High intensity exercise improves cardiac structure and function and reduces liver fat in adults with Type 2 diabetes

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1 High intensity exercise improves cardiac structure and function and reduces liver fat in adults with Type 2 diabetes Sophie Cassidy, s.cassidy@ncl.ac.uk

2 1) Concentric remodelling 1.2 * Eccentricity ratio (g/ml)) Type 2 diabetes Type 2 diabetes 2) Diastolic dysfunction A E/A (ml/s) * E 3) 9 Cardiac torsion Peak torsion ( ) *p<.5 Cassidy et al. 215 (Cardiovasc Diab)

3 Liver More than 9% of obese people with Type 2 diabetes have fatty liver Reversal of Type 2 diabetes with a 7% reduction in liver fat after Very-Low-Calorie-Diet (Lim et al. 211)

4 Can we use HIIT as a therapy to improve cardiac structure and function and reduce liver fat?

5 Background: High intensity intermittent training (HIIT)

6 Why HIIT? Traditional thinking 27 New thinking Oxygen uptake (% VO2max) VO2MAX HIIT Work intensity (W)

7 12 WEEK INTERVENTION CONTROL -Maintain standard care -Maintain diet and medication -Maintain daily physical activity HIIT -12 weeks of HIIT -Maintain diet and medication -Maintain daily physical activity

8 Exercise intervention weeks 3 sessions per week

9 Warm up Interval 1 Interval 3 Interval 4 Sprints: 2mins, >8RPM Progression: 1secs per week Recovery: 3mins Interval 5 Cool down

10 Study Visits 1) Maximal exercise screening test 2) Oral Glucose Tolerance Test Blood Glucose(mmol/L) Good Declining Poor Minutes after 75g glucose drink

11 3) MRI 4) DAILY PHYSICAL ACTIVITY

12 Parameter (n=11) exercise (n=12) P value Number (males:females) 8:3 1:2 Age (years) 59 ± 9 61 ± 9.72 BMI (kg/m 2 ) 32 ± 6 31 ± SBP (mmhg) 142 ± ± DBP (mmhg) 85 ± 1 88 ± HbA1c (mmol/mol)(%) 55 ± 6 (7 ±.5) 54 ± 11 (7 ± 1).883 Fasting glucose (mmol/l) 7. ± ± hour glucose (mmol/l) 11.7 ± ± IHL (%) 7.1 ± ± Diagnosis (yr) 5 (3) 5 (3) Medications Metformin Statins BP Baseline characteristics

13 Glucose 6 4 HbA1c change (mmol/mol) exercise 2hr glucose change (mmol/l) exercise p<.5 between group difference

14 3 Body weight Weight change (kg) * * -3 exercise Blood lipids: No change in blood Triglyceride or Total Cholesterol

15 Liver fat 1 8 * liver fat (%) 6 4 NAFLD 2 39% pre exercise post * p<.5 within and between group difference

16 2)Liver fat Intrahepatic lipid (%) mmol/mol -3mmol/mol +6 mmol/mol -14mmol/mol Intrahepatic lipid (%) Exercise s Δ Hba1c: r=.7, p=. Δ fasting glucose:r=.45, p=.3 Δ 2-hr glucose: r=.57, p=.4

17 Cardiac structure Left ventricular mass change (g) * exercise End-diastolic volume change (ml) * exercise * p<.5 within group difference p<.5 between group difference

18 Systolic function Stroke volume change (ml) * exercise Ejection fraction change (%) * exercise * p<.5 within group difference p<.5 between group difference

19 Diastolic function Early diastolic filling rate change (ml/s) * exercise * p<.5 within group difference p<.5 between group difference

20 2 Cardiac torsion Peak torsion change (⁰) * exercise * p<.5 within group difference p<.5 between group difference

21 Daily physical activity 1 Daily energy expenditure (Kcal) exercise

22 HIIT. reduces liver fat improves cardiac structure improves cardiac function in Type 2 diabetes

23 Magnetic resonance Centre, Newcastle -Roy Taylor -Kieren Hollingsworth -Radiographers

24 HIIT. reduces liver fat improves cardiac structure improves cardiac function in Type 2 diabetes