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Older persons with diabetes have a harder time maintaining blood pressure when standing up. When blood pressure drops when standing up, fainting may occur. This study will see how regular exercise can improve the ability of the body to keep blood pressure up when standing. We want to see how this improvement varies with a home-based walking program.
Detailed Summary
PURPOSE: Older adults with diabetes faint frequently, due to an impairment in the cardiovascular control mechanisms (arterial baroreceptor function, autonomic nervous system function and cerebral autoregulation) that prevent syncope. The purpose of this study is to examine the ability of a home based walking program to reverse these impairments.
HYPOTHESES: a) A home-based walking program will improve the compensatory cardiovascular responses that prevent syncope in older adults with Type 2 diabetes. A moderate, regular exercise program will:
increase arterial baroreflex sensitivity
increase heart rate variability (marker of autonomic nervous system function)
decrease cerebrovascular resistance
improve cerebral autoregulation during upright tilt. b) There will be relationship between the improvement in compensatory cardiovascular responses and regular exercise.
c) Design of more practicable training prescriptions than that used in a research setting.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Phase; Exercise Phase | Other | Participants act as their own control. Control Phase: Participants will not change their activity during the 3 month control phase (defined as no strength training and less than 30 minutes brisk walking/moderate exercise per week, no vigorous exercise) Baseline measures will be obtained. Exercise Phase: This phase will consist of a Titration phase followed by an Intervention Phase. During the Titration phase, under the guidance of a trainer, subjects will increase their number of steps by 20% per week until they have reached 10,000 steps or 3 months have passed. During the Intervention Phase subjects will continue to walk 10,000 steps (or the number of steps they reached in the Titration phase). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Control Phase; Exercise Phase | Behavioral | After the completion of the control phase and at the start of the titration phase of the study, participants will be given pedometers and log books, then contacted on a regular basis to help insure compliance with the goal of walking 10,000 steps per day. |
| Measure | Description | Time Frame |
|---|---|---|
| Pulse wave velocity (central and peripheral) | Measured at Baseline, 3 months after control phase and after 3 months of Intervention phase | |
| Drop in middle cerebral artery velocity with upright tilting | Measured at Baseline, 3 months after control phase and after 3 months of Intervention phase | |
| Drop in blood pressure with upright tilt | Measured at Baseline, 3 months after control phase and after 3 months of Intervention phase | |
| Arterial baroreflex sensitivity | Measured at Baseline, 3 months after control phase and after 3 months of Intervention phase |
| Measure | Description | Time Frame |
|---|---|---|
| Fasting blood glucose, HgbA1C | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. | |
| VO2max | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kenneth Madden | University of British Columbia | Principal Investigator |
| Karim Miran-Khan | University of British Columbia | Study Director |
| Janet McElhaney | University of British Columbia | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VITALiTY Research Centre - VGH Research Pavilion | Vancouver | British Columbia | V5Z 1M9 | Canada | ||
| Dr. Scott Lear's Lab, Simon Fraser University, Harbour |
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| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D007024 | Hypotension, Orthostatic |
| D003924 | Diabetes Mellitus, Type 2 |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
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|
| Dynamometry measures of muscle strength | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Resting and maximal heart rate | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Waist to hip ratio, BMI | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Lean body mass/% fat | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Catecholamines | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Increase in Gosling's pulsatility index | Measured at Baseline, 3 month after control phase and after 3 months of Intervention phase. |
| Vancouver |
| British Columbia |
| V6B 5K3 |
| Canada |
| D054971 | Orthostatic Intolerance |
| D054969 | Primary Dysautonomias |
| D001342 | Autonomic Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D007022 | Hypotension |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D001519 | Behavior |