Evaluation of the effects of resistance and aerobic exercise training on diabetic cardiomyopathy: participation of signaling pathways of energy metabolism and the renin-angiotensin system

Abstract

Diabetes mellitus (DM) is a chronic degenerative disease characterized by improper utilization of glucose by tissues and hyperglycemia, which can take a number of cardiovascular diseases (CVD, including: hypertension and coronary artery disease. Besides these, with DM can develop diabetic cardiomyopathy (DCMP) regardless of these complications. The DCMP causes structural and functional changes in the myocardium may lead to the development of irreversible, pathological left ventricular hypertrophy (LVH) and systolic dysfunction. Besides the increase of cardiomyocytes, pathological LVH is also characterized by reprogramming genes as a total and phosphorylated Akt, GSK3², p38 MAPK that act together to modulate cardiac contraction. The DM can also act on the renin-angiotensin system (RAS) stimulating the synthesis of angiotensin II also plays an important role in stimulating the pathological LVH. Besides these changes, the DCMP is also characterized by inhibiting the peroxisome proliferator-activated receptor-alpha (PPAR±), which reduces the metabolism of fatty acids, resulting in accumulation of these in cardiac tissue. Despite the cardiovascular consequences of diabetes as well as for their own development DCMP are worrisome, they can be significantly minimized by appropriate therapeutic measures. It is known that exercise along with diet and pharmacological treatment, has been considered as one of the three main approaches in the treatment of diabetes due to the beneficial effects on CVD, metabolic control and prevention of chronic complications of this disease. Thus, aerobic exercise training (AT) improves glycemic control, increases insulin sensitivity and reduces cardiovascular risk factors. However, to date, little is known about the effect of resistance exercise training (RT) on the signaling pathways of lipid metabolism and peptides, enzymes and receptors of the RAS in the development of DCMP. Thus, the objective of the study is to evaluate the influence of both modalities on the development of the DCMP training, evaluating the involvement of signaling pathways related to energy metabolism and modulation of the RAS. With this, we hope to contribute to the understanding of the pathophysiological mechanisms related to the development of this complication, comparing the effect of different types of exercise on this process. (AU)