title: Heart Rate Dynamics after Exercise in Cardiac Patients with and without Type 2 Diabetes.
abstract: OBJECTIVE
  The incidence of cardiovascular events is higher in coronary artery disease patients with type 2 diabetes (CAD + T2D) than in CAD patients without T2D. There is increasing evidence that the recovery phase after exercise is a vulnerable phase for various cardiovascular events. We hypothesized that autonomic regulation differs in CAD patients with and without T2D during post-exercise condition.
  
  
  METHODS
  A symptom-limited maximal exercise test on a bicycle ergometer was performed for 68 CAD + T2D patients (age 61 ± 5 years, 78% males, ejection fraction (EF) 67 ± 8, 100% on β-blockade), and 64 CAD patients (age 62 ± 5 years, 80% males, EF 64 ± 8, 100% on β-blockade). Heart rate (HR) recovery after exercise was calculated as the slope of HR during the first 60 s after cessation of exercise (HRR(slope)). R-R intervals were measured before (5 min) and after exercise from 3 to 8 min, both in a supine position. R-R intervals were analyzed using time and frequency methods and a detrended fluctuation method (α(1)).
  
  
  RESULTS
  BMI was 30 ± 4 vs. 27 ± 3 kg m(2) (p < 0.001); maximal exercise capacity, 6.5 ± 1.7 vs. 7.7 ± 1.9 METs (p < 0.001); maximal HR, 128 ± 19 vs. 132 ± 18 bpm (p = ns); and HRR(slope), -0.53 ± 0.17 vs. -0.62 ± 0.15 beats/s (p = 0.004), for CAD patients with and without T2D, respectively. There was no differences between the groups in HRR(slope) after adjustment for METs, BMI, and medication (ANCOVA, p = 0.228 for T2D and, e.g., p = 0.030 for METs). CAD + T2D patients had a higher HR at rest than non-diabetic patients (57 ± 10 vs. 54 ± 6 bpm, p = 0.030), but no other differences were observed in HR dynamics at rest or in post-exercise condition.
  
  
  CONCLUSIONS
  HR recovery is delayed in CAD + T2D patients, suggesting impairment of vagal activity and/or augmented sympathetic activity after exercise. Blunted HR recovery after exercise in diabetic patients compared with non-diabetic patients is more closely related to low exercise capacity and obesity than to T2D itself.
authors.affiliation: Department of Exercise and Medical Physiology Verve, Oulu, Finland.
authors.forename: Victor R
authors.initials: VR
authors.lastname: Neves
authors.forename: Antti M
authors.initials: AM
authors.lastname: Kiviniemi
authors.forename: Arto J
authors.initials: AJ
authors.lastname: Hautala
authors.forename: Jaana
authors.initials: J
authors.lastname: Karjalainen
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Piira
authors.forename: Aparecida M
authors.initials: AM
authors.lastname: Catai
authors.forename: Timo H
authors.initials: TH
authors.lastname: Mäkikallio
authors.forename: Heikki Veli
authors.initials: HV
authors.lastname: Huikuri
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Tulppo