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Superior effects of high-intensity interval versus moderate-intensity continuous training on endothelial function and cardiorespiratory fitness in patients with type 1 diabetes: a randomized controlled trial
Boff W, da Silva AM, Farinha JB, Rodrigues-Krause J, Reischak-Oliveira A, Tschiedel B, Punales M, Bertoluci MC
Frontiers in Physiology 2019 Apr 24;10(450):Epub
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

This study aimed to compare the effect of high-intensity interval training (HIIT) with moderate-intensity continuous training (MCT) on endothelial function, oxidative stress and clinical fitness in patients with type 1 diabetes. Thirty-six type 1 diabetic patients (mean age 23.5 +/- 6 years) were randomized into 3 groups: HIIT, MCT, and a non-exercising group (CON). Exercise was performed in a stationary cycle ergometers during 40 min, 3 times/week, for 8 weeks at 50 to 85% maximal heart rate (HRmax) in HIIT and 50% HRmax in MCT. Endothelial function was measured by flow-mediated dilation (FMD) (endothelium-dependent vasodilation (EDVD)), and smooth-muscle function by nitroglycerin-mediated dilation (endothelium-independent vasodilation (EIVD)). Peak oxygen consumption (VO2peak) and oxidative stress markers were determined before and after training. Endothelial dysfunction was defined as an increase < 8% in vascular diameter after cuff release. The trial is registered at ClinicalTrials.gov, identifier NCT03451201. Twenty-seven patients completed the 8-week protocol, 9 in each group (3 random dropouts per group). Mean baseline EDVD was similar in all groups. After training, mean absolute EDVD response improved from baseline in HIIT +5.5 +/- 5.4% (p = 0.0059), but remained unchanged in MCT 0.2 +/- 4.1% (p = 0.8593) and in CON -2.6 +/- 6.4% (p = 0.2635). EDVD increase was greater in HIIT versus MCT (p = 0.0074) and CON (p = 0.0042) (ANOVA with Bonferroni). Baseline VO2peak was similar in all groups (p = 0.96). VO2peak increased 17.6% from baseline after HIIT (p = 0.0001), but only 3% after MCT (p = 0.055); no change was detected in CON (p = 0.63). EIVD was unchanged in all groups (p = 0.18). Glycemic control was similar in all groups. In patients with type 1 diabetes without microvascular complications, 8-week HIIT produced greater improvement in endothelial function and physical fitness than MCT at a similar glycemic control.

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