title: Effects of physical activity and exercise training on cardiovascular risk in coronary artery disease patients with and without type 2 diabetes.
abstract: OBJECTIVE
  Leisure-time physical activity (LTPA) and exercise training are essential parts of current guidelines for patients with coronary artery disease (CAD). However, the contributions of LTPA and exercise training to cardiovascular (CV) risk in CAD patients with type 2 diabetes (T2D) are not well established.
  
  
  METHODS
  We examined the effects of LTPA (n = 539 and n = 507; with and without T2D, respectively) and 2-year controlled, home-based exercise training (n = 63 plus 64 control subjects with T2D and n = 72 plus 68 control subjects without T2D) on the CV risk profile and composite end point among CAD patients.
  
  
  RESULTS
  During the 2-year follow-up, patients with reduced LTPA at baseline had an increased risk of CV events (adjusted hazard ratio 2.3 [95% CI 1.1-5.1; P = 0.033], 2.1 [1.1-4.2; P = 0.027], and 2.0 [1.0-3.9; P = 0.044] for no LTPA, LTPA irregularly, and LTPA two to three times weekly, respectively) compared with those with LTPA more than three times weekly. Among patients who completed the 2-year exercise intervention, exercise training resulted in favorable changes in exercise capacity both in CAD patients with T2D (+0.2 ± 0.8 vs. -0.1 ± 0.8 MET, P = 0.030) and without T2D (+0.3 ± 0.7 vs. -0.1 ± 0.5 MET, P = 0.002) as compared with the control group but did not have any significant effects on major metabolic or autonomic nervous system risk factors in CAD patients with or without T2D.
  
  
  CONCLUSIONS
  There is an inverse association between habitual LTPA and short-term CV outcome, but controlled, home-based exercise training has only minor effects on the CV risk profile in CAD patients with T2D.
authors.affiliation: Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: Jaana J
authors.initials: JJ
authors.lastname: Karjalainen
authors.affiliation: Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland.
authors.forename: Antti M
authors.initials: AM
authors.lastname: Kiviniemi
authors.affiliation: Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland.
authors.forename: Arto J
authors.initials: AJ
authors.lastname: Hautala
authors.affiliation: Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Piira
authors.affiliation: Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: E Samuli
authors.initials: ES
authors.lastname: Lepojärvi
authors.affiliation: Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: Juha S
authors.initials: JS
authors.lastname: Perkiömäki
authors.affiliation: Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
authors.affiliation: Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.affiliation: Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland Department of Applied Sciences, London South Bank University, London, U.K. mikko.tulppo@verve.fi.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Tulppo
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002319:Cardiovascular System / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D012307:Risk Factors