Influence of 3 Months Endurance Training on Red Cell Deformability in Non Insulin Dependent Type 2 Diabetes Mellitus Patients

Abstract

The main purpose of the study was to examine if 3 months of bicycle endurance training alters the red cell deformability in non insulin dependent type 2 diabetes mellitus men.

The red cell deformability was measured with the Laser assisted optical rotational cell analyzer. The maximal elongation index and the semimaximal shear stress were measured with the Lineweaver Burke model.

At the beginning and the end of the intervention the patients passed a bicycle ergometry test. As a reference group, 13 males without diabetes passed the same testing procedure. Blood samplings were taken before testing, immediately after physical exhaustion and after a 30 min recovery phase.

After the training period diabetic patients could significantly reduce BMI, fasting glucose and HbA_1c. The reference group had significantly higher elongation indices than the diabetes patients independent from training status. After the training period the basal values of the maximal elongation index did not change significantly. However, maximal elongation indices were significantly reduced after physical examination and in resting time.

The semimaximal shear stress of diabetes patients did not alter during the training period. In comparison to the reference group semimaximal shear stress was significantly reduced at all measurement times.

This pilot study proves that the maximal elongation index is significantly decreased in diabetes mellitus patients. After 3 months endurance training the red cells become more rigid while the semimaximal shear stress remains constant. Further interventions are required to analyze the exact cause of the presented findings.

Key words

physical activity - diabetic men - erythrocyte flexibility - bicycle ergometer - maximal elongation index - semimaximal shear stress

• References

• 1 Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010 87. 4-14
• 2 Hu G, Lindstrom J, Valle TT et al. Physical activity, body mass index, and risk of type 2 diabetes in patients with normal impaired glucose regulation. Arch Intern Med 2004; 164: 892-896
• 3 Babu N, Singh M. Influence of hyperglycemia on aggregation, deformability and shape parameters of erythrocytes. Clin Hemorheol Microcirc 2004; 31: 273-280
• 4 Babu N, Singh M. Analysis of aggregation parameters of erythrocytes in diabetes mellitus. Clin Hemorheol Microcirc 2005; 32: 269-277
• 5 Fornal M, Lekka M, Pyka-Fosciak G et al. Erythrocyte stiffness in diabetes mellitus studied with atomic force microscope. Clin Hemorheol Microcirc 2006; 35: 273-276
• 6 Starodubtseva MN, Kuznetsova TG, Yegorenkov NI et al. Structural and Mechanical Characteristics of Erythrocyte Membranes in Patients with Type 2 Diabetes Mellitus. Bull Exp Biol Med 2008; 145: 106-110
• 7 Petropoulos IK, Margetis PI, Antonelou MH et al. Structural alterations of the erythrocyte membrane proteins in diabetic retinopathy. Graefe´s Arch Clin Exp Ophtalmol 2007; 245: 1179-1188
• 8 Singh M, Shin S. Changes in erythrocyte aggregation and deformability in diabetes mellitus: a brief review. Indian J Exp Biol 2009; 47: 7-15
• 9 Mawatari S, Saito K, Murakami K et al. Absence of correlation between glycated hemoglobin and lipid composition of erythrocyte membrane in type 2 diabetic patients. Metabolism 2004; 53: 123-127
• 10 Caimi G, Lo Presti R, Montana M et al. Diabetes mellitus: mean erythrocyte aggregation, glycometabolic pattern, red cell Ca2+ content, and erythrocyte membrane dynamic properties. Microvasc Res 1993; 46: 401-405
• 11 Discher DE. New insights into erythrocyte membrane organization and microelasticity. Curr Opinion Hematol 2000; 7: 117-122
• 12 Picart C, Dalhaimer P, Discher DE. Actin protofilament orientation in deformation of the erythrocyte membrane skeleton. Biophys J 2000; 79: 2987-3000
• 13 Schwartz RS, Madsen JW, Rybicki AC et al. Oxidation of spectrin and deformability defects in diabetic erythrocytes. Diabetes 1991; 40: 701-708
• 14 Symeonidis A, Athanassiou G, Psiroyannis A et al. Impairment of erythrocyte viscoelasticity is correlated with levels of glycosylated haemoglobin in diabetic patients. Clin Lab Haem 2001; 23: 103-109
• 15 Béder K, Maëae JE, Ársky J et al. Effect of selected substances with antiglycative and antioxidative properties on erythrocyte deformability in diabetic patients. Scripta Medica (BRNO) 2002; 75: 239-244
• 16 Resmi H, Iya H, Aysegu A et al. In vitro effects of high glucose concentrations on membrane protein oxidation, G-actin and deformability of human erythrocytes. Cell Biochem Funct 2005; 23: 163-168
• 17 Keymel S, Heiss C, Kleinbongard P et al. Impaired red cell deformability in patients with coronary artery disease and diabetes mellitus. Horm Metab Res 2011; 43: 760-765
• 18 Venerando B, Fiorilli A, Croci G et al. Acidic and neutral sialidase in the erythrocyte membrane of type 2 diabetic patients. Blood 2002; 99: 1064-1070
• 19 Cinara L, Bollini A, Gayol MC et al. In vitro effect of insulin on rats erythrocytes rheological behavior. Clin Hemorheol Microcirc 2006; 35: 367-373
• 20 Kaymaz AA, Tamer S, Albeniz I et al. Alterations in rheological properties and erythrocyte membrane proteins in cats with diabetes mellitus. Clin Hemorheol Microcirc 2005; 33: 81-88
• 21 Shin S, Ku YH, Ho JX et al. Progressive impairment of erythrocyte deformability as indicator of microangiopathy in type 2 diabetes mellitus. Clin Hemorheol Microcirc 2007; 36: 253-261
• 22 American Diabetes Association . Standards of medical care in diabetes 2010. Diabetes Care 2010; 33: 11-61
• 23 Boulé NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218-1227
• 24 Galbo H, Tobin L, van Loon LJ. Responses to acute exercise in type 2 diabetes, with an emphasis on metabolism and interaction with oral hypoglycemic agents and food intake. Appl Physiol Nutr Metab 2007; 32: 567-575
• 25 Ramachandran A, Snehalatha C, Mary S et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian Subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006; 49: 289-297
• 26 Donelly JE, Blair SN, Jakicic JM et al. American College of Sports Medicine. Position Stand: appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41: 459-471
• 27 Umpierre D, Ribeiro PA, Kramer CK et al. Physical activity advice only or structured exercise training and association with HbA_1c levels in type 2 diabetes: a systematic review and metaanalysis. JAMA 2011; 305: 1790-1799
• 28 Kokkinos P. Physical Activity, Health Benefits, and Mortality Risk. ISRN Cardiology. 2012 DOI: 10.5402/2012/718789
• 29 Brun JF, Varlet-Marie E, Cassan D et al. Blood fluidity is related to the ability to oxidize lipids at exercise. Clin Hemorheol Microcirc 2004; 30: 339-343
• 30 Yalcin O, Bor-Kucukatay M, Senturk UK et al. Effects of swimming exercise on red blood rheology in trained and untrained rats. J Appl Physiol 2000; 88: 2074-2080
• 31 Varlet-Marie E, Brun JF. Reciprocal relationships between blood lactate and hemorheology in athletes: another hemorheologic paradox?. Clin Hemorheol Microcirc 2004; 30: 331-337
• 32 Muravyov AV, Draygin SV, Eremin NN et al. The microrheological behavior of young and old red blood cells. Clin Hemorheol Microcirc 2002; 26: 183-188
• 33 Baskurt OK, Hardeman MR, Uyuklu M et al. Parameterization of red blood cell elongation index – shear stress curves obtained by ektacytometry. Scand J Clin Lab Investig 2009; 69: 777-788
• 34 Lapolla A, Calibro A, Gerhardinger L et al. Glycated erythrocyte membrane proteins and hemorheological parameters in IDDM subjects. Clin Hemorheol 1991; 11: 405-415
• 35 Vayá A, Bonet E, Romagnoli M et al. Erythrocyte deformability in macrocytosis is determined by means of ektacytometry techniques. Clin Hemorheol Microcirc 2010; 45: 27-33
• 36 Baynes JW. Role of oxidative stress in development of complications in diabetes. Diabetes 1991; 40: 405-412
• 37 Vayá A, Martínez Triguero M, Réganon E et al. Erythrocyte membrane composition in patients with primary hypercholesterolemia. Clin Hemorheol Microcirc 2008; 40: 289-294
• 38 Kilic Toprak E, Ardic F, Erken G et al. Hemorheological responses to progressive resistance training in healthy young males. Med Sci Monit 2012; 18: CR351-CR360
• 39 Ahmad B, Ferrari N, Montiel G et al. Influence of a moderate physical activity intervention on red cell deformability in patients suffering from chronic obstructive pulmonary disease (COPD). Wien Med Wochenschr DOI: 10.1007/s10354-013-0183-7.
• 40 Connes P, Bouix D, Py G et al. Opposite effects of in vitro lactate on erythrocyte deformability in athletes and untrained subjects. Clin Hemorheol Microcirc 2004; 31: 311-318
• 41 Smith JA, Telford RD, Kolbuch-Braddon M et al. Lactate/H+ uptake by red blood cells during exercise alters their physical properties. Eur J Appl Physiol Occup Physiol 1997; 75: 54-61
• 42 Cakir-Atabek H, Atsak P, Gunduz N et al. Effects of resistance training intensity on deformability and aggregation of red blood cells. Clin Hemorheol Microcirc 2009; 41: 251-261
• 43 Ernst E, Matrai A. Intermittent claudication, exercise, and blood rheology. Circulation 1987; 76: 1110-1112
• 44 Ernst E, Daburger L, Saradeth T. The kinetics of blood rheology during and after prolonged standardized exercise. Clin Hemorheol 1991; 11: 429-439