Instantaneous Outcomes of Simple Daily Walking on Arterial Stiffness for Type 2 Patients

Could the most inexpensive treatment for arterial stiffness be a healthy walk?

Cardiovascular disease remains the principal cause of morbidity and mortality in patients with type 2 diabetes. Additionally, diabetes seems to exacerbate the vascular remodeling and lead to arterial stiffness and atherosclerotic diseases (ASCVD). Evidence suggests that physical activities such as aerobic exercises are correlated with a reduction in cardiovascular disease (CVD) mortality in addition to helping control serum glucose. Although the cardioprotective effect of physical exercise has already been assessed through previous studies, the uncertainty remains current regarding the acute outcome of the exercise on arterial stiffness.

The results from a study, conducted by Tabara, suggested that a 30-minute aerobic exercise is associated with reduction in arterial stiffness. On the other hand, De Van et al conducted a study to evaluate the immediate effect of resistance exercise on arterial compliance and concluded that resistance exercise will cause a temporary rise in arterial stiffness. Another study showed that the impact of low intensity interval exercise led to a reduction of the cardio ankle vascular index (CAVI) which is used to assess central and peripheral arterial stiffness without regard to the blood pressure at the time of measurement. Therefore, it appears that the most important factor in terms of changes in arterial stiffness is the intensity of the exercise. Furthermore, the acute effect of physical activity on blood pressure is still debatable due to other confounders such as age and gender. Lastly, the effect of immediate exercise has not been studied in patients with type 2 diabetes.

A sub analysis of a new study published in March 2019 was conducted to examine the acute effect of aerobic exercise, such as healthy regular walking, on arterial stiffness in the population with cardiovascular risk.

Effectiveness of a Multifactorial Intervention in Patients with Diabetes, also known as EMID, is a randomized controlled trial designed to evaluate the effects of using an application on smartphone, healthy walking and a nutritional workshop in patients with type 2 diabetes. EMID included 200 men and women, ages 25 to 70, with type 2 diabetes from a primary health care in Spain. Participants were followed up with after 12 months.

In this study, the outcome of a 4-kilometer, low to moderate intensity, healthy walk, according to age and sex, was analyzed in the 89 participants included in the intervention group. Any patients with type 2 diabetes, of both sexes, who routinely monitored at the health care center, aged 40–70 years, were included in this study.

Additionally, the presence of previous cardiovascular events, and musculoskeletal, neurological/neuropsychological illness, were part of exclusion criteria. To evaluate the acute effects of the healthy walking, the main study variables such as CAVI, brachial ankle pulse wave velocity, blood pressure, and serum glucose were measured before and immediately after intervention.

Statistical analysis was conducted via Kolmogorov–Smirnov test for checking the statistical normality, and T-Student or U Mann-Whitney tests to assess the association of quantitative variables with Bonferroni correction. Likewise, A logistic regression analysis was performed to evaluate the CAVI and the ankle pulse pressure as dependent variables and gender, physical activity, blood pressure, BMI, age, hypertension, dyslipidemia and baseline CAVI value or baseline ankle pulse pressure value as independent variables.

The results showed a reduction in the parameters of arterial stiffness subsequent to healthy walking. The results are as follows: decrease in CAVI of − 0.2 (95%CI:-0.4 to − 0.1),  and pulse pressure of the lower extremities of − 3.9 mmHg (95%CI: -5.9 to − 2.0). Furthermore, it is observed that male participants had an OR of 2.981 (IC = 95% 1.095 to 8.119) to attain a drop in the CAVI (p < 0.05) and an OR of 2.433 (95%CI: 0.871 to 6.794) in the ankle PP (p > 0.05), in comparison to female participants.

Although this study had many limiting factors needed for results interpretation, the primary finding of the sub analysis revealed that a simple and inexpensive exercise such as healthy walking at low-moderate intensity may result in an instantaneous improvement of parameters of CAVI in patients with type 2 diabetes, especially in males and patients older than 65 years of age.

Practice Pearls:

• Physical activities such as aerobic exercises are correlated with a reduction in cardiovascular disease mortality in addition to helping control serum glucose.
• The most important factor in terms of changes in arterial stiffness is the intensity of the exercise
• A reduction was seen in the parameters of arterial stiffness subsequent to healthy walking.

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy

References:

Tabara Y, Yuasa T, Oshiumi A, Kobayashi T, Miyawaki Y, Miki T, et al. Effect of acute and long-term aerobic exercise on arterial stiffness in the elderly. Hypertens Res. 2007;30(10):895–902.

Rosario Alonso-Domínguez, et al. “Acute Effect of Healthy Walking on Arterial Stiffness in Patients with Type 2 Diabetes and Differences by Age and Sex: a Pre-Post Intervention Study.” BMC Cardiovascular Disorders, BioMed Central, 8 Mar. 2019, bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1039-x.

Alonso-Domínguez R, Gómez-Marcos MA, Patino-Alonso MC, et al Effectiveness of a multifactorial intervention based on an application for smartphones, heart-healthy walks and a nutritional workshop in patients with type 2 diabetes mellitus in primary care (EMID): study protocol for a randomized controlled trial BMJ Open 2017;7:e016191. doi: 10.1136/bmjopen-2017-016191