Long-Term Benefit of Exercise on Cardiovascular Health in Type 2 Diabetes

woman going for a run
Physical activity is known to reduce cardiovascular risk in people with type 2 diabetes, but little data exists on how long the benefit lasts. Researchers sought to find whether positive effects on endothelial function could be measured after five years of follow-up in patients with type 2 diabetes.

Findings from a 5-year study comparing physical activity levels in individuals with type 2 diabetes (T2D) and matched controls revealed those with T2D demonstrated significantly lower daytime physical activity levels. Decreased activity levels correlated with impaired endothelial dysfunction, contributing to an increased risk for cardiovascular disease (CVD). These findings were published in BMC Endocrine Disorders.

Researchers enrolled 51 patients with newly diagnosed T2D from Aarhus University Hospital in Denmark and 53 sex- and age- matched control participants into the study, which took place between 2009 and 2011.

The investigators obtained baseline physical activity levels for both groups using an Actiheart combined accelerometer and heart rate monitor (CamNtech) which measured low, moderate, and vigorous activity acceleration levels in counts per minute (cpm). Baseline endothelial function was measured using non-invasive peripheral arterial tonometry (PAT) with an EndoPAT 2000 device to assess digital pulse wave amplitudes before, during, and after brachial artery flow occlusion.

Investigators repeated PAT measurements after 5 years and measured body mass index (BMI) calculations, lipid profiles, glycated hemoglobin (HbA1C) levels, office and ambulatory blood pressures, and urinary albumin to creatinine ratios. Smoking history was also considered.

For every 1 standard deviation (SD) increase in daytime physical activity, endothelial function increased by 6.7% in reactive hyperemia index (RHI; 95% confidence interval: 1.1;12.5%, P=.02). When comparing individuals with T2D to the control group participants, investigators found no significant difference in RHI (0.67±0.29 vs 0.73±0.31. P=.28).

Peripheral arterial tonometry (PAT) measurements were only taken at baseline and at the five-year follow-up period, which researchers said was a limitation of the study.  Additionally, significant patient dropout and lack of complete data may have skewed the results.

“Endothelial dysfunction and type 2 diabetes mellitus synergistically increase cardiovascular risk,” the researchers said. “Thus, it has been suggested that endothelial dysfunction not only adds to the total amount of risk, but potentiates the effect of other traditional risk factors.”

When considering the clinical relevance of the findings, researchers said “evaluation of endothelial function may add important information in early risk stratification of patients with type 2 diabetes,” the researchers concluded.

Disclosure: The study was partially funded with grants from the Novo Nordisk Foundation.


Baier JM, Funck KL, VernstrØm L, et al. Low physical activity is associated with impaired endothelial function in patients with type 2 diabetes and controls after 5 years of follow-up. BMC Endocrine Disorders. 2021; 21:189. doi:10.1186/s12902-021-00857-9