Effects of Exercise Training on Cardiovascular Function by Cardiorespiratory Fitness Response in Obesity with and without Type 2 Diabetes

Introduction and Objective: Aerobic exercise training (AET) is a cornerstone treatment for obesity and type 2 diabetes (T2D), yet cardiometabolic adaptations vary widely among individuals. We examined how a 15-week supervised AET alters cardiometabolic measures in individuals with obesity, with and without T2D, stratified by changes in peak oxygen consumption (VO2). Methods: AET responders were defined as having changes in peak VO2 after AET > 0 and non-responders as having changes in peak VO2 after AET ≤ 0. Metabolic biomarkers, echocardiography, and cardiac magnetic resonance imaging were assessed before and after exercise training. Results: Thirty-six adults with obesity (39% with T2D) completed AET with 25 responders (female n=12, 45.7±7.1 years, 40% with T2D) and 11 non-responders (female n=7, 44.0±6.3 years, 36% with T2D). At baseline, responders exhibited higher anaerobic glycolysis compared with non-responders (P = 0.037). In a 2×2 ANOVA, significant Exercise × Responder interactions across the groups were observed for max workload (P < 0.001, η² = 0.31) and ejection fraction (P = 0.013, η² = 0.17). Within-group analyses showed unique profiles in responders compared to non-responders (Figure 1c). Conclusion: AET may elicit heterogeneous physiological adaptations, with only select parameters differing across the groups. Identifying predictors and biomarkers of peak VO2 response may enable more tailored exercise interventions. Disclosure: S. Park: None. E.K. Englund: None. L. Knaub: None. T. Fujiwara: None. L. Abushamat: Advisory Panel; Ended; New Amsterdam. Consultant; Ended; Novartis Pharmaceuticals Corporation, PeerDirect, Opus Medical. Research Support; Current; American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Diseases. R. Scalzo: None. I.E. Schauer: None. M.D. Sammel: None. J. Regensteiner: None. J. Reusch: Advisory Panel; Current; Medtronic. A. Barker: None. Funding: American Diabetes Association (4-24-PDF-51), VA Clinical Merit (CX001532), VA Merit (BX002046), NIH (5T32HL007171), VA CDA2 (BX004533), NIH (DK124344), NIH (5K12AR084226-19), NIH-NCATS (UL1TR001082), Ludeman Family Center for Women’s Health Research ADA Cardiovascular Metabolism Fellowship Award (1-21-CMF-003), NIH (P30DK116073), NIH/NCATS Colorado CTSA Grant Number K12 (TR004412), UM1 (TR004399), AHA (853697), AHA (23POSTCHF1025444)