F Pott

J. J. van Lieshout

JC Baldi

JD MacDougall

LM Fenicchia

M Miyachi

N. H. Secher

RB Panerai

RJ Sigal

RV Immink

S Ogoh

SFE Praet

Y. S. Kim

English

PubMed

Springer - Publisher Connector

Resistance exercise and control of cerebral blood flow in type 2 diabetes

Crossref

Kim, Y.S.

Secher, N.H.

van Lieshout, J.J.

International Migration, Integration and Social Cohesion online publications

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Resistance exercise and control of cerebral blood flow in type 2 diabetesKim, Y.S.; Secher, N.H.; van Lieshout, J.J.DOI10.1007/s00125-008-1068-yPublication date2008Document VersionFinal published versionPublished inDiabetologiaLink to publicationCitation for published version (APA):Kim, Y. S., Secher, N. H., & van Lieshout, J. J. (2008). Resistance exercise and control ofcerebral blood flow in type 2 diabetes. Diabetologia, 51(9), 1755-1756.https://doi.org/10.1007/s00125-008-1068-yGeneral rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:25 Jul 2022LETTERResistance exercise and control of cerebral blood flowin type 2 diabetesY. S. Kim & N. H. Secher & J. J. van LieshoutReceived: 21 April 2008 /Accepted: 20 May 2008 /Published online: 19 June 2008# The Author(s) 2008Keywords Blood pressure . Cerebral autoregulation .Cerebral circulation . Exercise . Transcranial DopplerTo the Editor: The challenge in diabetes care is to optimisemetabolic control to slow progression to vascular disease.In individuals with type 2 diabetes this may be achieved atleast in part by behavioural modification including regularphysical activity. In their recent article in Diabetologia,Praet and van Loon [1] comprehensibly and conciselyaddress the need for revision of the current guidelinesregarding the prescription of exercise for individuals withtype 2 diabetes, given the lack of information provided bycurrent exercise programmes on the preferred type andintensity of exercise.The combination of endurance and resistance exercisehas the potential to increase adherence and compliancerates, as it renders programmes more varied [1]. Loss ofskeletal muscle mass is one of the main factors responsiblefor the increase in the incidence of type 2 diabetes with age.Deconditioning (as a result of physical inactivity) andresistance exercise are associated with opposing adapta-tions. Resistance exercise provides better metabolic control[2], mitigates disuse-associated tendon stiffness andincreases skeletal muscle mass, which improves wholebody glucose disposal [3]. Not surprisingly, greater focuson resistance exercise has been recommended for type 2diabetes, specifically for the subgroup of sarcopenic orseverely deconditioned older patients [4].Resistance and endurance exercise have different car-diovascular effects. Resistance-type activities produce aconsiderably larger increase in arterial pressure, because ofthe mechanical compression of blood vessels together withrepeated Valsalva-like manoeuvres [5]. Unlike aerobicexercise, resistance training affects central arterial compli-ance in healthy men [6]. Although acute changes in arterialblood pressure during physiological challenges are trans-mitted to the cerebral circulation, under normal conditions,cerebral blood flow tends to return to its baseline valuewithin a few seconds [7]. Cerebral vasoconstrictionconstantly plays a protective role during exercise ofmoderate to heavy intensity, in particular when pulsepressure exceeds the autoregulatory range [8]. Whenautoregulatory mechanisms are failing or overwhelmed byacute blood pressure upsurges beyond the autoregulatoryrange (e.g. in serious hypertension), brain blood flowDiabetologia (2008) 51:1755–1756DOI 10.1007/s00125-008-1068-yY. S. KimDepartment of Internal Medicine, Academic Medical Center,University of Amsterdam,Amsterdam, the NetherlandsY. S. Kim : J. J. van LieshoutLaboratory for Clinical Cardiovascular Physiology,Heart Failure Research Center, Academic Medical Center,University of Amsterdam,Amsterdam, the NetherlandsN. H. SecherDepartment of Anesthesia, Rigshospitalet,University of Copenhagen,Copenhagen, DenmarkN. H. SecherThe Copenhagen Muscle Research Center,University of Copenhagen,Copenhagen, DenmarkJ. J. van Lieshout (*)Medium Care Unit, Department of Internal Medicine, F7-205,Academic Medical Center, University of Amsterdam,P.O. Box 22700, 1100 DE Amsterdam, the Netherlandse-mail: j.j.vanlieshout@amc.uva.nlbecomes directly related to its perfusion pressure, resultingin cerebral hyperperfusion manifested by retinal oedemaand encephalopathy [9].We consider the arterial pressure surges associated withresistance exercise to be substantial, heavily taxing cerebralautoregulatory mechanisms [10]. The integrity of the cerebralautoregulatory mechanisms protecting the brain is thereforeimportant under these conditions. To date, there is no directevidence indicating that resistance exercise is disadvanta-geous for individuals with type 2 diabetes. However, in theseindividuals, dynamic cerebral autoregulatory capacity isimpaired in the early stages of disease development, i.e.prior to the clinical recognition of microvascular complica-tions [11]. This means that arterial pressure surges arebuffered less efficiently, with more passive transmission ofblood pressure to the cerebral tissue occurring (Y. S. Kim, J. J.van Lieshout, unpublished results, Fig. 1), resulting inincreased exposure to cerebral hyperperfusion. Given thatrepetitive arterial pressure surges may contribute to long-term cerebral vasculopathy, detailed studies are needed toestablish the cerebrovascular effects of different types ofexercise in type 2 diabetic patients.We agree with Praet and van Loon that an individuallytailored exercise programme providing a more specificframework is important to optimise exercise therapy.However, when devising such programmes, any potentialunfavourable effects of blood pressure surges on the brainshould be taken into account.Duality of interest The authors declare that there is no duality ofinterest associated with this manuscript.Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which per-mits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source are credited.References1. Praet SFE, van Loon LJC (2008) Exercise: the brittle cornerstoneof type 2 diabetes treatment. Diabetologia 51:398–4012. Baldi JC, Snowling N (2003) Resistance training improvesglycaemic control in obese type 2 diabetic men. Int J SportsMed 24:419–4233. Fenicchia LM, Kanaley JA, Azevedo JL Jr et al (2004) Influenceof resistance exercise training on glucose control in women withtype 2 diabetes. Metabolism 53:284–2894. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, WhiteRD (2006) Physical activity/exercise and type 2 diabetes: aconsensus statement from the American Diabetes Association.Diabetes Care 29:1433–14385. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR (1985)Arterial blood pressure response to heavy resistance exercise. JAppl Physiol 58:785–7906. Miyachi M, Kawano H, Sugawara J et al (2004) Unfavorableeffects of resistance training on central arterial compliance: arandomized intervention study. Circulation 110:2858–28637. Panerai RB, Dawson SL, Potter JF (1999) Linear and nonlinearanalysis of human dynamic cerebral autoregulation. Am J PhysiolHeart Circ Physiol 277:H1089–H10998. Ogoh S, Dalsgaard MK, Yoshiga CC et al (2005) Dynamiccerebral autoregulation during exhaustive exercise in humans. AmJ Physiol Heart Circ Physiol 288:H1461–H14679. Immink RV, van den Born BJ, Van Montfrans GA, Koopmans RP,Karemaker JM, van Lieshout JJ (2004) Impaired cerebralautoregulation in patients with malignant hypertension. Circula-tion 110:2241–224510. Pott F, van Lieshout JJ, Ide K, Madsen P, Secher NH (2003)Middle cerebral artery blood velocity during intense staticexercise is dominated by a Valsalva maneuver. J Appl Physiol94:1335–134411. Kim YS, Immink RV, Stok WJ, Karemaker JM, Secher NH, vanLieshout JJ (2008) Dynamic cerebral autoregulatory capacity isaffected early in type 2 diabetes mellitus. Clin Sci (Lond) DOI10.1042/CS20070458Fig. 1 a In healthy individuals, normal autoregulation limits theincrease in middle cerebral artery mean blood velocity (ΔVmean, whitecircles) in response to a rise in mean arterial pressure (ΔMAP, blackcircles). b In type 2 diabetic patients impaired autoregulation results ina greater increase in Vmean. Data are presented as the mean±SEM(n=10)1756 Diabetologia (2008) 51:1755–1756

Kim, Y. S.

Secher, N. H.

van Lieshout, J. J.

NARCIS 

LETTER
Resistance exercise and control of cerebral blood flow
in type 2 diabetes
Y. S. Kim & N. H. Secher & J. J. van Lieshout
Received: 21 April 2008 /Accepted: 20 May 2008 /Published online: 19 June 2008
# The Author(s) 2008
Keywords Blood pressure . Cerebral autoregulation .
Cerebral circulation . Exercise . Transcranial Doppler
To the Editor: The challenge in diabetes care is to optimise
metabolic control to slow progression to vascular disease.
In individuals with type 2 diabetes this may be achieved at
least in part by behavioural modification including regular
physical activity. In their recent article in Diabetologia,
Praet and van Loon [1] comprehensibly and concisely
address the need for revision of the current guidelines
regarding the prescription of exercise for individuals with
type 2 diabetes, given the lack of information provided by
current exercise programmes on the preferred type and
intensity of exercise.
The combination of endurance and resistance exercise
has the potential to increase adherence and compliance
rates, as it renders programmes more varied [1]. Loss of
skeletal muscle mass is one of the main factors responsible
for the increase in the incidence of type 2 diabetes with age.
Deconditioning (as a result of physical inactivity) and
resistance exercise are associated with opposing adapta-
tions. Resistance exercise provides better metabolic control
[2], mitigates disuse-associated tendon stiffness and
increases skeletal muscle mass, which improves whole
body glucose disposal [3]. Not surprisingly, greater focus
on resistance exercise has been recommended for type 2
diabetes, specifically for the subgroup of sarcopenic or
severely deconditioned older patients [4].
Resistance and endurance exercise have different car-
diovascular effects. Resistance-type activities produce a
considerably larger increase in arterial pressure, because of
the mechanical compression of blood vessels together with
repeated Valsalva-like manoeuvres [5]. Unlike aerobic
exercise, resistance training affects central arterial compli-
ance in healthy men [6]. Although acute changes in arterial
blood pressure during physiological challenges are trans-
mitted to the cerebral circulation, under normal conditions,
cerebral blood flow tends to return to its baseline value
within a few seconds [7]. Cerebral vasoconstriction
constantly plays a protective role during exercise of
moderate to heavy intensity, in particular when pulse
pressure exceeds the autoregulatory range [8]. When
autoregulatory mechanisms are failing or overwhelmed by
acute blood pressure upsurges beyond the autoregulatory
range (e.g. in serious hypertension), brain blood flow
Diabetologia (2008) 51:1755–1756
DOI 10.1007/s00125-008-1068-y
Y. S. Kim
Department of Internal Medicine, Academic Medical Center,
University of Amsterdam,
Amsterdam, the Netherlands
Y. S. Kim : J. J. van Lieshout
Laboratory for Clinical Cardiovascular Physiology,
Heart Failure Research Center, Academic Medical Center,
University of Amsterdam,
Amsterdam, the Netherlands
N. H. Secher
Department of Anesthesia, Rigshospitalet,
University of Copenhagen,
Copenhagen, Denmark
N. H. Secher
The Copenhagen Muscle Research Center,
University of Copenhagen,
Copenhagen, Denmark
J. J. van Lieshout (*)
Medium Care Unit, Department of Internal Medicine, F7-205,
Academic Medical Center, University of Amsterdam,
P.O. Box 22700, 1100 DE Amsterdam, the Netherlands
e-mail: j.j.vanlieshout@amc.uva.nl
becomes directly related to its perfusion pressure, resulting
in cerebral hyperperfusion manifested by retinal oedema
and encephalopathy [9].
We consider the arterial pressure surges associated with
resistance exercise to be substantial, heavily taxing cerebral
autoregulatory mechanisms [10]. The integrity of the cerebral
autoregulatory mechanisms protecting the brain is therefore
important under these conditions. To date, there is no direct
evidence indicating that resistance exercise is disadvanta-
geous for individuals with type 2 diabetes. However, in these
individuals, dynamic cerebral autoregulatory capacity is
impaired in the early stages of disease development, i.e.
prior to the clinical recognition of microvascular complica-
tions [11]. This means that arterial pressure surges are
buffered less efficiently, with more passive transmission of
blood pressure to the cerebral tissue occurring (Y. S. Kim, J. J.
van Lieshout, unpublished results, Fig. 1), resulting in
increased exposure to cerebral hyperperfusion. Given that
repetitive arterial pressure surges may contribute to long-
term cerebral vasculopathy, detailed studies are needed to
establish the cerebrovascular effects of different types of
exercise in type 2 diabetic patients.
We agree with Praet and van Loon that an individually
tailored exercise programme providing a more specific
framework is important to optimise exercise therapy.
However, when devising such programmes, any potential
unfavourable effects of blood pressure surges on the brain
should be taken into account.
Duality of interest The authors declare that there is no duality of
interest associated with this manuscript.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Praet SFE, van Loon LJC (2008) Exercise: the brittle cornerstone
of type 2 diabetes treatment. Diabetologia 51:398–401
2. Baldi JC, Snowling N (2003) Resistance training improves
glycaemic control in obese type 2 diabetic men. Int J Sports
Med 24:419–423
3. Fenicchia LM, Kanaley JA, Azevedo JL Jr et al (2004) Influence
of resistance exercise training on glucose control in women with
type 2 diabetes. Metabolism 53:284–289
4. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White
RD (2006) Physical activity/exercise and type 2 diabetes: a
consensus statement from the American Diabetes Association.
Diabetes Care 29:1433–1438
5. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR (1985)
Arterial blood pressure response to heavy resistance exercise. J
Appl Physiol 58:785–790
6. Miyachi M, Kawano H, Sugawara J et al (2004) Unfavorable
effects of resistance training on central arterial compliance: a
randomized intervention study. Circulation 110:2858–2863
7. Panerai RB, Dawson SL, Potter JF (1999) Linear and nonlinear
analysis of human dynamic cerebral autoregulation. Am J Physiol
Heart Circ Physiol 277:H1089–H1099
8. Ogoh S, Dalsgaard MK, Yoshiga CC et al (2005) Dynamic
cerebral autoregulation during exhaustive exercise in humans. Am
J Physiol Heart Circ Physiol 288:H1461–H1467
9. Immink RV, van den Born BJ, Van Montfrans GA, Koopmans RP,
Karemaker JM, van Lieshout JJ (2004) Impaired cerebral
autoregulation in patients with malignant hypertension. Circula-
tion 110:2241–2245
10. Pott F, van Lieshout JJ, Ide K, Madsen P, Secher NH (2003)
Middle cerebral artery blood velocity during intense static
exercise is dominated by a Valsalva maneuver. J Appl Physiol
94:1335–1344
11. Kim YS, Immink RV, Stok WJ, Karemaker JM, Secher NH, van
Lieshout JJ (2008) Dynamic cerebral autoregulatory capacity is
affected early in type 2 diabetes mellitus. Clin Sci (Lond) DOI
10.1042/CS20070458
Fig. 1 a In healthy individuals, normal autoregulation limits the
increase in middle cerebral artery mean blood velocity (ΔVmean, white
circles) in response to a rise in mean arterial pressure (ΔMAP, black
circles). b In type 2 diabetic patients impaired autoregulation results in
a greater increase in Vmean. Data are presented as the mean±SEM
(n=10)
1756 Diabetologia (2008) 51:1755–1756


Kim, Y S

Secher, N H

van Lieshout, J J

Search4Dev

UvA-DARE is a service provided by the library of the University of Amsterdam (http://dare.uva.nl)
UvA-DARE (Digital Academic Repository)
Resistance exercise and control of cerebral blood flow in type 2 diabetes
Kim, Y.S.; Secher, N.H.; van Lieshout, J.J.
Published in:
Diabetologia
DOI:
10.1007/s00125-008-1068-y
Link to publication
Citation for published version (APA):
Kim, Y. S., Secher, N. H., & van Lieshout, J. J. (2008). Resistance exercise and control of cerebral blood flow in
type 2 diabetes. Diabetologia, 51(9), 1755-1756. https://doi.org/10.1007/s00125-008-1068-y
General rights
It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s),
other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons).
Disclaimer/Complaints regulations
If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating
your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask
the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam,
The Netherlands. You will be contacted as soon as possible.
Download date: 08 Feb 2021
LETTER
Resistance exercise and control of cerebral blood flow
in type 2 diabetes
Y. S. Kim & N. H. Secher & J. J. van Lieshout
Received: 21 April 2008 /Accepted: 20 May 2008 /Published online: 19 June 2008
# The Author(s) 2008
Keywords Blood pressure . Cerebral autoregulation .
Cerebral circulation . Exercise . Transcranial Doppler
To the Editor: The challenge in diabetes care is to optimise
metabolic control to slow progression to vascular disease.
In individuals with type 2 diabetes this may be achieved at
least in part by behavioural modification including regular
physical activity. In their recent article in Diabetologia,
Praet and van Loon [1] comprehensibly and concisely
address the need for revision of the current guidelines
regarding the prescription of exercise for individuals with
type 2 diabetes, given the lack of information provided by
current exercise programmes on the preferred type and
intensity of exercise.
The combination of endurance and resistance exercise
has the potential to increase adherence and compliance
rates, as it renders programmes more varied [1]. Loss of
skeletal muscle mass is one of the main factors responsible
for the increase in the incidence of type 2 diabetes with age.
Deconditioning (as a result of physical inactivity) and
resistance exercise are associated with opposing adapta-
tions. Resistance exercise provides better metabolic control
[2], mitigates disuse-associated tendon stiffness and
increases skeletal muscle mass, which improves whole
body glucose disposal [3]. Not surprisingly, greater focus
on resistance exercise has been recommended for type 2
diabetes, specifically for the subgroup of sarcopenic or
severely deconditioned older patients [4].
Resistance and endurance exercise have different car-
diovascular effects. Resistance-type activities produce a
considerably larger increase in arterial pressure, because of
the mechanical compression of blood vessels together with
repeated Valsalva-like manoeuvres [5]. Unlike aerobic
exercise, resistance training affects central arterial compli-
ance in healthy men [6]. Although acute changes in arterial
blood pressure during physiological challenges are trans-
mitted to the cerebral circulation, under normal conditions,
cerebral blood flow tends to return to its baseline value
within a few seconds [7]. Cerebral vasoconstriction
constantly plays a protective role during exercise of
moderate to heavy intensity, in particular when pulse
pressure exceeds the autoregulatory range [8]. When
autoregulatory mechanisms are failing or overwhelmed by
acute blood pressure upsurges beyond the autoregulatory
range (e.g. in serious hypertension), brain blood flow
Diabetologia (2008) 51:1755–1756
DOI 10.1007/s00125-008-1068-y
Y. S. Kim
Department of Internal Medicine, Academic Medical Center,
University of Amsterdam,
Amsterdam, the Netherlands
Y. S. Kim : J. J. van Lieshout
Laboratory for Clinical Cardiovascular Physiology,
Heart Failure Research Center, Academic Medical Center,
University of Amsterdam,
Amsterdam, the Netherlands
N. H. Secher
Department of Anesthesia, Rigshospitalet,
University of Copenhagen,
Copenhagen, Denmark
N. H. Secher
The Copenhagen Muscle Research Center,
University of Copenhagen,
Copenhagen, Denmark
J. J. van Lieshout (*)
Medium Care Unit, Department of Internal Medicine, F7-205,
Academic Medical Center, University of Amsterdam,
P.O. Box 22700, 1100 DE Amsterdam, the Netherlands
e-mail: j.j.vanlieshout@amc.uva.nl
becomes directly related to its perfusion pressure, resulting
in cerebral hyperperfusion manifested by retinal oedema
and encephalopathy [9].
We consider the arterial pressure surges associated with
resistance exercise to be substantial, heavily taxing cerebral
autoregulatory mechanisms [10]. The integrity of the cerebral
autoregulatory mechanisms protecting the brain is therefore
important under these conditions. To date, there is no direct
evidence indicating that resistance exercise is disadvanta-
geous for individuals with type 2 diabetes. However, in these
individuals, dynamic cerebral autoregulatory capacity is
impaired in the early stages of disease development, i.e.
prior to the clinical recognition of microvascular complica-
tions [11]. This means that arterial pressure surges are
buffered less efficiently, with more passive transmission of
blood pressure to the cerebral tissue occurring (Y. S. Kim, J. J.
van Lieshout, unpublished results, Fig. 1), resulting in
increased exposure to cerebral hyperperfusion. Given that
repetitive arterial pressure surges may contribute to long-
term cerebral vasculopathy, detailed studies are needed to
establish the cerebrovascular effects of different types of
exercise in type 2 diabetic patients.
We agree with Praet and van Loon that an individually
tailored exercise programme providing a more specific
framework is important to optimise exercise therapy.
However, when devising such programmes, any potential
unfavourable effects of blood pressure surges on the brain
should be taken into account.
Duality of interest The authors declare that there is no duality of
interest associated with this manuscript.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Praet SFE, van Loon LJC (2008) Exercise: the brittle cornerstone
of type 2 diabetes treatment. Diabetologia 51:398–401
2. Baldi JC, Snowling N (2003) Resistance training improves
glycaemic control in obese type 2 diabetic men. Int J Sports
Med 24:419–423
3. Fenicchia LM, Kanaley JA, Azevedo JL Jr et al (2004) Influence
of resistance exercise training on glucose control in women with
type 2 diabetes. Metabolism 53:284–289
4. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White
RD (2006) Physical activity/exercise and type 2 diabetes: a
consensus statement from the American Diabetes Association.
Diabetes Care 29:1433–1438
5. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR (1985)
Arterial blood pressure response to heavy resistance exercise. J
Appl Physiol 58:785–790
6. Miyachi M, Kawano H, Sugawara J et al (2004) Unfavorable
effects of resistance training on central arterial compliance: a
randomized intervention study. Circulation 110:2858–2863
7. Panerai RB, Dawson SL, Potter JF (1999) Linear and nonlinear
analysis of human dynamic cerebral autoregulation. Am J Physiol
Heart Circ Physiol 277:H1089–H1099
8. Ogoh S, Dalsgaard MK, Yoshiga CC et al (2005) Dynamic
cerebral autoregulation during exhaustive exercise in humans. Am
J Physiol Heart Circ Physiol 288:H1461–H1467
9. Immink RV, van den Born BJ, Van Montfrans GA, Koopmans RP,
Karemaker JM, van Lieshout JJ (2004) Impaired cerebral
autoregulation in patients with malignant hypertension. Circula-
tion 110:2241–2245
10. Pott F, van Lieshout JJ, Ide K, Madsen P, Secher NH (2003)
Middle cerebral artery blood velocity during intense static
exercise is dominated by a Valsalva maneuver. J Appl Physiol
94:1335–1344
11. Kim YS, Immink RV, Stok WJ, Karemaker JM, Secher NH, van
Lieshout JJ (2008) Dynamic cerebral autoregulatory capacity is
affected early in type 2 diabetes mellitus. Clin Sci (Lond) DOI
10.1042/CS20070458
Fig. 1 a In healthy individuals, normal autoregulation limits the
increase in middle cerebral artery mean blood velocity (ΔVmean, white
circles) in response to a rise in mean arterial pressure (ΔMAP, black
circles). b In type 2 diabetic patients impaired autoregulation results in
a greater increase in Vmean. Data are presented as the mean±SEM
(n=10)
1756 Diabetologia (2008) 51:1755–1756


Arterial blood pressure response to heavy resistance exercise.

Azevedo JL Jr et al (2004) Influence of resistance exercise training on glucose control in women with type 2 diabetes.

Dynamic cerebral autoregulatory capacity is affected early in type 2 diabetes mellitus. Clin Sci (Lond)

Exercise: the brittle cornerstone of type 2 diabetes treatment.

Impaired cerebral autoregulation in patients with malignant hypertension.

Linear and nonlinear analysis of human dynamic cerebral autoregulation.

Middle cerebral artery blood velocity during intense static exercise is dominated by a Valsalva maneuver.

Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 29:1433–1438

Resistance training improves glycaemic control in obese type 2 diabetic men.

Unfavorable effects of resistance training on central arterial compliance: a randomized intervention study.

Yoshiga CC et al (2005) Dynamic cerebral autoregulation during exhaustive exercise in humans.

Resistance exercise and control of cerebral blood flow in type 2 diabetes

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