Impact of exercise on cardiovascular autonomic neuropathy

Jonathan Saldarriaga, Facultad de Medicina de la Actividad Física y el Deporte, Universidad de Antioquia, Medellín, Colombia
Mauricio Duque-Ramírez, Departamento de Electrofisiología, Hospital San Vicente Fundación, sede Rionegro, Universidad CES, Medellín, Colombia
Juanita Velásquez, Clínica CES, Universidad CES, Medellín, Colombia
Jorge I. Palacio-Uribe, Departamento de Medicina de la Actividad Física y el Deporte, Clínica Las Américas AUNA. Medellín, Colombia

Diabetic cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, which is associated with a high burden of morbidity and a significant increase in mortality. Cardiovascular autonomic neuropathy can manifest through a wide spectrum of alterations, ranging from resting tachycardia to exercise intolerance, and the presence of silent ischemia. The treatment of this complication varies, as there are many factors involved in both its genesis and control; therefore, various strategies have been sought to affect its course. Exercise is considered a first-line strategy for the management of diabetes mellitus and its usefulness in the prevention and management of CAN has also been proven, reducing its incidence and progression over time. In order to safely and effectively prescribe exercise in patients with CAN, healthcare providers need to understand the pathophysiology of the disease, its clinical manifestations and their behavior during exercise, to be able to structure an individualized program for the patients. A database literature search was carried out in PubMed, MEDLINE, EMBASE, and Scopus using the MESH terms diabetic neuropathies + diabetes mellitus + exercise therapy, where it was determined that performing moderate aerobic exercise decreases the incidence and progression of CAN, favors the control of symptoms and is associated with a decrease mortality risk. Other types of exercise such as strength training and high intensity intermittent training have also shown improvement; nevertheless there is still limited evidence regarding their use.

Keywords: Diabetes mellitus. Cardiac autonomic neuropathy. Exercise. Physical activity.