Type 2 diabetes is associated with damage, dysfunction, and failure of various organs. The coexistence of diabetes and hypertension is particularly damaging to cardiac and peripheral vascular structure and function. These diseases, either alone or combined, result in increased left ventricular mass and wall thickness, left ventricular diastolic dysfunction, impaired endothelial vasodilator function, and increased vascular stiffness. Although several health organizations endorse exercise training as a therapeutic modality for type 2 diabetes, most studies of exercise and diabetes have focused on glycemic control but not on cardiovascular health. Although exercise lowers blood pressure in persons without diabetes, there are profound gaps in knowledge about the effects of exercise training on blood pressure and cardiovascular health in persons with type 2 diabetes. The primary specific aim of this study is to determine if exercise training reduces blood pressure in persons who have both type 2 diabetes and high normal blood pressure or mild hypertension. Subjects will be randomized to 6-months of exercise training, consistent with established guidelines for diabetes and for hypertension, or to a usual care control group. The second specific aim is to identify the effects of exercise training on parameters of cardiac and peripheral vascular structure and function related to cardiovascular disease in diabetes and hypertension. We will assess left ventricular mass, left ventricular diastolic function, endothelial vasodilator function, and vascular stiffness using high-resolution ultrasound, Doppler echocardiography, and magnetic resonance imaging. We will also examine interleukin-6 and high resolution C-reactive protein as novel risk factors for cardiovascular disease and diabetes to determine the effects of exercise training on the inflammatory process. Because exercise training improves fitness and may improve body composition and regional fat distribution, the associations of change in these parameters with change in blood pressure and cardiac and peripheral vascular structure and function will be analyzed. An equal number of men and women will be enrolled, and a third specific aim of the study is to examine gender differences in response to exercise training. This study will expand the scientific knowledge that defines exercise guidelines and will provide new insight into the mechanisms by which exercise reduces blood pressure and improves cardiovascular health in persons with type 2 diabetes and hypertension.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK062368-01A2
Application #
6731344
Study Section
Special Emphasis Panel (ZRG1-SNEM-5 (02))
Program Officer
Staten, Myrlene A
Project Start
2004-02-02
Project End
2007-12-31
Budget Start
2004-02-02
Budget End
2004-12-31
Support Year
1
Fiscal Year
2004
Total Cost
$533,456
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Yalamanchi, Swaytha V; Stewart, Kerry J; Ji, Nan et al. (2016) The relationship of fasting hyperglycemia to changes in fat and muscle mass after exercise training in type 2 diabetes. Diabetes Res Clin Pract 122:154-161
Barone Gibbs, Bethany; Dobrosielski, Devon A; Althouse, Andrew D et al. (2013) The effect of exercise training on ankle-brachial index in type 2 diabetes. Atherosclerosis 230:125-30
Dobrosielski, Devon A; Barone Gibbs, Bethany; Chaudhari, Sameer et al. (2013) Effect of exercise on abdominal fat loss in men and women with and without type 2 diabetes. BMJ Open 3:e003897
Nam, Soohyun; Dobrosielski, Devon A; Stewart, Kerry J (2012) Predictors of exercise intervention dropout in sedentary individuals with type 2 diabetes. J Cardiopulm Rehabil Prev 32:370-8
Barone Gibbs, Bethany; Dobrosielski, Devon A; Bonekamp, Susanne et al. (2012) A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis 224:446-53
Dobrosielski, Devon A; Gibbs, Bethany Barone; Ouyang, Pamela et al. (2012) Effect of exercise on blood pressure in type 2 diabetes: a randomized controlled trial. J Gen Intern Med 27:1453-9
Moseley, Kendall F; Dobrosielski, Devon A; Stewart, Kerry J et al. (2011) Lean mass predicts hip geometry in men and women with non-insulin-requiring type 2 diabetes mellitus. J Clin Densitom 14:332-9
Gibbs, Bethany Barone; Dobrosielski, Devon A; Lima, Michael et al. (2011) The association of arterial shear and flow-mediated dilation in diabetes. Vasc Med 16:267-74
Coylewright, Megan; Reckelhoff, Jane F; Ouyang, Pamela (2008) Menopause and hypertension: an age-old debate. Hypertension 51:952-9