점진적 운동시 제2형 당뇨병 환자의 심혈관 자율신경장애 정도에 따른 심혈관계 반응
Cardiovascular Response to Incremental Exercise in Type 2 Diabetic Patients with The Different Severity of Cardiac Autonomic Neuropathy
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당뇨병성 심혈관계 자율신경장애(cardiovascular autonomic neuropathy: CAN)는 손상된 교감신경과 부교감신경계에 의해 개인의 운동능력이 제한되어진다. 이 연구는 자전거 에르고미터에서의 점진적 운동시 제2형 당뇨병 환자의 CAN의 정도에 따른 심혈관계 반응의 차이를 알아보는 데 그 목적이 있다. 총 65명의 제2형 당뇨병 환자를 대상으로 신체구성성분, 혈액검사, 운동부하검사, 심혈관계 자율신경증 검사를 실시하였으며, 심호흡에 의한 동성부정맥, 체위변동에 따른 심박동수의 변화, 발살바 수기에 의한 심박동수의 변화에 따라 자율신경 기능지수를 기초로 정상군 13명, 초기 장애군 19명, 그리고 장애군 33명으로 분류하였다. 무산소성역치 시점에서 최대운동 시점 간에 장애군은 정상군과 초기 장애군에 비해 낮은 심박수를 나타내었으며(p<.001), 최대산소섭취량과 MET으로 나타내는 운동능력은 장애군에서 유의한 감소를 나타내었다(p<0.01). 그러나 %최대심박수와 %최대심박수예비량은 유의한 집단간 차이를 나타내지 못하였다. 자율신경기능 점수는 최대운동시 심박수(r=-.425, p<.001)와 산소섭취량(r=-.240, p<.05)과 유의한 음의 상관관계를 나타내었다. 비록 자율신경장애가 당뇨환자의 운동수행능력에 큰 영향을 주지 않는다고 할지라도 운동처방을 위한 심박수의 적용은 자율신경장애를 가지고 있는 당뇨환자를 위해 적절하게 고려되어져야 할 것으로 사료된다.
Abstract
In diabetic individuals with cardiac autonomic neuropathy (CAN), exercise tolerance is limited as a result of impaired parasympathetic/sympathetic responses. We investigated influence of autonomic neuropathy of different severity on cardiovascular response during incremental exercise. Sixteen five type 2 diabetic patients were divided into Definitive CAN (n=33), Early CAN (n=19) and without CAN (n=13) based on the score by CAN tests including heart rate variability during deep breathing, valsalva maneuver, and 30:15 ratio. All the subjects underwent incremental exercise test using a cycle-ergometer to estimate the rate of oxygen consumption (VO2), metabolic equivalent (MET), heart rate, percent HRmax, and percent HR reserve at the level of anaerobic threshold and maximum. Heart rate was significantly lower in Definite CAN than Early CAN (p<.001) and Normal (p<.05) both at anaerobic threshold and at maximum. Exercise capacity expressed as maximal oxygen consumption and MET at maximal exercise load was significantly decreased in Definite CAN patients (p<0.01). However, the significant differences among groups on %HRmax and %HRreserve were not observed. The total score of cardiac autonomic neuropathy correlated inversely with maximal increase in heart rate (r=-.425, p<.001) and VO2 (r=-.240, p<.05). These findings suggest that heart rate based exercise prescription might be cautiously considered for diabetics with Definite CAN, but not Early CAN, even though the presence of CAN does not affect their exercise capacity.
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