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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Apr 26, 2023 (publication date) through Mar 11, 2026

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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

ARTICLE HIGHLIGHTS

Research 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. The improvement of endothelial dysfunction is associated with a significant increase in exercise capacity.

Research motivation

High intensity interval training (HIIT) seems to be superior than moderate-intensity continuous training (MICT) in cardiovascular diseases by improving endothelial indices 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.

Research objectives

The aim of this systematic review is to evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with type 2 diabetes and present updated knowledge in literature.

Research methods

A search on three large databases was performed, selecting randomized controlled trials (RCTs) published between 2012 and 2022 regarding exercise training programs in patients with T2DM. The primary outcome was peak VO₂ and the secondary outcome was endothelial function assessed either by FMD or other indices of microcirculation.

Research results

Twelve RCTs resulted in 661 participants in total. Peak VO₂ increased in 10 out of 12 studies after HIIT. Four out of 10 studies demonstrated additional beneficial effects of HIIT over MICT or other exercise regimens. In 2 out of 4 studies, HIIT further improved endothelial function compared to MICT and/or the control group.

Research conclusions

Regular aerobic exercise has been proven to be safe and efficient and presents 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.

Research perspectives

Initial screening assessment and appropriate exercise training protocols based on HIIT should be implemented in outpatient settings under supervision in patients with T2DM. A multidisciplinary team approach is necessary prior to participation at these programs.