Röhling Martin, Strom Alexander, Bönhof Gidon J, Roden Michael, Ziegler Dan
Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany.
Curr Diab Rep. 2017 Oct 23;17(12):125. doi: 10.1007/s11892-017-0959-z.
This review summarizes the current knowledge on the relationship of physical activity, exercise, and cardiorespiratory fitness (CRF) with cardiovascular autonomic neuropathy (CAN) based on epidemiological, clinical, and interventional studies.
The prevalence of CAN increases with age and duration of diabetes. Further risk factors for CAN comprise poor glycemic control, dyslipidemia, abdominal obesity, hypertension, and the presence of diabetic complications. CAN has been also linked to reduced CRF. We recently showed that CRF parameters (e.g., maximal oxidative capacity or oxidative capacity at the anaerobic threshold) are associated with cardiac autonomic function in patients recently diagnosed with type 1 or type 2 diabetes. Exercise interventions have shown that physical activity can increase cardiovagal activity and reduce sympathetic overactivity. In particular, long-term and regularly, but also supervised, performed endurance and high-intense and high-volume exercise improves cardiac autonomic function in patients with type 2 diabetes. By contrast, the evidence in those with type 1 diabetes and also in individuals with prediabetes or metabolic syndrome is weaker. Overall, the studies reviewed herein addressing the question whether favorably modulating the autonomic nervous system may improve CRF during exercise programs support the therapeutic concept to promote physical activity and to achieve physical fitness. However, high-quality exercise interventions, especially in type 1 diabetes and metabolic syndrome including prediabetes, are further required to better understand the relationship between physical activity, fitness, and cardiac autonomic function.
本综述基于流行病学、临床和干预性研究，总结了目前关于体力活动、运动和心肺适能（CRF）与心血管自主神经病变（CAN）之间关系的知识。
CAN的患病率随年龄和糖尿病病程增加。CAN的其他危险因素包括血糖控制不佳、血脂异常、腹型肥胖、高血压以及糖尿病并发症的存在。CAN还与CRF降低有关。我们最近表明，CRF参数（如最大氧化能力或无氧阈时的氧化能力）与新诊断的1型或2型糖尿病患者的心脏自主神经功能相关。运动干预表明，体力活动可增加迷走神经活动并减少交感神经过度活跃。特别是长期、有规律且在监督下进行的耐力、高强度和大量运动可改善2型糖尿病患者的心脏自主神经功能。相比之下，1型糖尿病患者以及糖尿病前期或代谢综合征患者的相关证据较弱。总体而言，本文综述的研究探讨了在运动计划中有利地调节自主神经系统是否可改善CRF这一问题，支持促进体力活动和实现体能的治疗理念。然而，还需要高质量的运动干预，尤其是针对1型糖尿病以及包括糖尿病前期在内的代谢综合征，以更好地理解体力活动、体能和心脏自主神经功能之间的关系。
