Impaired heart rate variability, Valsalva and 30:15 ratio indexes are associated with reduced submaximal exercise capacity in subjects with diabetes mellitus

Aims: To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). Methods: Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. Results: Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms(2) (IQR: 18.6-35.4) vs. 45.1 (IQR: 39.2-62.67), p < 0.001] and Total Power [median 785 ms(2) (IQR: 256-1264) vs. 1757 ms(2) (IQR: 1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 +/- 6.4 vs. 95.2 +/- 11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (rho = -0.40), SDNN pre-6MWT (rho = 0.39), TP pre-6MWT (rho = 0.38), Valsalva ratio (rho = 0.39) and 30:15 ratio (rho = 0.38) were all correlated with maximal walked distance. Conclusions: DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30: 15 ratios), was associated with lower exercise capacity. (C) 2019 Elsevier B.V. All rights reserved.