Introduction: Current calculators to estimate risk of cardiovascular (CV) disease mortality do not include cardiorespiratory fitness (CRF) or physical activity (PA) measures. This is problematic as CRF is an independent risk factor for CV mortality. To address this issue, Wickramasinghe et al. developed a calculator which includes CRF along with other traditional CV risk factors. The purpose of the present study is to determine the effect of aerobic (AER), resistance (RES) or combination (COMB) exercise training on 30-year CV mortality risk in individuals with type 2 diabetes (T2D). Methods: The present study is an ancillary analysis of the Health Benefits of Aerobic and Resistance Training Study (HART-D). Adults with type 2 diabetes (T2D) (n=196) were randomized to 9 months of AER, RES, COMB exercise training or a control group (CON). Thirty-year CV mortality risk was evaluated by entering each participant’s sex, age, blood pressure, smoking status, T2D status, cholesterol, and BMI into a risk calculator developed by Wickramasinghe et al. at baseline and follow-up. CRF was quantified as the highest metabolic equivalent level (estimated from the final speed and grade using American College of Sports Medicine equations) achieved during a maximal treadmill test at baseline and follow-up. Analysis of covariance was used to evaluate change in CV risk with adjustments for age, sex and baseline CV risk. Results: Participants in the present analysis had a mean (SD) 30-year CV risk of 30.4% (17.8). A significant reduction in 30-year CV risk was observed in the AERO (-2.9%, CI: -4.7 to -1.0) and COMB groups (-2.8%, CI: -4.5 to -1.0), but not in the RES group (0.0%, CI: -1.8 to 1.7) compared to CON (2.1%, CI: -0.1 to 4.3). In the AERO and COMB groups, change in CV risk was associated with change in fat mass (r= -0.19, p=0.04), but not change in lean mass or hemoglobin A1c (all ps>0.05). Conclusions: The present study suggests that 9 months of aerobic exercise training or combination of resistance with aerobic exercise training resulted in a ~3% reduction in absolute 30-year CV risk (~11% relative risk), and further validates the importance of aerobic exercise in the treatment of individuals with T2D.
In Brief Physical fitness is one of the strongest predictors of individual future health status. Together with cardiorespiratory fitness (CRF), muscular strength has been increasingly recognized in the pathogenesis and prevention of chronic disease. We review the most recent literature on the effect of muscular strength in the development of cardiovascular disease, with special interest in elucidating its specific benefits beyond those from CRF and body composition. Muscular strength has shown an independent protective effect on all-cause and cancer mortality in healthy middle-aged men, as well as in men with hypertension and patients with heart failure. It has also been inversely associated with age-related weight and adiposity gains, risk of hypertension, and prevalence and incidence of the metabolic syndrome. In children and adolescents, higher levels of muscular fitness have been inversely associated with insulin resistance, clustered cardiometabolic risk, and inflammatory proteins. Generally, the influence of muscular fitness was weakened but remained protective after considering CRF. Also, interestingly, higher levels of muscular fitness seems to some extent counteract the adverse cardiovascular profile of overweight and obese individuals. As many of the investigations have been conducted with non-Hispanic white men, it is important to examine how race/ethnicity and gender may affect these relationships. To conclude, most important effects of resistance training are also summarized, to better understand how higher levels of muscular fitness may result in a better cardiovascular prognosis and survival. Muscular strength has been increasingly recognized in the pathogenesis and prevention of chronic disease. This review summarizes the specific benefits of muscle strength on cardiovascular disease development, prognosis and survival. Findings from resistance training interventions are also summarized to suggest plausible physiologic mechanisms for this association.
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