Diabetic Cardiomyopathy and the Role of Regular Exercise in Preventing the Disease: A Review

Abstract

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting over 450 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose level beyond physiological range or hyperglycaemia (HG), which in turn leads to a number of long-term complications, including diabetic cardiomyopathy (DC) over time. Around 80% of all diabetics will eventually die from DC. If left untreated, DC has been shown to be a critical factor in HF, independent of atherosclerosis, hypertension and valvular malfunction. The inability to maintain glucose homeostasis in the myocardium compromises cardiac structure and function in human diabetic subjects and also in animals with experimental diabetes. Daily exercise is known to protect the heart from sudden cardiac death. Exercise training (ET) is a beneficial non-pharmacological intervention for the treatment of cardiovascular diseases (CVDs). ET can induce cardio-protection in normal hearts and also in a partially diseased heart through a range of molecular mechanisms. The cardio-protective effect of ET is associated with the improvement of antioxidant capacity, mitochondrial viability and it can activate physiological cardiac growth, which are all mediated via distinct cellular and molecular mechanisms compared to those in pathological hypertrophy. Beneficial cardiac protection following regular ET in diabetes has been reported in both clinical and experimental animal studies. ET is a cost-effective strategy for prevention and treatment DC. However, the cellular and molecular mechanisms underlying DC and HF in diabetes and how regular exercise can reverse the pathology are not fully clear and further research should be carried out.