Endocrinology Diabetology and Metabolic Diseases, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
Endocrinology Diabetology and Metabolic Diseases, Université Clermont Auvergne, GReD, CNRS, INSERM, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
PLoS One. 2021 May 17;16(5):e0251863. doi: 10.1371/journal.pone.0251863. eCollection 2021.
Cardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)-known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients.
PubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality.
We included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV.
Exercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.
心脏自主神经病变是 2 型糖尿病（T2DM）的常见并发症，可通过心率变异性（HRV）来衡量，已知 T2DM 患者的 HRV 降低。运动可以改善健康人群的 HRV，但在 T2DM 中结果存在争议。我们进行了系统评价和荟萃分析，以评估运动对 T2DM 患者 HRV 的影响。
在 2020 年 9 月 20 日之前，检索了 PubMed、Cochrane、Embase 和 ScienceDirect 数据库中所有报告 T2DM 患者运动训练前后 HRV 参数的研究，没有特定年份的限制。我们对每种 HRV 参数进行了随机效应荟萃分析，分为运动类型：RR 间隔（或正常到正常间隔-NN）、RR 间隔标准差（SDNN）、NN 间隔变化超过 50 毫秒的百分比（pNN50）、连续 RR 间隔差异的均方根（RMSSD）、总功率、低频（LF）、高频（HF）和 LF/HF 比值。对质量最高的研究进行了敏感性分析。
我们纳入了 21 项研究（其中 9 项为随机研究），共纳入 523 名 T2DM 患者：472 名接受运动训练，151 名接受对照组（无运动）。干预措施为耐力（14 项研究）、抗阻（2 项研究）、耐力结合抗阻（4 项研究）和高强度间歇训练（HIIT）（4 项研究）。运动训练后，所有 HRV 参数均得到改善，即 SDNN（效应大小=0.59，95%CI 0.26 至 0.93）、RMSSD（0.62，0.28 至 0.95）、pNN50（0.62，0.23 至 1.00）、HF（0.58，-0.16 至 0.99）和 LF 降低（-0.37，-0.69 至 -0.05）和 LF/HF（-0.52，-0.79 至 -0.24）。对照组没有变化。按运动类型分层，耐力训练后大多数 HRV 参数（SDNN、RMSSD、pNN50、LF、HF、LF/HF）均得到改善，而抗阻训练和 HIIT 后主要是 LF/HF 得到改善。监督训练改善了大多数 HRV 参数。训练的持续时间和频率对 HRV 的获益没有影响。
运动训练改善了 T2DM 患者的 HRV 参数，这可能反映了自主神经系统活动的改善。耐力训练的证据水平最高。监督训练似乎有益。
