Effect of exercise training on metabolism and atherosclerosis in patients with diabettus mellitus and coronary artery diseases.

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Adiponectin plays an important role in the metabolic syndrome and insulin sensitivity. To investigate its clinical roles, the relationships of plasma adiponectin levels with blood sugar and exercise capacity were studied in patients with coronary artery diseases, who have diabetes mellitus, hypertension, and/or obesity. The effects of cardiac rehabilitation on plasma adiponectin, exercise capacity, and exhaled nitric oxide output were also evaluated. The plasma adiponectin level was low (8.1±5.9 [mean±SD] μg/ml) in these patients. Their body mass index was 25.4±3.1. They had higher levels of fasting blood sugar (126±39 mg/dl) and HbAlc (5.9±1.2 %). Peak oxygen uptake was moderately decreased (68±12 % of predicted normal values). Cardiac rehabilitation increased plasma adiponectin level from 14.3±2.0 to 16.1±2.1 μg/ml (p<0.05) in the training group, but not in the non-training group. Cardiac rehabilitation increased peak oxygen uptake and anaerobic threshold in the training group, but not in the non-training group. Cardiac rehabilitation also increased exhaled nitric oxide output at peak exercise in the training group, but not in the non-training group. Plasma adiponectin level was decreased in patients with coronary artery diseases, and this was due to the high existence of obesity and diabetes mellitus in these patients. Exercise capacity such as peak oxygen uptake and anaerobic threshold was decreased in these subjects, and mall amount of exercise in daily activities plays an important role in the lower level of plasma adiponectin. Cardiac rehabilitation increased plasma adiponectin level with the simultaneous increase in exercise capacity. Cardiac rehabilitation also increased exhaled nitric oxide output during exercise, suggesting that it improved endothelium function. The beneficial effect of exercise training on plasma adiponectin level may play important role in the improvement of insulin resistance in these patients.