Superior Effects of High-Intensity Interval vs. Moderate-Intensity Continuous Training on Endothelial Function and Cardiorespiratory Fitness in Patients With Type 1 Diabetes: A Randomized Controlled Trial

Abstract

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 50-85% maximal heart rate (HR_max) in HIIT and 50% HR_max 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 (VO_2peak) 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%, (<i>P</i> = 0.0059), but remained unchanged in MCT: 0.2 ± 4.1% (<i>P</i> = 0.8593) and in CON: -2.6 ± 6.4% (<i>P</i> = 0.2635). EDVD increase was greater in HIIT vs. MCT (<i>P</i> = 0.0074) and CON (<i>P</i> = 0.0042) (ANOVA with Bonferroni). Baseline VO_2peak was similar in all groups (<i>P</i> = 0.96). VO_2peak increased 17.6% from baseline after HIIT (<i>P</i> = 0.0001), but only 3% after MCT (<i>P</i> = 0.055); no change was detected in CON (<i>P</i> = 0.63). EIVD was unchanged in all groups (<i>P</i> = 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.