Metabolische und Herz-Kreislauf-Auswirkungen von Muskelaktivität, Sport und Fitness bei Typ-2-Diabetes

Zusammenfassung

Die Zahl der Menschen mit Diabetes mellitus Typ 2 erreicht weltweit epidemische Proportionen und führt bei den betroffenen Patienten zu einem erhöhten Risiko für kardiovaskuläre Erkrankungen zu vorzeitiger Mortalität. Die chronische Hyperglykämie ist die klinische Manifestation des Diabetes mellitus, die aus einer multifaktoriellen Ätiologie genetischer, Umwelt- und Verhaltensfaktoren entsteht. In der Pathogenese des Typ 2 Diabetes spielt die Kombination aus Insulinresistenz von Leber, Muskulatur und Fettgewebe gemeinsam mit einem zunehmenden Insulinsekretionsdefekt der β-Zellen eine zentrale Rolle. Bewegungsarmut und körperliche Inaktivität sind prädisponierende Faktoren bei der Entstehung des Typ 2 Diabetes. In diesem Zusammenhang gilt es als bewiesen, dass vermehrte körperliche Aktivität eine Bedeutung in der Prävention und Therapie des Typ 2 Diabetes und dessen Folgeerkrankungen hat. In dieser Übersichtsarbeit werden wesentliche Studien zu den metabolischen und kardiovaskulären Auswirkungen von Muskelaktivität, gesteigerter körperlicher Aktivität und Fitness bei Patienten mit Typ 2 Diabetes diskutiert.

Abstract

Diabetes mellitus has reached epidemic proportions worldwide and is associated with an increased risk of cardiovascular disease and premature mortality. Chronic hyperglycemia is the clinical manifestation of diabetes and evolves through a multifactorial etiology of genetic, environmental, and behavioural factors. In the pathogenesis of type 2 diabetes, insulin resistance of the liver, skeletal muscle and fat as well as the inability of insulin secreting beta-cells to fully compensate for this insulin resistance are the central pathophysiological events. There are several lines of scientific evidence demonstrating a role of physical inactivity in the etiology and beneficial effects of exercise in both prevention and treatment of type 2 diabetes and its related morbidity. This review is focussing on recent studies that have examined the effects of increased physical activity and fitness on metabolic and cardiovascular parameters in patients with type 2 diabetes.

Schlüsselwörter

Sport - Diabetes mellitus Typ 2 - Stoffwechsel - Insulinresistenz - Adipositas - Hypoglykämie

Keywords

exercise - type 2 diabetes - metabolism - insulin resistance - obesity - hypoglycemia

Literatur

• 1 Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity L S. American College of Sports Medicine position stand. Exercise and type 2 diabetes.  Med Sci Sports Exerc. 2000;  32 1345-60
• 2 Blair S N, Jackson A S. Physical fitness and activity as separate heart disease risk factors.  Med Sci Sports Exerc. 2001;  33 762-764
• 3 Blair S N, Kampert J B, Kohl III H W. et al . Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.  JAMA. 1996;  276 205-10
• 4 Blüher M. Adipose tissue dysfunction in obesity.  Exp Clin Endocrinol Diabetes. 2009;  117 241-50
• 5 Blüher M, Stumvoll M. Metabolisches Syndrom – Mythen, Mechanismen, Management.  Dtsch Med Wochenschr. 2006;  131 1167-72
• 6 Boden W E. High-density lipoprotein cholesterol as an independent risk factor in cardiovascular diseasel.  Am J Cardiol. 2000;  86 19L-22L
• 7 Boule N G, Haddad E, Kenny G P, Wells G A, Sigal R J. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus.  J Am Med Assoc. 2001;  286 1218-1227
• 8 Cauza E, Hanusch-Enserer U. et al . The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.  Arch Phys Med Rehabil. 2005;  86 1527-1533
• 9 Church T S, LaMonte M J, Barlow C E, Blair S N. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes.  Arch Intern Med. 2005;  165 2114-2120
• 10 Knowler W C. Diabetes Prevention Program Research Group . 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.  Lancet. 2009;  374 1677-1686
• 11 Eckel R H, Grundy S M, Zimmet P Z. The metabolic syndrome.  Lancet. 2005;  365 1415-1428
• 12 Ernst E. Influence of regular physical activity on blood rheology.  Eur Heart J. 1987;  8 59-62
• 13 Fagard R H. Exercise characteristics and the blood pressure response to dynamic physical training.  Med Sci Sports Exerc. 2001;  33 S484-492
• 14 Festa A, D’Agostino Jr R, Howard G, Mykkanen L, Tracy R P, Haffner S M. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).  Circulation. 2000;  102 42-47
• 15 Fleshner M. Physical activity and stress resistance: sympathetic nervous system adaptations prevent stress-induced immunosuppression.  Exerc Sport Sci Rev. 2005;  33 120-126
• 16 Franco O H, de Laet C, Peeters A. et al . Effects of physical activity on life expectancy with cardiovascular disease.  Arch Intern Med. 2005;  165 2355-2360
• 17 Hambrecht R. Sport als Therapie.  Herz. 2004;  29 381-90
• 18 Hambrecht R, Walther C, Möbius-Winkler S. et al . Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial.  Circulation. 2004;  109 1371-1378
• 19 Hambrecht R, Wolff A. et al . Effect of exercise on coronary endothelial function in patients with coronary artery disease.  N Engl J Med. 2000;  342 454-460
• 20 Hansen D, Dendale P, Jonkers R A, Beelen M, Manders R J, Corluy L, Mullens A. et al . Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients.  Diabetologia. 2009;  52 1789-97
• 21 Hansen D, Dendale P, Berger J, van Loon L J, Meeusen R. The effects of exercise training on fat-mass loss in obese patients during energy intake restriction.  Sports Med. 2007;  37 31-46
• 22 Haskell W L. The influence of exercise on the concentrations of triglyceride and cholesterol in human plasma.  Exerc Sport Sci Rev. 1984;  12 205-244
• 23 Helmrich S P, Ragland D R, Leung R W, Paffenbarger R S. Physical activity and reduced occurrence of non-insulin-dependant diabetes mellitus.  N Engl J Med. 1991;  325 147-152
• 24 Houston M C, Fazio S, Chilton F H. et al . Nonpharmacologic treatment of dyslipidemia.  Prog Cardiovasc Dis. 2009;  52 61-94
• 25 Irving B A, Davis C K, Brock D W, Weltman J Y, Swift D, Barrett E J, Gaesser G A, Weltman A. Effect of exercise training intensity on abdominal visceral fat and body composition.  Med Sci Sports Exerc. 2008;  40 (11) 1863-1872
• 26 Irwin M L, Yasui Y, Ulrich C M. et al . Effect of exercise on total and intra-abdominal body fat in postmenopausal women.  JAMA. 2003;  289 323-330
• 27 Joslin E P, Root H F, White P, Marble A. In: The Treatment of Diabetes Mellitus. Philadelphia: Lea Febiger; 1935
• 28 Karlsson M K. Skeletal effects of exercise in men.  Calcif Tissue Int. 2001;  69 196-199
• 29 Kemmer F W, Halle M, Stumvoll M, Thurm U, Zimmer P. Diabetes, Sport und Bewegung.  Diabetologie. 2009;  4 S 183-S185
• 30 King H, Aubert R E, Hermann W H. Global burden of diabetes, 1995 – 2025: prevalence, numerical estimates, and projections.  Diabetes Care. 1998;  21 1414-1431
• 31 Kraus W E, Houmard J A, Duscha B D. et al . Effects of the amount and intensity of exercise on plasma lipoproteins.  N Engl J Med. 2002;  347 1483-1492
• 32 LaMonte M J, Blair S N, Church T S. Physical activity and diabetes prevention.  J Appl Physiol. 2005;  99 1205-1213
• 33 Lampman R M, Schteingart D E. Effects of exercise training on glucose control, lipid metabolism, and insulin sensitivity in hypertriglyceridemia and non-insulin dependent diabetes mellitus.  Med Sci Sports Exerc. 1991;  23 703-712
• 34 Larson E B, Wang L, Bowen J D, McCormick W C, Teri L, Crane P, Kukull W. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.  Ann Intern Med. 2006;  144 73-81
• 35 Lyerly G W, Sui X, Church T S, Lavie C J, Hand G A, Blair S N. Maximal exercise electrocardiography responses and coronary heart disease mortality among men with diabetes mellitus.  Circulation. 2008;  117 2734-2742
• 36 Malik S, Wong N D, Franklin S S. et al . Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults.  Circulation. 2004;  110 1245-1250
• 37 Manson J E, Rimm E B, Stampfer M J, Colditz G A, Willett W C. et al . Physical activity and incidence of non-insulin dependent diabetes mellitus in women.  Lancet. 1991;  338 774-778
• 38 Manson J E, Nathan D M, Krolewski A S. et al . A prospective study of exercise and incidence of diabetes among US male physicians.  JAMA. 1992;  268 63-67
• 39 Matthaei S, Bierwirth R, Fritsche A. et al . Behandlung des Diabetes mellitus Typ 2.  Diabetologie. 2009;  4 S138-S143
• 40 Matthaei S, Stumvoll M, Kellerer M, Häring H U. Pathophysiology and pharmacological treatment of insulin resistance.  Endocr Rev. 2000;  21 585-618
• 41 Mattusch F, Dufaux B, Heine O, Mertens I, Rost R. Reduction of the plasma concentration of C-reactive protein following nine months of endurance training.  Int J Sports Med. 2000;  21 21-24
• 42 Myers J, Prakash M, Froelicher V. et al . Exercise capacity and mortality among men referred for exercise testing.  N Engl J Med. 2002;  346 793-801
• 43 Nicklas B J, Wang X, You T. et al . Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight and obese postmenopausal women.  Am J Clin Nutr. 2009;  89 1043-1052
• 44 Oberbach A, Tönjes A, Klöting N. et al . Effect of a 4 week physical training program on plasma concentrations of inflammatory markers in patients with abnormal glucose tolerance.  Eur J Endocrinol. 2006;  154 577-585
• 45 O’Gorman D J, Krook A. Exercise and the treatment of diabetes and obesity.  Endocrinol Metab Clin North Am. 2008;  37 887-903
• 46 Okura T, Nakata Y, Lee D J, Ohkawara K, Tanaka K. Effects of aerobic exercise and obesity phenotype on abdominal fat reduction in response to weight loss.  Int J Obes (Lond). 2005;  29 1259-1266
• 47 O’Leary V B, Marchetti C M, Krishnan R K, Stetzer B P, Gonzalez F, Kirwan J P. Exercise-induced reversal of insulin resistance in obese elderly is associated with reduced visceral fat.  J Appl Physiol. 2006;  100 1584-1589
• 48 Paffenbarger R S, Hyde R T, Wing A L. et al . Physical activity, allcause mortality, and longevity of college alumni.  N Engl J Med. 1986;  314 605-613
• 49 Palitzsch A D, Nusser J, Arndt H. et al . Diabetomobil-Studiengruppe: Die Prävalenz des Diabetes mellitus wird in Deutschland deutlich unterschätzt.  Diab Stoffw. 2000;  8 189-200
• 50 Petersen A M, Pedersen B K. The anti-inflammatory effect of exercise.  J Appl Physiol. 2005;  98 1154-1162
• 51 Pischon T, Girman C J, Hotamisligil G S. et al . Plasma adiponectin levels and risk of myocardial infarction in men.  JAMA. 2004;  291 1730-1737
• 52 Richter E A, Garreto L P, Goodman M N, Ruderman N B. Enhanced muscle glucose metabolism after exercise.  Am J Physiol. 1984;  246 E476-82
• 53 Ristow M, Zarse K, Oberbach A, Klöting N, Birringer M, Kiehntopf M, Stumvoll M, Kahn C R, Blüher M. Antioxidants prevent health-promoting effects of physical exercise in humans.  Proc Natl Acad Sci. 2009;  106 8665-8670
• 54 Sessa W C, Pritchard K, Seyedi N. et al . Chronic exercise in dogs increases coronary vascular nitric oxide production and endothelial cell nitric oxide synthase gene expression.  Circ Res. 1994;  74 349-353
• 55 Sesso H D, Paffenbarger R S, Lee I -M. Physical activity and coronary heart disease in men.  Circulation. 2000;  102 975-980
• 56 Slattery M L, Jacobs D R, Nichaman Z M. Leisure time physical activity and coronary heart disease death.  Circulation. 2001;  79 304-311
• 57 Spranger J, Kroke A, Mohlig M. et al . Adiponectin and protection against type 2 diabetes mellitus.  Lancet. 2003;  361 226-228
• 58 Stumvoll M, Goldstein B J, van Haeften T W. Type 2 diabetes: pathogenesis and treatment.  Lancet. 2008;  371 2153-2156
• 59 Thompson A M, Church T S, Janssen I, Katzmarzyk P T, Earnest C P, Blair S N. Cardiorespiratory fitness as a predictor of cancer mortality among men with pre-diabetes and diabetes.  Diabetes Care. 2008;  31 764-769
• 60 Tönjes A, Scholz M, Fasshauer M, Kratzsch J, Rassoul F, Stumvoll M, Blüher M. Beneficial effects of a 4-week exercise program on plasma concentrations of adhesion molecules.  Diabetes Care. 2007;  30 e1
• 61 Treuth M S, Hunter G R, Kekes-Szabo T, Weinsier R L, Goran M I, Berland L. Reduction in intra-abdominal adipose tissue after strength training in older women.  J Appl Physiol. 1995;  78 1425-1431
• 62 Tuomilehto J. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
• 63 Whelton S P, Chin A, Xin X. et al . Effect of aerobic exercise on blood pressure.  Ann Intern Med. 2002;  136 493-503
• 64 Zanuso S, Balducci S, Jimenez A. Physical activity, a key factor to quality of life in type 2 diabetic patients.  Diabetes Metab Res Rev. 2009;  25 S24-28
• 65 Zimmet P, Alberti K G, Shaw J. Global and societal implications of the diabetes epidemic.  Nature. 2001;  414 782-787