TY - JOUR

T1 - Cerebral vs. Cardiovascular Responses to Exercise in Type 2 Diabetic Patients

AU - Kim, Yu Sok

AU - van der Ster, Björn J.P.

AU - Brassard, Patrice

AU - Secher, Niels H.

AU - van Lieshout, Johannes J.

N1 - Funding Information: BS is supported by an educational grant from Edwards Lifesciences (2010B0797). Publisher Copyright: © Copyright © 2021 Kim, van der Ster, Brassard, Secher and van Lieshout.

PY - 2021/1/15

Y1 - 2021/1/15

N2 - The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for “central” fatigue during exhaustive exercise is addressed in relation to brain’s attenuated vascular response to exercise in type 2 diabetic subjects.

AB - The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for “central” fatigue during exhaustive exercise is addressed in relation to brain’s attenuated vascular response to exercise in type 2 diabetic subjects.

KW - cardiac output

KW - cerebral blood flow

KW - cerebral metabolism

KW - cerebral oxygenation

KW - diabetes

KW - vascular conductance

U2 - 10.3389/fphys.2020.583155

DO - 10.3389/fphys.2020.583155

M3 - Review

C2 - 33519500

AN - SCOPUS:85100201399

VL - 11

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

M1 - 583155

ER -