The effect of aerobic exercise on blood glucose values, lactate levels and exercise capacity with diabetic and non-diabetic coronary artery patients

Objectives : The aim of this study was to investigate the effects of aerobic exercise on exercise capacity with diabetic and non-diabetic coronary artery patients and comparison of diabetic and non-diabetic coronary artery patients. Another aim of our study was to investigate the relationship between hyperglycemia, exercise and lactate. Methods : 24 diabetic coronary artery patients and 24 non-diabetic coronary artery patients; treated and followed up the Cardiology Clinic of Hafsa Sultan Hospital, Faculty of Medicine, Manisa Celal Bayar University, were included in our study. 6 patients in the diabetic group and 9 patients in the non-diabetic group could not complete the study due to various reasons. Before the rehabilitation program, demographic characteristics, medical history and medications were questioned. Echocardiography was performed in the cardiology clinic. Basal ECG's were evaluated before exercise. General condition examinations were performed in detail and each patient was referred to a dietician before exercise. Patients were evaluated 6-minute walk test (6MWT), quality of life assessment form (SF-36), exercise benefits / barriers scale (EBBS), International physical activity questionnaire (IPAQ), Health assessment questionnaire (HAQ). Cardiopulmonary exercise test was performed on the treadmill before the rehabilitation program and Vo2 maximum levels were calculated. Lactate levels were measured when maximal fatigue was reached at the end of cardiopulmonary exercise test. The patients were enrolled in a total of 18 sessions of training for 6 weeks, 3 days a week; increasing the intensity of exercise gradually between 40-80% of Vo2max. Plasma glucose parameters and cholesterol levels were evaluated before and after exercise. Cardiopulmonary exercise test was repeated after the training program and the results were compared. Hba1c was measured 3 months after the beginning of rehabilitation and compared with baseline values. Results : In all patients CPET data showed an increase in exercise time, slope and speed (work load) and 6 minutes walking test. There was no significant increase in Vo2max and other CPET parameters. When the groups were compared with each other, there was a significant increase in walking test distance in isolated CAD group (p = 0.026 *). Total cholesterol levels were significantly decreased in all patients (0.017 *). There was no significant decrease in fasting blood glucose and Hba1c values in diabetic group. In the diabetic group, after exercise program, although it was not significant, the lactate values were decreased, measured when the maximum fatigue was reached during the cardiopulmonary exercise test. Baseline FEV1, FVC values were lower in diabetic group, although not significant (p = 0.16, p = 0.09). SF-36 total score, pain and vitality subtitles were increased in all patients (p = 0.001 *, p = 0.015 *, p = 0.005 *). When the groups were evaluated within themselves, there was a significant increase in pain subscale in non-diabetic CAD group (P = 0.03 *). Conclusion : İn this study we demonstrated that exercise test duration, workload and walking distance were increased in all CAD patient's with aerobic exercise. Despite the increase in functional capacity, we couldn't show it in Vo2max. We have improved hypercholesterolemia, one of the risk factors for coronary artery disease. We could not detect significant improvement in Hba1c values. We think that the lack of attention to the diet of the patients affects our results. After exercise therapy, we found a decrease in lactate values in diabetic group when maximal fatigue was reached during cardiopulmonary exercise test. We believe that the increase in aerobic capacity causes a decrease in lactate levels. Pulmonary functional capacity can be improved with diabetic patients with strict glycemic control and regular exercise. We improved the quality of life of all coronary artery patients with cardiac rehabilitation and in addition improved pain sensation with non-diabetic patients. Key words : coronary artery, aerobic exercise, diabetes, lactate