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

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

1) Concentric remodelling 1.2 * Eccentricity ratio (g/ml)) 1.8.6 Type 2 diabetes Type 2 diabetes 2) 2.5 2 Diastolic dysfunction A E/A (ml/s) 1.5 1.5 * E 3) 9 Cardiac torsion Peak torsion ( ) 8 7 6 5 *p<.5 Cassidy et al. 215 (Cardiovasc Diab)

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)

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

Background: High intensity intermittent training (HIIT)

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

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

Exercise intervention + + 12 weeks 3 sessions per week

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

Study Visits 1) Maximal exercise screening test 2) Oral Glucose Tolerance Test Blood Glucose(mmol/L) 14 12 1 8 6 4 2 Good Declining Poor Minutes after 75g glucose drink

3) MRI 4) DAILY PHYSICAL ACTIVITY

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 ± 5.712 SBP (mmhg) 142 ± 14 141 ± 18.921 DBP (mmhg) 85 ± 1 88 ± 12.66 HbA1c (mmol/mol)(%) 55 ± 6 (7 ±.5) 54 ± 11 (7 ± 1).883 Fasting glucose (mmol/l) 7. ± 1. 6.8 ± 1.6.693 2-hour glucose (mmol/l) 11.7 ± 3.1 12.5 ± 3.1.566 IHL (%) 7.1 ± 6.8 6.9 ± 6.9.938 Diagnosis (yr) 5 (3) 5 (3) Medications Metformin Statins BP Baseline characteristics 7 6 5 7 7 3

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

3 Body weight Weight change (kg) 2 1-1 -2 * * -3 exercise Blood lipids: No change in blood Triglyceride or Total Cholesterol

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

2)Liver fat Intrahepatic lipid (%) 25 2 15 1 5-12mmol/mol -3mmol/mol +6 mmol/mol -14mmol/mol Intrahepatic lipid (%) 25 2 15 1 5 Exercise s Δ Hba1c: r=.7, p=. Δ fasting glucose:r=.45, p=.3 Δ 2-hr glucose: r=.57, p=.4

Cardiac structure Left ventricular mass change (g) 2 1-1 -2 * exercise End-diastolic volume change (ml) 15 1 5-5 -1-15 * exercise * p<.5 within group difference p<.5 between group difference

Systolic function Stroke volume change (ml) 15 1 5-5 -1-15 * exercise Ejection fraction change (%) 8 4-4 -8 * exercise * p<.5 within group difference p<.5 between group difference

Diastolic function Early diastolic filling rate change (ml/s) 8 6 4 2 * exercise * p<.5 within group difference p<.5 between group difference

2 Cardiac torsion Peak torsion change (⁰) 1-1 -2 * exercise * p<.5 within group difference p<.5 between group difference

Daily physical activity 1 Daily energy expenditure (Kcal) -3-7 -11-15 exercise

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

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

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