Efficacy Of Cardiovascular Rehabilitation In Diabetic Subjects: systematic review of the Literature.
Article Sidebar
Published:
Jun 10, 2024
Keywords:
diabetes mellitus; rehabilitation; physiotherapy; physical exercise; cardiovascular.
Main Article Content
Abstract
Introduction and objective
Cardiovascular disease is the leading primary cause of death mortality in diabetic patients. Considering the high incidence and prevalence of both diabetes mellitus and cardiovascular diseases in the Italian population, it is essential to study rehabilitation approaches for the prevention of complications. Our objective is to establish and evaluate the most specific and effective form of physical exercise for the conservative treatment of diabetes mellitus.
Materials and methods
This Systematic Review has been conducted in accordance with the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analyses) checklist. The literature search was done using the following databases: PubMed, Pedro, Scopus, LILACS and Trip Database and was conducted from December 2022 to October 2023. The pedro scale was used to evaluate the methodological quality of the articles included.
Results
After the review, 9 randomised controlled trials (RCTs) were selected. The final score obtained in the evaluation of the included RCTs varies from 5 to 8, with an average score of 7.2 on the PEDro Scale. The analisys revelead that multiple treatment strategies: regular exercise, interval exercise, aerobic training, endurance training and combined training.
Discussion and Conclusion
The results of this Systematic Review highlight that regular exercise has the potential to be effective in reducing, or at least slowing down, the risk of developing damage to the physical and functional health of the individual. The considerable variation in the methods, times and form of the proposed rehabilitation interventions, as well as the wide variability of the outcome measures used, prevents the identification of a preferred protocol for this type of patient.
Downloads
Download data is not yet available.
Article Details
How to Cite
Cuscito, R. ., Sanrocchi, L. ., Servadio, A. ., & Tamburlani, M. . (2024). Efficacy Of Cardiovascular Rehabilitation In Diabetic Subjects: systematic review of the Literature. Journal of Biomedical Practitioners, 8(1). https://doi.org/10.13135/2532-7925/10353
Issue
Section
Physical medicine, physiotherapy and rehabilitation
The authors agree to transfer the right of their publication to the Journal, simultaneously licensed under a Creative Commons License - Attribution that allows others to share the work indicating intellectual authorship and the first publication in this magazine.
References
[1] J. J. Joseph et al., «Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Associ-ation», Circulation, vol. 145, fasc. 9, mar. 2022, doi: 10.1161/CIR.0000000000001040.
[2] World Health Organization, «The top 10 causes of death». 9 dicembre 2020.
[3] Angelo Avogaro, «La malattia cardiovascolare nel paziente diabetico: fattori di ri-schio, storia clinica e prevenzione», G. Ital. Cardiol., fasc. 2016Dicembre, dic. 2016, doi: 10.1714/2616.26910.
[4] K. R. Ambrose e Y. M. Golightly, «Physical exercise as non-pharmacological treat-ment of chronic pain: Why and when», Best Pract. Res. Clin. Rheumatol., vol. 29, fasc. 1, pp. 120–130, feb. 2015, doi: 10.1016/j.berh.2015.04.022.
[5] K. L. Piercy et al., «The Physical Activity Guidelines for Americans», JAMA, vol. 320, fasc. 19, p. 2020, nov. 2018, doi: 10.1001/jama.2018.14854.
[6] Linee Guida della Società Italiana di Diabetologia (SID) e dell’Associazione dei Me-dici Diabetologi (AMD) - La terapia del diabete mellito di tipo 2». dicembre 2022.
[7] J. L. Durstine, B. Gordon, Z. Wang, e X. Luo, «Chronic disease and the link to physical activity», J. Sport Health Sci., vol. 2, fasc. 1, pp. 3–11, mar. 2013, doi: 10.1016/j.jshs.2012.07.009.
[8] F. Ricci, F. Archilletti, e R. De Caterina, «Diagnostic and therapeutic approach to the ACS patient», Glob. Reg. Health Technol. Assess., vol. 9, fasc. Suppl. 1, pp. 2–13, mag. 2022, doi: 10.33393/grhta.2022.2389.
[9] L. Hansson e A. et al Zanchetti, «Effetti dell’abbassamento intensivo della pressione sanguigna e dell’aspirina a basso dosaggio in pazienti con ipertensione: principali ri-sultati dello studio randomizzato Hypertension Optimal Treatment (HOT).» Lancetta, 1998.
[10] R. O. Estacio, B. W. Jeffers, N. Gifford, e R. W. Schrier, «Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes», Diabetes Care, vol. 23 Suppl 2, pp. B54-64, apr. 2000.
[11] M. et al Mänttäri, «Lipoproteins and coronary heart disease in the Helsinki Heart Study», European Heart Journal, vol. 11, pp. 26–31, 1990.
[12] M. et al Franz, «American Diabetes Association: principi nutrizionali e raccomanda-zioni nel diabete», Cura del diabete, pp. S36–S46, 2004.
[13] S. Balducci, G. Rapisarda, F. Mantia, e G. Pugliese, «ATTIVITÀ FISICA/ESERCIZIO FISICO NELLA TERAPIA DEL DIABETE DI TIPO 2», Il Diabete, vol. 31, fasc. 4, dicembre 2019, dic. 2019, doi: 10.30682/ildia1904c.
[14] S. H. Saydah, «Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes», JAMA, vol. 291, fasc. 3, p. 335, gen. 2004, doi: 10.1001/jama.291.3.335.
[15] C. S. Fox, «Trends in Cardiovascular Complications of Diabetes», JAMA, vol. 292, fasc. 20, p. 2495, nov. 2004, doi: 10.1001/jama.292.20.2495.
[16] J. B. Buse et al., «Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus», Diabetes Care, vol. 30, fasc. 1, pp. 162–172, gen. 2007, doi: 10.2337/dc07-9917.
[17] «Diabetes Mellitus: A Major Risk Factor for Cardiovascular Disease: A Joint Editori-al Statement by the American Diabetes Association; the National Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation International; the National Insti-tute of Diabetes and Digestive and Kidney Diseases; and the American Heart Associa-tion», Circulation, vol. 100, fasc. 10, pp. 1132– 1133, set. 1999, doi: 10.1161/01.CIR.100.10.1132.
[18] D. Moher, A. Liberati, e J. Tetzlaff, «Linee guida internazionali della checklist Pre-ferred reporting Items for Systemic reviews and Meta-Analyses (PRISMA», fasc. 7(6), 2015.
[19] A. Berardi et al., «The psychometric properties of the Italian version of the PEDro Scale», Gazzetta Medica Ital. Arch. Sci. Mediche, vol. 181, fasc. 5, ott. 2022, doi: 10.23736/S0393- 3660.22.04593-4.
[20] Ahmadreza A et al., «Effect of cardiac rehabilitation on endothelial function and HbA1c in diabetic patients with ischemic heart disease (IHD).», Research Journal of Pharmaceutical, Biological and Chemical Sciences, vol. 7, fasc. 3, pp. 2633–2636, 2016.
[21] S. Cassidy et al., «High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial», Diabetologia, vol. 59, fasc. 1, pp. 56–66, gen. 2016, doi: 10.1007/s00125-015-3741-2.
[22] M. E. Francois, C. Durrer, K. J. Pistawka, F. A. Halperin, e J. P. Little, «Re-sistance-based interval exercise acutely improves endothelial function in type 2 dia-betes», Am. J. Physiol.-Heart Circ. Physiol., vol. 311, fasc. 5, pp. H1258–H1267, nov. 2016, doi: 10.1152/ajpheart.00398.2016.
[23] N. M. Johannsen, D. L. Swift, C. J. Lavie, C. P. Earnest, S. N. Blair, e T. S. Church, «Categorical Analysis of the Impact of Aerobic and Resistance Exercise Training, Alone and in Combination, on Cardiorespiratory Fitness Levels in Patients With Type 2 Diabetes», Diabetes Care, vol. 36, fasc. 10, pp. 3305–3312, ott. 2013, doi: 10.2337/dc12-2194.
[24] J. P. Magalhães et al., «Effects of combined training with different intensities on vascular health in patients with type 2 diabetes: a 1-year randomized controlled tri-al», Cardiovasc. Diabetol., vol. 18, fasc. 1, p. 34, dic. 2019, doi: 10.1186/s12933-019-0840-2.
[25] J. Rossen et al., «Physical activity promotion in the primary care setting in pre- and type 2 diabetes - the Sophia step study, an RCT», BMC Public Health, vol. 15, fasc. 1, p. 647, dic. 2015, doi: 10.1186/s12889-015-1941-9.
[26] S. Shakil Ur Rehman, H. Karimi, e S. A. Gilani, «Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus», Pak. J. Med. Sci., vol. 33, fasc. 1, feb. 2017, doi: 10.12669/pjms.331.11758.
[27] J. Suryanegara et al., «High intensity interval training protects the heart during in-creased metabolic demand in patients with type 2 diabetes: a randomised controlled trial», Acta Diabetol., vol. 56, fasc. 3, pp. 321–329, mar. 2019, doi: 10.1007/s00592-018-1245-5.
[28] B. Szilágyi, A. Kukla, A. Makai, P. Ács, e M. Járomi, «Sports therapy and recrea-tion exercise program in type 2 diabetes: randomized controlled trial, 3-month fol-low-up», J. Sports Med. Phys. Fitness, vol. 59, fasc. 4, mar. 2019, doi: 10.23736/S0022-4707.18.08591-2.
[29] L. Liu, X. Ma, H. Xu, S. Ruan, e X. Yuan, «Comparing the effects of 12 months aerobic exercise and resistance training on glucose metabolism among prediabetes phenotype: A explorative randomized controlled trial», Prim. Care Diabetes, vol. 15, fasc. 2, pp. 340–346, apr. 2021, doi: 10.1016/j.pcd.2020.11.003.
[30] Z. Yang, C. A. Scott, C. Mao, J. Tang, e A. J. Farmer, «Resistance Exercise Versus Aerobic Exercise for Type 2 Diabetes: A Systematic Review and Meta-Analysis», Sports Med., vol. 44, fasc. 4, pp. 487– 499, apr. 2014, doi: 10.1007/s40279-013-0128-8.
[31] S. Bweir et al., «Resistance exercise training lowers HbA1c more than aerobic train-ing in adults with type 2 diabetes», Diabetol. Metab. Syndr., vol. 1, fasc. 1, p. 27, dic. 2009, doi: 10.1186/1758- 5996-1-27.
[32] L. U. Pagan, M. J. Gomes, e M. P. Okoshi, «Endothelial Function and Physical Ex-ercise», Arq. Bras. Cardiol., 2018, doi: 10.5935/abc.20180211.
[33] Christos Kourek et al., «A Cardiac Rehabilitation Program Increases the Acute Re-sponse of Endothelial Progenitor Cells to Maximal Exercise in Heart Failure Pa-tients», Acta Cardiol. Sin., vol. 38, fasc. 4, lug. 2022, doi: 10.6515/ACS.202207_38(4).20220221B.
[34] C. Kourek et al., «Effectiveness of high intensity interval training on cardiorespira-tory fitness and endothelial function in type 2 diabetes: A systematic review», World J. Cardiol., vol. 15, fasc. 4, pp. 184–199, apr. 2023, doi: 10.4330/wjc.v15.i4.184.
[2] World Health Organization, «The top 10 causes of death». 9 dicembre 2020.
[3] Angelo Avogaro, «La malattia cardiovascolare nel paziente diabetico: fattori di ri-schio, storia clinica e prevenzione», G. Ital. Cardiol., fasc. 2016Dicembre, dic. 2016, doi: 10.1714/2616.26910.
[4] K. R. Ambrose e Y. M. Golightly, «Physical exercise as non-pharmacological treat-ment of chronic pain: Why and when», Best Pract. Res. Clin. Rheumatol., vol. 29, fasc. 1, pp. 120–130, feb. 2015, doi: 10.1016/j.berh.2015.04.022.
[5] K. L. Piercy et al., «The Physical Activity Guidelines for Americans», JAMA, vol. 320, fasc. 19, p. 2020, nov. 2018, doi: 10.1001/jama.2018.14854.
[6] Linee Guida della Società Italiana di Diabetologia (SID) e dell’Associazione dei Me-dici Diabetologi (AMD) - La terapia del diabete mellito di tipo 2». dicembre 2022.
[7] J. L. Durstine, B. Gordon, Z. Wang, e X. Luo, «Chronic disease and the link to physical activity», J. Sport Health Sci., vol. 2, fasc. 1, pp. 3–11, mar. 2013, doi: 10.1016/j.jshs.2012.07.009.
[8] F. Ricci, F. Archilletti, e R. De Caterina, «Diagnostic and therapeutic approach to the ACS patient», Glob. Reg. Health Technol. Assess., vol. 9, fasc. Suppl. 1, pp. 2–13, mag. 2022, doi: 10.33393/grhta.2022.2389.
[9] L. Hansson e A. et al Zanchetti, «Effetti dell’abbassamento intensivo della pressione sanguigna e dell’aspirina a basso dosaggio in pazienti con ipertensione: principali ri-sultati dello studio randomizzato Hypertension Optimal Treatment (HOT).» Lancetta, 1998.
[10] R. O. Estacio, B. W. Jeffers, N. Gifford, e R. W. Schrier, «Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes», Diabetes Care, vol. 23 Suppl 2, pp. B54-64, apr. 2000.
[11] M. et al Mänttäri, «Lipoproteins and coronary heart disease in the Helsinki Heart Study», European Heart Journal, vol. 11, pp. 26–31, 1990.
[12] M. et al Franz, «American Diabetes Association: principi nutrizionali e raccomanda-zioni nel diabete», Cura del diabete, pp. S36–S46, 2004.
[13] S. Balducci, G. Rapisarda, F. Mantia, e G. Pugliese, «ATTIVITÀ FISICA/ESERCIZIO FISICO NELLA TERAPIA DEL DIABETE DI TIPO 2», Il Diabete, vol. 31, fasc. 4, dicembre 2019, dic. 2019, doi: 10.30682/ildia1904c.
[14] S. H. Saydah, «Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes», JAMA, vol. 291, fasc. 3, p. 335, gen. 2004, doi: 10.1001/jama.291.3.335.
[15] C. S. Fox, «Trends in Cardiovascular Complications of Diabetes», JAMA, vol. 292, fasc. 20, p. 2495, nov. 2004, doi: 10.1001/jama.292.20.2495.
[16] J. B. Buse et al., «Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus», Diabetes Care, vol. 30, fasc. 1, pp. 162–172, gen. 2007, doi: 10.2337/dc07-9917.
[17] «Diabetes Mellitus: A Major Risk Factor for Cardiovascular Disease: A Joint Editori-al Statement by the American Diabetes Association; the National Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation International; the National Insti-tute of Diabetes and Digestive and Kidney Diseases; and the American Heart Associa-tion», Circulation, vol. 100, fasc. 10, pp. 1132– 1133, set. 1999, doi: 10.1161/01.CIR.100.10.1132.
[18] D. Moher, A. Liberati, e J. Tetzlaff, «Linee guida internazionali della checklist Pre-ferred reporting Items for Systemic reviews and Meta-Analyses (PRISMA», fasc. 7(6), 2015.
[19] A. Berardi et al., «The psychometric properties of the Italian version of the PEDro Scale», Gazzetta Medica Ital. Arch. Sci. Mediche, vol. 181, fasc. 5, ott. 2022, doi: 10.23736/S0393- 3660.22.04593-4.
[20] Ahmadreza A et al., «Effect of cardiac rehabilitation on endothelial function and HbA1c in diabetic patients with ischemic heart disease (IHD).», Research Journal of Pharmaceutical, Biological and Chemical Sciences, vol. 7, fasc. 3, pp. 2633–2636, 2016.
[21] S. Cassidy et al., «High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial», Diabetologia, vol. 59, fasc. 1, pp. 56–66, gen. 2016, doi: 10.1007/s00125-015-3741-2.
[22] M. E. Francois, C. Durrer, K. J. Pistawka, F. A. Halperin, e J. P. Little, «Re-sistance-based interval exercise acutely improves endothelial function in type 2 dia-betes», Am. J. Physiol.-Heart Circ. Physiol., vol. 311, fasc. 5, pp. H1258–H1267, nov. 2016, doi: 10.1152/ajpheart.00398.2016.
[23] N. M. Johannsen, D. L. Swift, C. J. Lavie, C. P. Earnest, S. N. Blair, e T. S. Church, «Categorical Analysis of the Impact of Aerobic and Resistance Exercise Training, Alone and in Combination, on Cardiorespiratory Fitness Levels in Patients With Type 2 Diabetes», Diabetes Care, vol. 36, fasc. 10, pp. 3305–3312, ott. 2013, doi: 10.2337/dc12-2194.
[24] J. P. Magalhães et al., «Effects of combined training with different intensities on vascular health in patients with type 2 diabetes: a 1-year randomized controlled tri-al», Cardiovasc. Diabetol., vol. 18, fasc. 1, p. 34, dic. 2019, doi: 10.1186/s12933-019-0840-2.
[25] J. Rossen et al., «Physical activity promotion in the primary care setting in pre- and type 2 diabetes - the Sophia step study, an RCT», BMC Public Health, vol. 15, fasc. 1, p. 647, dic. 2015, doi: 10.1186/s12889-015-1941-9.
[26] S. Shakil Ur Rehman, H. Karimi, e S. A. Gilani, «Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus», Pak. J. Med. Sci., vol. 33, fasc. 1, feb. 2017, doi: 10.12669/pjms.331.11758.
[27] J. Suryanegara et al., «High intensity interval training protects the heart during in-creased metabolic demand in patients with type 2 diabetes: a randomised controlled trial», Acta Diabetol., vol. 56, fasc. 3, pp. 321–329, mar. 2019, doi: 10.1007/s00592-018-1245-5.
[28] B. Szilágyi, A. Kukla, A. Makai, P. Ács, e M. Járomi, «Sports therapy and recrea-tion exercise program in type 2 diabetes: randomized controlled trial, 3-month fol-low-up», J. Sports Med. Phys. Fitness, vol. 59, fasc. 4, mar. 2019, doi: 10.23736/S0022-4707.18.08591-2.
[29] L. Liu, X. Ma, H. Xu, S. Ruan, e X. Yuan, «Comparing the effects of 12 months aerobic exercise and resistance training on glucose metabolism among prediabetes phenotype: A explorative randomized controlled trial», Prim. Care Diabetes, vol. 15, fasc. 2, pp. 340–346, apr. 2021, doi: 10.1016/j.pcd.2020.11.003.
[30] Z. Yang, C. A. Scott, C. Mao, J. Tang, e A. J. Farmer, «Resistance Exercise Versus Aerobic Exercise for Type 2 Diabetes: A Systematic Review and Meta-Analysis», Sports Med., vol. 44, fasc. 4, pp. 487– 499, apr. 2014, doi: 10.1007/s40279-013-0128-8.
[31] S. Bweir et al., «Resistance exercise training lowers HbA1c more than aerobic train-ing in adults with type 2 diabetes», Diabetol. Metab. Syndr., vol. 1, fasc. 1, p. 27, dic. 2009, doi: 10.1186/1758- 5996-1-27.
[32] L. U. Pagan, M. J. Gomes, e M. P. Okoshi, «Endothelial Function and Physical Ex-ercise», Arq. Bras. Cardiol., 2018, doi: 10.5935/abc.20180211.
[33] Christos Kourek et al., «A Cardiac Rehabilitation Program Increases the Acute Re-sponse of Endothelial Progenitor Cells to Maximal Exercise in Heart Failure Pa-tients», Acta Cardiol. Sin., vol. 38, fasc. 4, lug. 2022, doi: 10.6515/ACS.202207_38(4).20220221B.
[34] C. Kourek et al., «Effectiveness of high intensity interval training on cardiorespira-tory fitness and endothelial function in type 2 diabetes: A systematic review», World J. Cardiol., vol. 15, fasc. 4, pp. 184–199, apr. 2023, doi: 10.4330/wjc.v15.i4.184.