The Relative Efficacy of Land-Based and Water-Based Exercise Training on Macro- and Microvascular Functions in Older Patients With Type 2 Diabetes

in Journal of Aging and Physical Activity
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $76.00

1 year subscription

USD  $101.00

Student 2 year subscription

USD  $144.00

2 year subscription

USD  $189.00

Microvascular and macrovascular dysfunction plays an important role in the pathogenesis of diabetic vascular disease. Twenty-nine older patients with type 2 diabetes were randomly assigned into the land-based (LB; n = 14) or water-based (WB; n = 15) groups. Both groups completed supervised aerobic cycling exercises three times per week for 12 weeks. The WB group performed cycling exercise training in warm water (36 °C) immersed to the hip level. After 12 weeks, blood glucose concentration and insulin resistance did not change but hemoglobin A1c levels decreased (P < .05) in both groups. Plasma nitric oxide concentrations increased (P < .05) in both groups. Flow-mediated dilation in the popliteal artery increased and arterial stiffness decreased (P < .05) in both exercise groups. Indices of microvascular reactivity improved (P < .05) only in the WB group. The benefits of warm water-based training were similar in general, and superior in some measures, to the more established land-based cycling exercise.

Suntraluck and Suksom are with the Faculty of Sports Science, Chulalongkorn University, Bangkok, Thailand. Tanaka is with the Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX.

Address author correspondence to Daroonwan Suksom at daroonwanc@hotmail.com.
  • Almdal, T., Scharling, H., Jensen, J.S., & Vestergaard, H. (2004). The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13, 000 men and women with 20 years of follow-up. Archives of Internal Medicine, 164(13), 1422–1426. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • American Diabetes Association. (2015). Standards of medical care in diabetes--2015: summary of revisions. Diabetes Care, 38(Suppl), 4. PubMed doi:

  • Asa, C., Maria, S., Katharina, S.S., & Bert, A. (2012). Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evidence-Based Complementary and Alternative Medicine, 2012, 349209. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aso, K., Miyata, M., Kubo, T., Hashiguchi, H., Fukudome, M., Fukushige, E., … Tei, C. (2003). Brachial-ankle pulse wave velocity is useful for evaluation of complications in type 2 diabetic patients. Hypertension Research, 26(10), 807–813. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ayme, K., Gavarry, O., Rossi, P., Desruelle, A.V., Regnard, J., & Boussuges, A. (2014). Effect of head-out water immersion on vascular function in healthy subjects. Applied Physiology, Nutrition, and Metabolism, 39(4), 425–431. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bergamin, M., Ermolao, A., Matten, S., Sieverdes, J.C., & Zaccaria, M. (2015). Metabolic and cardiovascular responses during aquatic exercise in water at different temperatures in older adults. Research Quarterly for Exercise and Sport, 86(2), 163–171. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bergamin, M., Ermolao, A., Tolomio, S., Berton, L., Sergi, G., & Zaccaria, M. (2013). Water- versus land-based exercise in elderly subjects: effects on physical performance and body composition. Clinical Interventions in Aging, 8, 1109–1117. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Caballero, A.E., Arora, S., Saouaf, R., Lim, S.C., Smakowski, P., Park, J.Y., … Veves, A. (1999). Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes. Diabetes, 48(9), 1856–1862. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Christ-Roberts, C.Y., Pratipanawatr, T., Pratipanawatr, W., Berria, R., Belfort, R., Kashyap, S., & Mandarino, L.J. (2004). Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight nondiabetic and type 2 diabetic subjects. Metabolism, 53(9), 1233–1242. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Filippis, E., Cusi, K., Ocampo, G., Berria, R., Buck, S., Consoli, A., & Mandarino, L.J. (2006). Exercise-induced improvement in vasodilatory function accompanies increased insulin sensitivity in obesity and type 2 diabetes mellitus. The Journal of Clinical Endocrinology and Metabolism, 91(12), 4903–4910. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dupont, W.D., & Plummer, W.D. (1997). PS Power and sample size program available for free on the Internet. Controlled Clinical Trials, 18, 274. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Green, D.J., Carter, H.H., Fitzsimons, M.G., Cable, N.T., Thijssen, D.H., & Naylor, L.H. (2010). Obligatory role of hyperaemia and shear stress in microvascular adaptation to repeated heating in humans. The Journal of Physiology, 588(Pt 9), 1571–1577. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Henry, R.M., Ferreira, I., Kostense, P.J., Dekker, J.M., Nijpels, G., Heine, R.J., … Stehouwer, C.D. (2004). Type 2 diabetes is associated with impaired endothelium-dependent, flow-mediated dilation, but impaired glucose metabolism is not; The Hoorn study. Atherosclerosis, 174(1), 49–56. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jaruchart, T., Suwanwela, N.C., Tanaka, H., & Suksom, D. (2016). Arterial stiffness is associated with age-related differences in cerebrovascular conductance. Experimental Gerontology, 73, 59–64. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kelley, D.E., & Goodpaster, B.H. (2001). Effects of exercise on glucose homeostasis in Type 2 diabetes mellitus. Medicine and Science in Sports and Exercise, 33(Suppl6), S495–501. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kendzierski, D., & DeCarlo, K.J. (1991). Physical activity enjoyment scale: two validation studies. Journal of Sport and Exercise Psychology, 13, 50–64. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F., & Turner, R.C. (1985). Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28(7), 412–419. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mitranun, W., Deerochanawong, C., Tanaka, H., & Suksom, D. (2014). Continuous vs interval training on glycemic control and macroand microvascular reactivity in type 2 diabetic patients. Scandinavian Journal of Medicine and Science in Sports, 24, e69–e76. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Naidu, O.A., Rajasekhar, D., & Latheef, S. (2011). Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovascular Ultrasound, 9(1), 1–5. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nishiyama, S.K., Walter Wray, D., Berkstresser, K., Ramaswamy, M., & Richardson, R.S. (2007). Limb-specific differences in flow-mediated dilation: the role of shear rate. Journal of Applied Physiology, 103(3), 843–851. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nuttamonwarakul, A., Amatyakul, S., & Suksom, D. (2014). Effects of water-based versus land-based exercise training on cutaneous microvascular reactivity and c-reactive protein in older women with type 2 diabetes mellitus. Journal of Exercise Physiology, 17(4), 27–33.

    • Search Google Scholar
    • Export Citation
  • Petrofsky, J., Lohman, E., Lee, S., de la Cuesta, Z., Labial, L., Iouciulescu, R., … Malty, A.A. (2007). The effects of aging on the skin blood response to warm, cold, and contrast warm and cold baths. Physical and Occupational Therapy in Geriatrics, 25(3), 19–33. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Quattrini, C., Harris, N.D., Malik, R.A., & Tesfaye, S. (2007). Impaired skin microvascular reactivity in painful diabetic neuropathy. Diabetes Care, 30(3), 655–659. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Roberts, A.C., & Porter, K.E. (2013). Cellular and molecular mechanisms of endothelial dysfunction in diabetes. Diabetes and Vascular Disease Research, 10(6), 472–482. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sandeman, D.D., Pym, C.A., Green, E.M., Seamark, C., Shore, A.C., & Tooke, J.E. (1991). Microvascular vasodilatation in feet of newly diagnosed non-insulin dependent diabetic patients. British Medical Journal, 302(6785), 1122–1123. PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sena, C.M., Pereira, A.M., & Seica, R. (2013). Endothelial dysfunction - a major mediator of diabetic vascular disease. Biochimica et Biophysica Acta, 1832(12), 2216–2231. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tanaka, H. (2009). Swimming exercise: impact of aquatic exercise on cardiovascular health. Sports Medicine, 39(5), 377–387. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Umpierre, D., Ribeiro, P.A., Kramer, C.K., Leitao, C.B., Zucatti, A.T., Azevedo, M.J., … Schaan, B.D. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. Journal of the American Medical Association, 305(17), 1790–1799. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walter, M.F., Jacob, R.F., Jeffers, B., Ghadanfar, M.M., Preston, G.M., Buch, J., & Mason, R.P. (2004). Serum levels of thiobarbituric acid reactive substances predict cardiovascular events in patients with stable coronary artery disease: a longitudinal analysis of the PREVENT study. Journal of the American College of Cardiology, 44(10), 1996–2002. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wang, Y., Simar, D., & Fiatarone Singh, M.A. (2009). Adaptations to exercise training within skeletal muscle in adults with type 2 diabetes or impaired glucose tolerance: a systematic review. Diabetes/Metabolism Research and Reviews, 25(1), 13–40. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yokoyama, H., Emoto, M., Fujiwara, S., Motoyama, K., Morioka, T., Koyama, H., … Nishizawa, Y. (2004). Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Research and Clinical Practice, 65(2), 85–93. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zoppini, G., Targher, G., Zamboni, C., Venturi, C., Cacciatori, V., Moghetti, P., & Muggeo, M. (2006). Effects of moderate-intensity exercise training on plasma biomarkers of inflammation and endothelial dysfunction in older patients with type 2 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 16(8), 543–549. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 199 199 22
Full Text Views 12 12 0
PDF Downloads 9 9 0