week aerobic exercise. Conclusionally, 12 week aerobic exercise may be improvement in decreased cardiovascular mortality factors (ST-segment) and abnormal autonomic dysfunction (QTc interval) and potentially increased exercise capacity.

12주 유산소 트레이닝 결과, 제 2형 당뇨 대상자의 신체적 특성 및 심혈관계 기능은 향상되었고, 심근허혈을 판단하는 ST-level과 ST-slope가 트레이닝 후 감소함을 나타냈다. 또한, 당뇨에서 자주 나타나는 대표적인 자율신경계 이상 마커인 QTc interval을 감소시켰다. 따라서, 12주 유산소 트레이닝은 심혈관계 기능과 당뇨로 인한 심장허혈, 자율신경계 기능을 증진시킨 것으로 나타냈다.

Keywords

References

  1. American Collage of Sport Medicine. 2000. ACSM guidelines for exercise testing and prescriptions. 6th eds. Philadelphia, Lippincott Williarms and Wilkins
  2. American Heart Association. 1975. Exercise testing and training of individuals with heart disease or at high risk for its development: A hand book for physicians. Dallas
  3. Bacci, S., M. Villella, A. Villella, T. Langialonga, M. Grilli, A. Rauseo, S. Mastroianno, S. De Cosmo, R. Fanelli and V. Trischitta. 2002. Screening for silent myocardial ischaemia in type 2 diabetic patients with additional atherogenic risk factors: applicability and accuracy of the exercise stress test. European journal of endocrinology 147, 649-654 https://doi.org/10.1530/eje.0.1470649
  4. Bazett, H. C. 1920. An analysis of the time relations of electrocardiograms. Heart. 7, 353-367
  5. Borg, G. 1982. Psychophysical base of perceived exertion. Journal of science and medicine in sport 14, 377-381
  6. Bruce, R. A., F. Kusumi and D. Hosmer. 1973. Maximal oxygen intake and monographic assessment of functional aerobic impairment in cardiovascular disease. American heart journal 85, 546-562 https://doi.org/10.1016/0002-8703(73)90502-4
  7. Bruce, R. A., K. F. Hossack, T. A. DeRouen and V. Hofer. 1983. Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. Journal of the American College of Cardiology 2, 565-573 https://doi.org/10.1016/S0735-1097(83)80286-1
  8. Chahine, R. A., M. H. Lowery and E. J. Bauerlein. 1993. Interpretation of the exercise-induced ST-segment elevation. The American journal of cardiology 72, 100-102 https://doi.org/10.1016/0002-9149(93)90227-4
  9. Chambers, J. B., M. J. Sampson, D. C. Sprigings and G. Jackson. 1990. QT prolongation on the electrocardiogram in diabetic autonomic neuropathy. Diabetic medicine 7, 105-110 https://doi.org/10.1111/j.1464-5491.1990.tb01342.x
  10. Dekker, J. M., E. J. Feskens, E. G. Schouten, P. Klootwijk, J. Pool and D. Kromhout. 1996. QTc duration is associated with levels of insulin and glucose intolerance. Diabetes 45, 376-380 https://doi.org/10.2337/diabetes.45.3.376
  11. Ehsani, A. A., G. W. Heath, J. M. Hagberg, B. E. Sobel and J. O. Holloszy. 1981. Effects of 12 months of intense exercise training on ischemic ST-segment depression in patients with coronary artery disease. Circulation 64, 1116-1124 https://doi.org/10.1016/S0003-9993(95)80613-X
  12. El-Atat, F. A., S. I. McFarlane, J. R. Sowers and J. T. Bigger. 2004. Sudden cardiac death in patients with diabetes. Current diabetes reports 4, 187-193 https://doi.org/10.1007/s11892-004-0022-8
  13. Elming, H., E. Holm, L, Jun, C. Torp-Pedersen, L. Kober, M. Kircshoff, M. Malik and J. Camm. 1998. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. European heart journal 19, 1391-1400 https://doi.org/10.1053/euhj.1998.1094
  14. Ewing, D. J., O. Boland, J. M. Neilson, C. G. Cho and B. F. Clarke. 1991. Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients. Diabetologia 34, 182-185 https://doi.org/10.1007/BF00418273
  15. Fleg, J. L., G. Gerstenblith, A. B. Zonderman, L. C. Becker, M. L. Weisfeldt, P. T. Costa Jr and E. G. Lakatta. 1990. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 81, 428-436 https://doi.org/10.1161/01.CIR.81.2.428
  16. Foster, D. W., A. S. Fauci, E. Braunwald and K. Z. Isselbacher. 1998. Harrison's principles of international Medicine, pp. 2076-2077, McGraw Hill Co., USA
  17. Hung, M. J., M. Y. Hung, C. W. Cheng, Yang, N. I and W. J. Cherng. 2006. Clinical characteristics of patients with exercise-induced ST-segment elevation without prior myocardial infarction. Circulation journal 270, 254-261 https://doi.org/10.2459/JCM.0b013e32832b34c1
  18. Jorgensen, C. R., F. L. Gobel, H. L. Taylor and Y. Wang. 1977. Myocardial blood flow and oxygen consumption during exercise. Annals of the New York Academy of Sciences 301, 213-223 https://doi.org/10.1111/j.1749-6632.1977.tb38200.x
  19. Kahn, J. K., J. C. Sisson and A. I. Vinik. 1987. QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. The Journal of clinical endocrinology and metabolism 64, 751-754 https://doi.org/10.1210/jcem-64-4-751
  20. Kurl, S., J. A. Laukkanen, T. P. Tuomainen, R. Rauramaa, T. A. Lakka, R. Salonen, J. Eranen, J. Sivenius and J. T. Salonen. 2003. Association of exercise-induced, silent ST-segment depression with the risk of stroke and cardiovascular diseases in men. Stroke 34, 1760-1765 https://doi.org/10.1161/01.STR.0000078564.46376.0A
  21. Lachterman, B., K. G. Lehmann, D, Abrahamson and V. F. Froelicher. 1990. 'Recovery only' ST-segment depression and the predictive accuracy of the exercise test. Annals of internal medicine 112, 11-16 https://doi.org/10.1059/0003-4819-112-1
  22. Lanza, G. A., M. Mustilli, A. Sestito, F. Infusino, G. A. Sgueglia and F. Crea. 2007. Diagnostic and prognostic value of ST segment depression limited to the recovery phase of exercise stress test. Heart 920. 1417-1421
  23. Matthews, D. R., J. P. Hosker, A. S. Rudenski, B. A. Naylor, D. F. Treacher and R. C. Turner. 1985. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412-419 https://doi.org/10.1007/BF00280883
  24. Marfella, R., F. Nappo, L. De Angelis, M. Siniscalchi, F. Rossi and D. Giugliano. 2000. The effect of acute hyperglycaemia on QTc duration in healthy man. Diabetologia 43, 571-575 https://doi.org/10.1007/s001250051345
  25. Molon, G., G. Targher, A. Costa, L. Bertolini, E. Barbieri and L. Zenari. 2006. Measurement of microvolt T-wave alternans, a new arrhythmic risk stratification test, in Type 2 diabetic patients without clinical cardiovascular disease. Diabetic medicine 23, 207-210
  26. Morris, C. K., K. Morrow, V. F. Froelicher, A. Hideg, D. Hunter, T. Kawaguchi, P. M. Ribisl, K. Ueshima and J. Wallis. 1993. Prediction of cardiovascular death by means of clinical and exercise test variables in patients selected for cardiac catheterization. American heart journal 125, 1717-1726 https://doi.org/10.1016/0002-8703(93)90764-Z
  27. Nesto, R. W. 2004. Correlation between cardiovascular disease and diabetes mellitus: current concepts. The American journal of medicine 116, 11S-22S
  28. Matthews, D. R., J. P. Hosker, A. S. Rudenski, B. A. Naylor, D. F. Treacher and R. C. Turner. 1985. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412-149 https://doi.org/10.1007/BF00280883
  29. Pourmoghaddas, A. and A. Hekmatnia. 2007. The relationship between QTc interval and cardiac autonomic neuropathy in diabetes mellitus. Molecular and cellular biochemistry 249, 125-128 https://doi.org/10.1023/A:1024790823309
  30. Ryden, L., E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M. J. de Boer and F. Cosentino. 2007. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). European heart journal 28, 88-136 https://doi.org/10.1093/eurheartj/ehl260
  31. Rywik, T. M., R. C. Zink, N. S. Gittings, A. A. Khan, J. G. Wright, F. C. O'Connor and J. L. Fleg. 1998. Independent prognostic significance of ischemic ST-segment response limited to recovery from treadmill exercise in asymptomatic subjects. Circulation 97, 2117-2122 https://doi.org/10.1161/01.CIR.97.21.2117
  32. Soto, J. R., D. D. Watson and G. A. Beller. 2001. Incidence and significance of ischemic ST-segment depression occurring solely during recovery after exercise testing. The American journal of cardiology 88, 670-672 https://doi.org/10.1016/S0002-9149(01)01812-4
  33. Veglio, M., M. Borra, L. K. Stevens, J. H. Fuller and P. C. Perin. 1999. The relation between QTc interval prolongation and diabetic complications. Diabetologia 42, 68-75 https://doi.org/10.1007/s001250051115
  34. Weiner, D. A., T. J. Ryan, L. Parsons, L. D. Fisher, B. R. Chaitman, L. T. Sheffield and F. E. Tristani. 1991. Significance of silent myocardial ischemia during exercise testing in patients with diabetes mellitus: a report from the Coronary Artery Surgery Study (CASS) Registry. The American journal of cardiology 68, 729-734 https://doi.org/10.1016/0002-9149(91)90644-Z
  35. Zola, B., J. K. Kahn, J. E. Juni and A. I. Vinik. 1986. Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischemic heart disease. Clinics in endocrinology and metabolism 63, 208-214 https://doi.org/10.1210/jcem-63-1-208