Impact of continuous vs. interval training on oxygen extraction and cardiac function during exercise in type 2 diabetes mellitus

Abstract

Purpose Exercise training improves exercise capacity in type 2 diabetes mellitus (T2DM). It remains to be elucidated whether such improvements result from cardiac or peripheral muscular adaptations, and whether these are intensity dependent. Methods 27 patients with T2DM [without known cardiovascular disease (CVD)] were randomized to high-intensity interval training (HIIT, n = 15) or moderate-intensity endurance training (MIT, n = 12) for 24 weeks (3 sessions/week). Exercise echocardiography was applied to investigate cardiac output (CO) and oxygen (O 2) extraction during exercise, while exercise capacity [(̇ VO 2peak (mL/kg/min)] was examined via cardiopulmonary exercise testing at baseline and after 12 and 24 weeks of exercise training, respectively. Changes in glycaemic control (HbA1c and glucose tolerance), lipid profile and body composition were also evaluated. Results 19 patients completed 24 weeks of HIIT (n = 10, 66 ± 11 years) or MIT (n = 9, 61 ± 5 years). HIIT and MIT similarly improved glucose tolerance (p Time = 0.001, p Interaction > 0.05), ̇ VO 2peak (mL/kg/min) (p Time = 0.001, p Interaction > 0.05), and exercise performance (W peak) (p Time < 0.001, p Interaction > 0.05). O 2 extraction increased to a greater extent after 24 weeks of MIT (56.5%, p 1 = 0.009, p Time = 0.001, p Interaction = 0.007). CO and left ventricular longitudinal strain (LS) during exercise remained unchanged (p Time > 0.05). A reduction in HbA1c was correlated with absolute changes in LS after 12 weeks of MIT (r = − 0.792, p = 0.019, LS at rest) or HIIT (r = − 0.782, p = 0.038, LS at peak exercise). Conclusion In patients with well-controlled T2DM, MIT and HIIT improved exercise capacity, mainly resulting from increments in O 2 extraction capacity, rather than changes in cardiac output. In particular, MIT seemed highly effective to generate these peripheral adaptations. Trial Registration NCT03299790, initially released 09/12/2017.