Kardiologia Polska 2007; 65: 4
In population studies decreased HRV has been of predictive value for mortality among healthy adults [3].Among the diverse conditions associated with decreasein HRV areMI, congestive heart failure (CHF) anddiabetes mellitus (DM) [4]. Several studies indicatedthat diabetic patients have reduced HRV [4-7].Abnormal HRV in diabetes represents an increased riskfor ventricular arrhythmias, as well as totalcardiovascular morbidity and mortality [8].Although data on the effects of physical training onautonomic control in healthy subjects remaincontroversial, the mortality reduction observed inphysically active subjects compared with sedentarypersons strongly suggests that exercise is beneficial.Individuals who engage in regular physical activity havealower prevalence of cardiovascular risk factors.Accordingly, exercise is considered an importantadjuvant therapy in risk factor modification [9]. Hence,there is still aneed to demonstrate to the communityand physicians the numerous benefits of regularphysical training. Regular exercise training is capable of modifying the autonomic balance. Recent studiesshowed that even asingle bout of maximal exercise isable to positively affect the autonomic balance of normal subjects for up to24 h. Longitudinal studieshave shown that exercise training increases HRV invarious conditions such as coronary artery disease(CAD) [10], acuteMI [11], cardiac rehabilitation patients[12], in patients on haemodialysis [13] and in healthyyoung and older adults [14]. However, very fewprospective studies have assessed the effects of exercise training on HRV in type2 diabetes patients.Hence the present research work was taken up withthe aim of studying the effects of integrated exerciseson HRV in patients with type2 diabetes mellitus. Ourresearch hypothesis was that integrated exercisetraining might increase HRV in diabetic patients.
Methods
Fifty-five type2DM patients who attendedadiabetes camp held in the hospital were included inthis study. Patients were interviewed and then invitedfor abaseline clinical examination. General physicalexamination, including height, body weight, waist-hipratio, blood pressure, pulse rate, respiratory rate andcomplete systemic examination, was performed.Detailed examination for pulmonary vascular disease,cerebral vascular disease and CAD was also done.
Measurements
Body weight and height were measured by standardmethods. A12-lead ECG was recorded and findings werenoted down. Blood was drawn from the antecubital veinof the seated patients and from the blood samples fastingblood glucose was measured by glucose dehydrogenasemethod. Glycosylated haemoglobin (HbA
1C
) was assessedby the immunoterbidimetric method.Diabetes mellitus patients were classified as havingdiabetes on the basis of history, regardless of durationof disease or need for anti-diabetic agents. Diabeteswas defined as fasting glucose
≥
7.0 mmol/l. Diabetesmellitus patients with CHF, atrial fibrillation, frequentectopic beats, unstable angina, patients withMI andthose diabetes patients who were unable to performdeep breathing test were excluded from this study.From55 diabetic patients, twenty-eight wereenrolled for the exercise programme, which wasconducted under the guidance of aphysiotherapist.All28 diabetes patients were requested to visit thehospital regularly for5 days per week and practice theexercise daily.
Exercise programme
The training programme included:
•
warming up exercise for5 minutes,
•
cycling or treadmill exercise, depending on theexercise capacity of the patients for30 minutes,
•
cooling down exercise for10 minutes.The entire duration of the exercise did notexceed45 minutes for each session on each day.Twenty diabetes mellitus patients were recruited asanon-exercised group and served as controls. Thepharmacological treatment did not differ significantlybetween the two groups at baseline and there were nomajor changes during the study.Seven patients were withdrawn during the studyfor various reasons. In all,48 patients completed thestudy:20 controls and28 in the exercised group. Aninformed consent was obtained from all patientsbefore enrolling in the exercise programme and thestudy received the approval of the Institutional EthicalCommittee.
Heart rate variability analysis
Deep breathing HR test [15] was conducted inasupine positionduringstandard ECG recording.Before beginning the test, the subjects were taught tobreathe at arate of6 respiratory cycles per minute,5sfor each inhalation and5 s for each exhalation.Electrocardiogram was recorded continuously ataspeed of25 mm/s for60 s while the patientsbreathed as instructed.Beat-to-beat alterations in HR were evaluated by thetime domain method. The HRV interval (R-R intervals364
Shreedhar Bhagyalakshmi et al.
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