Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes

The look ahead (action for health in diabetes) study

Jeffrey M. Curtis, Edward S. Horton, Judy Bahnson, Edward W. Gregg, John M. Jakicic, Judith G. Regensteiner, Paul M. Ribisl, Judith E. Soberman, Kerry Stewart, Mark A. Espeland

Research output: Contribution to journalArticle

Abstract

OBJECTIVE - We examined maximal graded exercise test (GXT) results in 5,783 overweight/obese men and women, aged 45-76 years, with type 2 diabetes, who were entering the Look AHEAD (Action for Health in Diabetes) study, to determine the prevalence and correlates of exercise-induced cardiac abnormalities. RESEARCH DESIGN AND METHODS - Participants underwent symptom-limited maximal GXTs. Questionnaires and physical examinations were used to determine demographic, anthropometric, metabolic, and health status predictors of abnormal GXT results, which were defined as an ST segment depression ≥1.0 mm, ventricular arrhythmia, angina pectoris, poor postexercise heart rate recovery (>22 bpm reduction 2 min after exercise), or maximal exercise capacity less than 5.0 METs. Systolic blood pressure response to exercise was examined as a continuous variable, without a threshold to define abnormality. RESULTS - Exercise-induced abnormalities were present in 1,303 (22.5%) participants, of which 693 (12.0%) consisted of impaired exercise capacity. ST segment depression occurred in 440 (7.6%), abnormal heart rate recovery in 206 (5.0%), angina in 63 (1.1%), and arrhythmia in 41 (0.7%). Of potential predictors, only greater age was associated with increased prevalence of all abnormalities. Other predictors were associated with some, but not all, abnormalities. Systolic blood pressure response decreased with greater age, duration of diabetes, and history of cardiovascular disease. CONCLUSIONS - We found a high rate of abnormal GXT results despite careful screening for cardiovascular disease symptoms. In this cohort of overweight and obese individuals with type 2 diabetes, greater age most consistently predicted abnormal GXT. Long-term follow-up of these participants will show whether these abnormalities are clinically significant.

Original languageEnglish (US)
Pages (from-to)901-907
Number of pages7
JournalDiabetes Care
Volume33
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Type 2 Diabetes Mellitus
Exercise
Exercise Test
Health
Blood Pressure
Cardiac Arrhythmias
Cardiovascular Diseases
Heart Rate
Angina Pectoris
Health Status
Physical Examination
Research Design
Demography

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes : The look ahead (action for health in diabetes) study. / Curtis, Jeffrey M.; Horton, Edward S.; Bahnson, Judy; Gregg, Edward W.; Jakicic, John M.; Regensteiner, Judith G.; Ribisl, Paul M.; Soberman, Judith E.; Stewart, Kerry; Espeland, Mark A.

In: Diabetes Care, Vol. 33, No. 4, 04.2010, p. 901-907.

Research output: Contribution to journalArticle

Curtis, JM, Horton, ES, Bahnson, J, Gregg, EW, Jakicic, JM, Regensteiner, JG, Ribisl, PM, Soberman, JE, Stewart, K & Espeland, MA 2010, 'Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes: The look ahead (action for health in diabetes) study', Diabetes Care, vol. 33, no. 4, pp. 901-907. https://doi.org/10.2337/dc09-1787
Curtis, Jeffrey M. ; Horton, Edward S. ; Bahnson, Judy ; Gregg, Edward W. ; Jakicic, John M. ; Regensteiner, Judith G. ; Ribisl, Paul M. ; Soberman, Judith E. ; Stewart, Kerry ; Espeland, Mark A. / Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes : The look ahead (action for health in diabetes) study. In: Diabetes Care. 2010 ; Vol. 33, No. 4. pp. 901-907.
@article{925a7ebf73bb4a549feb3feff652e945,
title = "Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes: The look ahead (action for health in diabetes) study",
abstract = "OBJECTIVE - We examined maximal graded exercise test (GXT) results in 5,783 overweight/obese men and women, aged 45-76 years, with type 2 diabetes, who were entering the Look AHEAD (Action for Health in Diabetes) study, to determine the prevalence and correlates of exercise-induced cardiac abnormalities. RESEARCH DESIGN AND METHODS - Participants underwent symptom-limited maximal GXTs. Questionnaires and physical examinations were used to determine demographic, anthropometric, metabolic, and health status predictors of abnormal GXT results, which were defined as an ST segment depression ≥1.0 mm, ventricular arrhythmia, angina pectoris, poor postexercise heart rate recovery (>22 bpm reduction 2 min after exercise), or maximal exercise capacity less than 5.0 METs. Systolic blood pressure response to exercise was examined as a continuous variable, without a threshold to define abnormality. RESULTS - Exercise-induced abnormalities were present in 1,303 (22.5{\%}) participants, of which 693 (12.0{\%}) consisted of impaired exercise capacity. ST segment depression occurred in 440 (7.6{\%}), abnormal heart rate recovery in 206 (5.0{\%}), angina in 63 (1.1{\%}), and arrhythmia in 41 (0.7{\%}). Of potential predictors, only greater age was associated with increased prevalence of all abnormalities. Other predictors were associated with some, but not all, abnormalities. Systolic blood pressure response decreased with greater age, duration of diabetes, and history of cardiovascular disease. CONCLUSIONS - We found a high rate of abnormal GXT results despite careful screening for cardiovascular disease symptoms. In this cohort of overweight and obese individuals with type 2 diabetes, greater age most consistently predicted abnormal GXT. Long-term follow-up of these participants will show whether these abnormalities are clinically significant.",
author = "Curtis, {Jeffrey M.} and Horton, {Edward S.} and Judy Bahnson and Gregg, {Edward W.} and Jakicic, {John M.} and Regensteiner, {Judith G.} and Ribisl, {Paul M.} and Soberman, {Judith E.} and Kerry Stewart and Espeland, {Mark A.}",
year = "2010",
month = "4",
doi = "10.2337/dc09-1787",
language = "English (US)",
volume = "33",
pages = "901--907",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "4",

}

TY - JOUR

T1 - Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes

T2 - The look ahead (action for health in diabetes) study

AU - Curtis, Jeffrey M.

AU - Horton, Edward S.

AU - Bahnson, Judy

AU - Gregg, Edward W.

AU - Jakicic, John M.

AU - Regensteiner, Judith G.

AU - Ribisl, Paul M.

AU - Soberman, Judith E.

AU - Stewart, Kerry

AU - Espeland, Mark A.

PY - 2010/4

Y1 - 2010/4

N2 - OBJECTIVE - We examined maximal graded exercise test (GXT) results in 5,783 overweight/obese men and women, aged 45-76 years, with type 2 diabetes, who were entering the Look AHEAD (Action for Health in Diabetes) study, to determine the prevalence and correlates of exercise-induced cardiac abnormalities. RESEARCH DESIGN AND METHODS - Participants underwent symptom-limited maximal GXTs. Questionnaires and physical examinations were used to determine demographic, anthropometric, metabolic, and health status predictors of abnormal GXT results, which were defined as an ST segment depression ≥1.0 mm, ventricular arrhythmia, angina pectoris, poor postexercise heart rate recovery (>22 bpm reduction 2 min after exercise), or maximal exercise capacity less than 5.0 METs. Systolic blood pressure response to exercise was examined as a continuous variable, without a threshold to define abnormality. RESULTS - Exercise-induced abnormalities were present in 1,303 (22.5%) participants, of which 693 (12.0%) consisted of impaired exercise capacity. ST segment depression occurred in 440 (7.6%), abnormal heart rate recovery in 206 (5.0%), angina in 63 (1.1%), and arrhythmia in 41 (0.7%). Of potential predictors, only greater age was associated with increased prevalence of all abnormalities. Other predictors were associated with some, but not all, abnormalities. Systolic blood pressure response decreased with greater age, duration of diabetes, and history of cardiovascular disease. CONCLUSIONS - We found a high rate of abnormal GXT results despite careful screening for cardiovascular disease symptoms. In this cohort of overweight and obese individuals with type 2 diabetes, greater age most consistently predicted abnormal GXT. Long-term follow-up of these participants will show whether these abnormalities are clinically significant.

AB - OBJECTIVE - We examined maximal graded exercise test (GXT) results in 5,783 overweight/obese men and women, aged 45-76 years, with type 2 diabetes, who were entering the Look AHEAD (Action for Health in Diabetes) study, to determine the prevalence and correlates of exercise-induced cardiac abnormalities. RESEARCH DESIGN AND METHODS - Participants underwent symptom-limited maximal GXTs. Questionnaires and physical examinations were used to determine demographic, anthropometric, metabolic, and health status predictors of abnormal GXT results, which were defined as an ST segment depression ≥1.0 mm, ventricular arrhythmia, angina pectoris, poor postexercise heart rate recovery (>22 bpm reduction 2 min after exercise), or maximal exercise capacity less than 5.0 METs. Systolic blood pressure response to exercise was examined as a continuous variable, without a threshold to define abnormality. RESULTS - Exercise-induced abnormalities were present in 1,303 (22.5%) participants, of which 693 (12.0%) consisted of impaired exercise capacity. ST segment depression occurred in 440 (7.6%), abnormal heart rate recovery in 206 (5.0%), angina in 63 (1.1%), and arrhythmia in 41 (0.7%). Of potential predictors, only greater age was associated with increased prevalence of all abnormalities. Other predictors were associated with some, but not all, abnormalities. Systolic blood pressure response decreased with greater age, duration of diabetes, and history of cardiovascular disease. CONCLUSIONS - We found a high rate of abnormal GXT results despite careful screening for cardiovascular disease symptoms. In this cohort of overweight and obese individuals with type 2 diabetes, greater age most consistently predicted abnormal GXT. Long-term follow-up of these participants will show whether these abnormalities are clinically significant.

UR - http://www.scopus.com/inward/record.url?scp=77953033238&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953033238&partnerID=8YFLogxK

U2 - 10.2337/dc09-1787

DO - 10.2337/dc09-1787

M3 - Article

VL - 33

SP - 901

EP - 907

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 4

ER -