Cardiovascular Events

Heart problems related to exercise in the nondiabetic population are rare. Various studies have shown that only 1 in 18,000 heart attacks occurs in healthy male runners. And it was found that those with higher physical activity levels have even lower rates of cardiovascular events. We must be careful when trying to put a number on the incidence of cardiovascular events related to exercise in the diabetic population. Heart problems such as heart attacks occur in relationship to underlying disease of the cardiovascular system (the heart and blood vessels that supply it). Simply put, the more diseases that are present, the more risks you have for such an event.

We do know that those with type 2 diabetes have nearly a fourfold increase in significant cardiovascular risk factors, such as dyslipidemia and high blood pressure, that lead to heart disease. So, to know your cardiovascular risk for exercise, you must know what your risk factors are and the extent of any underlying heart disease. Your doctor can help you determine your risk.

Your physician may wish to do a special test that can assess the health of your heart. The current guidelines for such testing (the exercise stress test, commonly referred to as the treadmill test) from the ACSM state that if you have diabetes and would like to start an exercise program at a comfortable pace (a gradual start and progression for roughly 60 minutes), you should have an exercise stress test. The guidelines from the American Heart Association are similar. Both guidelines suggest that if you have diabetes and wish to start a vigorous exercise program (one that requires intense exercise that can cause fatigue within 20 minutes), you should in fact have a stress test first. Nonetheless, you should discuss with your health care provider your risk factors as well as possible tests and treatment plans that can prevent or minimize your cardiovascular risks in exercise. It is generally established that all people with diabetes should have an exercise stress test before starting an exercise regimen if (1) they are over 35 years of age, (2) they have had type 1 diabetes for more than 15 years, (3) they have had type 2 diabetes for more than 10 years, or (4) they have diabetes with other cardiovascular risk factors.