Reduced Leg Blood Flow during Submaximal Exercise in Type 2 Diabetes

Abstract

It is unclear whether impaired cardiac and/or vascular function contribute to exercise intolerance in patients with type 2 diabetes. Purpose: Magnetic resonance imaging (MRI) was used to determine whether reductions in cardiac output and/or femoral arterial blood flow contribute to reduced aerobic capacity in patients with type 2 diabetes. Methods: Cardiac and femoral arterial blood flow MRI scans were performed at rest and during low-intensity leg exercise in eight patients with type 2 diabetes and 11 healthy individuals. Maximal aerobic capacity (V·O2max) and maximal oxygen pulse were also determined in all participants. Results: V·O2max was 20% lower and maximal oxygen pulse was 16% lower in patients with type 2 diabetes (P < 0.05), whereas maximal heart rate was the same between groups. Low-intensity exercise induced a 20% increase in heart rate and cardiac output as well as a 60-70% increase in femoral blood flow in both groups (P < 0.05). Femoral arterial blood flow indexed to thigh lean mass was reduced during exercise in patients with type 2 diabetes compared with healthy individuals. Stroke volume indexed to fat-free mass was lower in patients with type 2 diabetes, but greater heart rate allowed cardiac output to be maintained during submaximal exercise. Conclusions: These findings suggest that impaired femoral arterial blood flow, an indirect marker of muscle perfusion, affects low-intensity exercise performance in patients with type 2 diabetes. However, because of lower exercising stroke volume, we propose that femoral arterial blood flow and, possibly, cardiac output, limit V·O2max in patients with type 2 diabetes.