Evaluating Exercise Capacity and Heart Rate Recovery in Diabetic Type II Patients

Document Type : Original Article


1 Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Iran

2 MD, General Practitioner, Hormozgan University of Medical Sciences, Bandarabass, Iran,

3 Sport sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

4 Clinical Research development center, Najafabad branch,Islamic Azad University, Najafabad, Iran

5 Health Information Technology Department, Ferdows school of paramedical and health, Birjand University of Medical Sciences, Birjand, Iran.


Introduction: Type 2 diabetes is a chronic disease with an increase in microvascular risks such as retinopathy and neuropathy. According to cardiac neuropathy in diabetic patients and the high prevalence of diabetes, the current study is designed to evaluate heart rate recovery and exercise capacity in diabetic versus healthy individuals. . Methods: This clinical study was performed on 228 patients. The age, sex, weight, BMI, educational level, duration of disease, history of other medical disease and smoking, TG, LDL, CHOL, HDL, FBS, SBP, and DBP were listed in the checklist and were evaluated later. The SPSS software was used to analyze data statistically using t-test, Mann-Whitney, and Chi-Square tests. P>0.05 was considered significant.  Results: Mean Heart Rate Recovery, in the first mean, was 16.35 ± 10.56 in the study group and was 25.9 ± 13 in the control group (P=0.001). The mean heart rate during rest in the study group was 84.39 ± 13.5 and in the control group was 81.44 ± 14.27 beat/min (P=0.110). The mean Heart Rate Reserve in the study group was 48.43 ± 18.87 and in the control group was 57.8 ± 24.17 (P=0.001). Negative Chronotropic Incompetence was seen in 10 patients and 19 healthy individuals (P=0.048).  Conclusion: According to our results and previous studies, heart rate recovery in diabetic patients is significantly less than in healthy individuals. The risk of cardiovascular disease in these patients is higher versus healthy individuals, and according to this fact, they need periodic visits.


1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2005;28(Supplement 1):S37-S42.
2. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nature Reviews Disease Primers. 2015;1(1):15019.
3. Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Research and Clinical Practice. 2011;94(3):311-21.
4. Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
5. Leon BM, Maddox TM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6(13):1246-58.
6. Mishra A, Mishra C, Mohanty RR, Behera M, Mishra K. Heart rate recovery as a predictor of mortality with or without revascularization. Indian Heart J. 2009;61(1):74-9.
7. Snader Claire E, Marwick Thomas H, Pashkow Fredric J, Harvey Sharon A, Thomas James D, Lauer Michael S. Importance of Estimated Functional Capacity as a Predictor of All-Cause Mortality Among Patients Referred for Exercise Thallium Single-Photon Emission Computed Tomography: Report of 3,400 Patients From a Single Center. Journal of the American College of Cardiology. 1997;30(3):641-8.
8. Fang ZY, Sharman J, Prins JB, Marwick TH. Determinants of Exercise Capacity in Patients With Type 2 Diabetes. Diabetes Care. 2005;28(7):1643-8.
9. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-Rate Recovery Immediately after Exercise as a Predictor of Mortality. New England Journal of Medicine. 1999;341(18):1351-7.
10. Qiu S, Cai X, Sun Z, Li L, Zuegel M, Steinacker Juergen M, et al. Heart Rate Recovery and Risk of Cardiovascular Events and All‐Cause Mortality: A Meta‐Analysis of Prospective Cohort Studies. Journal of the American Heart Association.6(5):e005505.
11. Antelmi I, Chuang EY, Grupi CJ, Latorre MdRDdO, Mansur AJ. Heart rate recovery after treadmill electrocardiographic exercise stress test and 24-hour heart rate variability in healthy individuals. Arquivos brasileiros de cardiologia. 2008;90(6):413-8.
12. Töyry JP, Niskanen LK, Mäntysaari MJ, Länsimies EA, Uusitupa MI. Occurrence, Predictors, and Clinical Significance of Autonomic Neuropathy in NIDDM: Ten-Year Follow-Up From the Diagnosis. Diabetes. 1996;45(3):308-15.
13. Mark DB, Lauer MS. Exercise Capacity: The Prognostic Variable That Doesn’t Get Enough Respect. Circulation. 2003;108(13):1534-6.
14. McElroy PA, Janicki JS, Weber KT. Cardiopulmonary exercise testing in congestive heart failure. The American Journal of Cardiology. 1988;62(2):35A-40A.
15. Karjalainen JJ, Kiviniemi AM, Hautala AJ, Piira O-P, Lepojärvi ES, Perkiömäki JS, et al. Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes. Diabetes Care. 2015;38(4):706-15.
16. Cheng YJ, Lauer MS, Earnest CP, Church TS, Kampert JB, Gibbons LW, et al. Heart Rate Recovery Following Maximal Exercise Testing as a Predictor of Cardiovascular Disease and All-Cause Mortality in Men With Diabetes. Diabetes Care. 2003;26(7):2052-7.
17. Shafie D, Sadeghi M, Hashemi M, Heydarpour M, Aghababaei E, Tallaei M, et al. Evaluation of Heart Rate Recovery and Exercise Capacity in Individuals with and without Metabolic Syndrome. Journal of Isfahan Medical School. 2011;28(115):11.
18. Chacko KM, Bauer TA, Dale RA, Dixon JA, Schrier RW, Estacio RO. Heart rate recovery predicts mortality and cardiovascular events in patients with type 2 diabetes. Med Sci Sports Exerc. 2008;40(2):288-95.
19. Georgoulias P, Demakopoulos N, Orfanakis A, Xydis K, Xaplanteris P, Vardas P, et al. Evaluation of abnormal heart-rate recovery after exercise testing in patients with diabetes mellitus: Correlation with myocardial SPECT and chronotropic parameters. Nuclear Medicine Communications. 2007;28(3):165-71.
20. Turker Y, Aslantas Y, Aydin Y, Demirin H, Kutlucan A, Tibilli H, et al. Heart rate variability and heart rate recovery in patients with type 1 diabetes mellitus. Acta Cardiologica. 2013;68(2):145-50.
Volume 3, Issue 1
March 2022
Pages 11-14
  • Receive Date: 24 October 2021
  • Revise Date: 22 December 2021
  • Accept Date: 01 March 2022
  • First Publish Date: 01 March 2022