Physical activity is an important non-therapeutic tool in primary prevention and treatment of diabetes mellitus (DM). To improve activity-based health management, patients need to quantify activity-related energy expenditure and the other components of total daily energy expenditure. This review explores differences between the components of total energy expenditure in patients with DM and healthy people and presents various tools for assessing the energy expenditure in subjects with DM. From this review, it appears that patients with uncontrolled DM have a higher basal energy expenditure than healthy people which must be considered in the establishment of new basal energy expenditure estimate equations. Moreover, studies showed a lower activity energy expenditure in patients with DM than in healthy ones. This difference may be partially explained by patient with DM’s poor compliance with exercise recommendations and their greater participation in lower intensity activities. These specificities of physical activity need to be taken into account in the development of adapted tools to assess activity energy expenditure and daily energy expenditure in people with DM. Few estimation tools are tested in subjects with DM and this results in a lack of accuracy especially for their particular patterns of activity. Thus, future studies should examine sensors coupling different technologies or method that is specifically designed to accurately assess energy expenditure in patients with diabetes in daily life.

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Energy Expenditure in People with Diabetes Mellitus: A Review

Our study aimed to assess predictors of the stress test technique used and to evaluate the impact of exercise level achieved on risk stratification in patients with asymptomatic type 2 diabetes without a previous coronary artery disease. Little is known whether co-morbidities of these patients predict the stress technique and whether physical performance provides risk stratification: 400 patients underwent clinical evaluation and myocardial perfusion scintigraphy (MPS) using physical or pharmacological stress. Physical patients were divided into 2 groups: achieving 30 kg/m 2 (hazard ratio 1.076, 95% confidence interval 1.027 to 1.127, p = 0.002) and a peripheral arterial disease (hazard ratio 2.888, 95% confidence interval 1.446 to 5.769, p = 0.003). Pharmacological patients had more MACE than physical patients (3.2% vs 1.0%, p = 0.03). Patients achieving

Prognostic Usefulness of Cardiac Stress Test Modalities in Patients With Type 2 Diabetes Mellitus Who Underwent Myocardial Perfusion Scintigraphy (from the Basel Asymptomatic High-Risk Diabetics' Outcome Trial)

Observationally, the association of basal metabolic rate (BMR) with mortality is mixed, although some ageing theories suggest that higher BMR should reduce lifespan. It remains unclear whether a causal association exists. In this one-sample Mendelian randomization study, we aimed to estimate the casual effect of BMR on parental attained age, a proxy for lifespan, using two-sample Mendelian randomization methods. We obtained genetic variants strongly (p-value < 5 × 10-8) and independently (r2 < 0.001) predicting BMR from the UK Biobank and applied them to a genome-wide association study of parental attained age based on the UK Biobank. We meta-analyzed genetic variant-specific Wald ratios using inverse-variance weighting with multiplicative random effects by sex, supplemented by sensitivity analysis. A total of 178 and 180 genetic variants predicting BMR in men and women were available for father's and mother's attained age, respectively. Genetically predicted BMR was inversely associated with father's and mother's attained age (years of life lost per unit increase in effect size of genetically predicted BMR, 0.46 and 1.36; 95% confidence interval 0.07-0.85 and 0.89-1.82), with a stronger association in women than men. In conclusion, higher BMR might reduce lifespan. The underlying pathways linking to major causes of death and relevant interventions warrant further investigation. 

/pdf/effect-of-basal-metabolic-rate-on-lifespan-a-sex-specific-2nwpsmc5.pdf

Effect of basal metabolic rate on lifespan: a sex-specific Mendelian randomization study

Background: Prevalence of peripheral arterial disease is equal in men and women. However, women seem to suffer more from the burden of disease. Current studies on gender-related outcomes following supervised exercise therapy (SET) for intermittent claudication (IC) yield conflicting results. Methods: A follow-up analysis on data from the 2010 ExercIse Therapy in Peripheral Arterial Disease (EXITPAD) study: a multicentre randomized controlled trial including IC patients following SET, was performed. The SET program was supervised by physiotherapists and included interval-based treadmill walking approximating maximal pain, combined with activities such as cycling and rowing. Patients usually started with three 30 minutes sessions a week. Training frequency was adapted during the following year on the basis of individual needs. Primary outcome was gender differences regarding the change in absolute claudication distance (ACD) following SET. ACD was defined as the number of meters that a patient had covered just before he/she was forced to stop walking because of intolerable pain. Secondary outcomes were gender differences in change of functional walking distance (FWD), quality of life and walking (dis)ability following SET. Walking distances were obtained by standardized treadmill testing according the Gardner-Skinner protocol. Quality of life was measured by the Short Form (36) Health Survey and walking (dis)ability was determined by the Walking Impairment Questionnaire (WIQ). Measurements were performed at baseline and after 3, 6, 9 and 12 months. Only patients who met the 12 months follow-up measure were included in the analysis. Results: A total of 113 men and 56 women were available for analysis. At baseline, groups were similar in terms of clinical characteristics and ACD walking distances (men: 250 meters vs. women: 270 meters; P=.45). ACD improved for both sexes. However, ACD increase was significantly lower for women than for men, during the first 3 months of SET (men: Δ 280 meters vs. women: Δ 220 meters, P=.04). Moreover, absolute walking distance was significantly shorter for women compared to men after 1 year (565 meters vs. 660 meters, P=.032). Women also reported less on several WIQ subdomains, although total WIQ score was similar (men: 0.69 vs. women: 0.61; P=.592). No differences in quality of life after SET were observed. 4 Conclusion: Women with IC benefit less during the first 3 months of SET and have lower absolute walking distances after twelve months of follow-up compared to men. More research is needed to determine whether gender-based IC treatment strategies are required.

/pdf/supervised-exercise-therapy-for-intermittent-claudicxation-1dm9zvrt0s.pdf

Supervised exercise therapy for intermittent claudicxation : subgroups, gait and physical activity

Aging patients with type 2 diabetes (T2DM) have a high risk of frailty and disability. This narrative review summarizes the current findings and future tasks regarding the following issues: (1) the optimum body mass index (BMI) target for patients with T2DM, (2) energy expenditure and requirements of patients with T2DM, and (3) the significance of low-intensity physical activity (LPA) as a key determinant of total energy expenditure (TEE) among the older population. While weight reduction is associated with an improvement in glycemic control, an increased risk of mortality as well as disability related to unhealthy BMI must also be considered, especially in older patients. The optimum BMI range and energy requirements for maintaining a healthy BMI should be identified. Limited evidence has shown that the TEE measured using the doubly labeled water method in patients with T2DM did not differ from that of subjects without diabetes, suggesting that the energy requirement data of subjects without diabetes may be applicable to these populations. LPA is one of the determinants of variability in the energy requirements of older patients with T2DM, and the beneficial effects of increasing LPA on nutritional intake and frailty prevention should be investigated further.

Energy Requirements for Older Patients with Type 2 Diabetes: A Narrative Review of the Current Findings and Future Tasks.

Background The disease-related components such as physical fitness and daily energy expenditure may change in each progressive period of type 2 diabetes. The purpose of this study was to compare the maximal aerobic capacity (VO2 max), muscle strength, trunk flexibility, total energy expenditure, daily physical activity, resting metabolic rate (RMR), body composition, and body fat distribution in newly diagnosed type 2 diabetic patients with those of healthy controls. Methods Eighty patients (40 male, 40 female) with type 2 diabetes and 80 (40 male, 40 female) controls were included in this study. All participants completed the measurements. Results It was determined that the VO2 max, muscle strength, daily number of steps, and total energy expenditure were lower, and the body fat percentage, and central obesity were higher in male and female type 2 diabetic patients, when compared with the controls. In addition, the lean body mass was decreased in male diabetic patients, compared with the controls. The fasting plasma glucose showed negative correlations with the maximal aerobic capacity, daily number of steps, and muscle strength in the patients in both genders. RMR and trunk flexibility values were not significantly different between the patients and the controls in either gender. Conclusion We suggest that using exercise intervention especially comprised of strength training and aerobic activities, including not only daily slow activities but also moderate to vigorous activities, as a lifestyle modification in newly diagnosed type 2 diabetic patients might be helpful for the development of earlier and more successful illness management strategies.

Do patients with newly diagnosed type 2 diabetes have impaired physical fitness, and energy expenditures?

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Do patients with newly diagnosed type 2 diabetes have impaired physical fitness, and energy expenditures?