INS and endothelial dysfunction: The mechanisms that lead to muscle dysfunction in those patients can be related to impaired cardiac output not able to increases in oxygen demand by the skeletal muscles during exercise; chronic arterial hypoxemia, inflammation, increased sympathetic tone that reduce the perfusion of the skeletal muscles increasing peripheral vascular resistance; the inhibition of hormonal/anabolic pathways, such as the insulin-signaling pathway, sedentary lifestyle and endothelial dysfunction [9, 31].