Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes: A systematic review

doi:10.4330/wjc.v15.i4.184

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World Journal of Cardiology

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World J Cardiol. Apr 26, 2023; 15(4): 184-199
Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.184

Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes: A systematic review

Christos Kourek, Eleftherios Karatzanos, Vasiliki Raidou, Ourania Papazachou, Anastassios Philippou, Serafim Nanas, Stavros Dimopoulos

Christos Kourek, Eleftherios Karatzanos, Anastassios Philippou, Serafim Nanas, Stavros Dimopoulos, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1^st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece

Christos Kourek, Department of Cardiology, 417 Army Share Fund Hospital of Athens, Athens 11521, Greece

Vasiliki Raidou, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece

Ourania Papazachou, Department of Cardiology, "Helena Venizelou" Hospital, Athens 10676, Greece

Anastassios Philippou, Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece

Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece

Author contributions: Dimopoulos S designed the research; Kourek C performed the research; Kourek C, and Dimopoulos S analysed the data; Kourek C wrote the paper; All authors revised the paper.

Conflict-of-interest statement: All the authors received no financial support for the research, authorship, and/or publication of this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Stavros Dimopoulos, MD, PhD, Director, Research Scientist, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1^st Critical Care Medicine Department, Evangelismos Hospital, 45-47 Ipsilantou Street, Athens 10676, Greece. stdimop@med.uoa.gr

Received: January 29, 2023
Peer-review started: January 29, 2023
First decision: February 8, 2023
Revised: February 22, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 26, 2023
Processing time: 80 Days and 14.5 Hours

Abstract

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction, reduced functional capacity and exercise intolerance. Regular aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular diseases. High intensity interval training (HIIT) seems to be superior than moderate-intensity continuous training (MICT) in cardiovascular diseases by improving brachial artery flow-mediated dilation (FMD) and cardiorespiratory fitness to a greater extent. However, the beneficial effects of HIIT in patients with T2DM still remain under investigation and number of studies is limited.

AIM

To evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with T2DM.

METHODS

We performed a search on PubMed, PEDro and CINAHL databases, selecting papers published between December 2012 and December 2022 and identified published randomized controlled trials (RCTs) in the English language that included community or outpatient exercise training programs in patients with T2DM. RCTs were assessed for methodological rigor and risk of bias via the Physiotherapy Evidence Database (PEDro). The primary outcome was peak VO₂ and the secondary outcome was endothelial function assessed either by FMD or other indices of microcirculation.

RESULTS

Twelve studies were included in our systematic review. The 12 RCTs resulted in 661 participants in total. HIIT was performed in 310 patients (46.8%), MICT to 271 and the rest 80 belonged to the control group. Peak VO₂ increased in 10 out of 12 studies after HIIT. Ten studies compared HIIT with other exercise regimens (MICT or strength endurance) and 4 of them demonstrated additional beneficial effects of HIIT over MICT or other exercise regimens. Moreover, 4 studies explored the effects of HIIT on endothelial function and FMD in T2DM patients. In 2 of them, HIIT further improved endothelial function compared to MICT and/or the control group while in the rest 2 studies no differences between HIIT and MICT were observed.

CONCLUSION

Regular aerobic exercise training has beneficial effects on cardiorespiratory fitness and endothelial function in T2DM patients. HIIT may be superior by improving these parameters to a greater extent than MICT.

Keywords: Type 2 diabetes mellitus; Exercise; High intensity interval training; Cardiorespiratory fitness; Peak VO₂; Endothelial function

Core Tip: Beneficial effects of high intensity interval training (HIIT) in patients with type 2 diabetes mellitus (T2DM) still remain under investigation and number of studies is limited. We investigated the effectiveness of HIIT on cardiorespiratory fitness and endothelial function in patients with T2DM. We observed that regular aerobic exercise training has beneficial effects on peak VO₂ and flow-mediated dilation in type 2 diabetic patients. Moreover, HIIT may be superior by improving these parameters to a greater extent than moderate-intensity continuous training.