1251
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Wright A, Chopak-Foss J. School Personnel Knowledge and Perceived Skills in Diabetic Emergencies in Georgia Public Schools. J Sch Nurs 2018; 36:304-312. [DOI: 10.1177/1059840518820106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetes affects tens of thousands of school-aged children in the United States. The ability to appropriately manage their diabetes is essential to preventing life-threatening health complications if occurring during the school day. The purpose of this study was to assess school personnel’s knowledge of diabetes (types 1 and 2) and perceived self-competence in performing diabetes management skills. A non-probability sample of elementary school personnel ( N = 809) from five different school districts in Georgia completed a diabetes knowledge and competence questionnaire. Descriptive statistics, one-way analysis of variance, and principal component analysis were performed to analyze the data. School personnel reported limited knowledge of diabetes basics and an overall low perceived self-competence in performing many of the diabetic management skills. Despite state legislation enacted to assist children with diabetes in school and available training for school districts, the study found that school personnel are not well trained and lack confidence in performing diabetes management.
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1252
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Matson RIB, Leary SD, Cooper AR, Thompson C, Narendran P, Andrews RC. Objective Measurement of Physical Activity in Adults With Newly Diagnosed Type 1 Diabetes and Healthy Individuals. Front Public Health 2018; 6:360. [PMID: 30581813 PMCID: PMC6293090 DOI: 10.3389/fpubh.2018.00360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/22/2018] [Indexed: 01/04/2023] Open
Abstract
Aims: Physical activity (PA) has many benefits in type 1 diabetes mellitus (type 1 DM). However, PA levels in people with type 1 DM have not previously been measured accurately. We aimed to compare objectively measured PA in adults recently diagnosed with type 1 DM and healthy adults. Methods: Accelerometer data from 65 healthy adults [mean (SD) age 31 (13), 29% men] were compared with data from 50 people with type 1 DM [mean (SD) age 33 (10), 64% men], time since diagnosis <3months, HbA1c 76 ± 25 mmol/mol) in the EXTOD (Exercise for Type 1 Diabetes) pilot study. Briefly, EXTOD investigated the feasibility of recruiting recently diagnosed adults with type 1 DM into a yearlong exercise intervention. Multiple-regression models were used to investigate the association between diabetes status and activity outcomes. Results: Adults recently diagnosed with type 1 DM spent on average a quarter less time in moderate-to-vigorous-physical-activity (MVPA) per day than healthy adults [after adjusting for confounders, predicted values: type 1 DM adults: [mean (SD)] 37.4 mins/day (9.1) Healthy adults: 52.9 mins/day (11.0)]. No difference in MVPA between the groups was seen at the weekend, but adults with type 1 DM spent more time in light physical activity (LPA), and less time in sedentary behavior. Time spent in sedentary or LPA during weekdays did not differ between groups. Summary: Adults recently diagnosed with type 1 DM do less MVPA. Health care workers should encourage these people to engage in more PA. Further studies are needed to assess PA in people with type 1 DM of longer duration.
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Affiliation(s)
- Rhys I B Matson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Sam D Leary
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Ashley R Cooper
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom.,Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Catherine Thompson
- Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Parth Narendran
- Institute of Biomedical Research, University of Birmingham, Birmingham, United Kingdom.,Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rob C Andrews
- Department of Diabetes, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom.,University of Exeter Medical School, Exeter, United Kingdom
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1253
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Hwang CL, Lim J, Yoo JK, Kim HK, Hwang MH, Handberg EM, Petersen JW, Holmer BJ, Leey Casella JA, Cusi K, Christou DD. Effect of all-extremity high-intensity interval training vs. moderate-intensity continuous training on aerobic fitness in middle-aged and older adults with type 2 diabetes: A randomized controlled trial. Exp Gerontol 2018; 116:46-53. [PMID: 30576716 DOI: 10.1016/j.exger.2018.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 01/16/2023]
Abstract
Aging and diabetes are associated with decreased aerobic fitness, an independent predictor of mortality. Aerobic exercise is prescribed to improve aerobic fitness; however, middle-aged/older diabetic patients often suffer from mobility limitations which restrict walking. Non-weight-bearing/low-impact exercise is recommended but the optimal exercise prescription is uncertain. The goal of this randomized controlled trial was twofold: 1) to test if high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), implemented on a non-weight-bearing all-extremity ergometer, are feasible, well-tolerated and safe in middle-aged/older adults with type 2 diabetes; and 2) to test whether all-extremity HIIT is more effective in improving aerobic fitness than MICT. A total of 58 sedentary individuals with type 2 diabetes (46 to 78 years; 63 ± 1) were randomized to all-extremity HIIT (n = 23), MICT (n = 19) or non-exercise control (CONT; n = 16). All-extremity HIIT and MICT, performed 4×/week for 8 weeks under supervision, resulted in no adverse events requiring hospitalization or medical treatment. Aerobic fitness (VO2peak) improved by 10% in HIIT and 8% in MICT and maximal exercise tolerance increased by 1.8 and 1.3 min, respectively (P ≤ 0.002 vs. baseline; P ≥ 0.9 for HIIT vs. MICT). In conclusion, all-extremity HIIT and MICT are feasible, well-tolerated and safe and result in similar improvements in aerobic fitness in middle-aged/older individuals with type 2 diabetes. These findings have important implications for exercise prescription for diabetic patients; they indicate that all-extremity exercise is a feasible alternative to weight-bearing exercise and those who are unable or unwilling to engage in HIIT may receive similar benefits from MICT.
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Affiliation(s)
- Chueh-Lung Hwang
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America
| | - Jisok Lim
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America
| | - Jeung-Ki Yoo
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America
| | - Han-Kyul Kim
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America
| | - Moon-Hyon Hwang
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America; Division of Health and Exercise Science, Incheon National University, Incheon, Republic of Korea
| | - Eileen M Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - John W Petersen
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Brady J Holmer
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America
| | - Julio A Leey Casella
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, United States of America
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, United States of America
| | - Demetra D Christou
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States of America.
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1254
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Lee SY, Jung SH, Lee SU, Ha YC, Lim JY. Effect of Balance Training After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies. J Gerontol A Biol Sci Med Sci 2018; 74:1679-1685. [DOI: 10.1093/gerona/gly271] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although balance impairment after hip fracture surgery (HFS) can constitute a long-term problem of limiting mobility and increasing the risk of falls in older adults, little is known about the effect of balance training (BT) on physical functioning after HFS. Thus, we performed a meta-analysis to evaluate whether BT improved the overall physical functioning of patients after HFS.
Methods
We searched the PubMed-Medline, Embase, and Cochrane Library databases in January 2018 and included all randomized controlled trials comparing BT with usual care after HFS. We performed a pairwise meta-analysis using fixed- and random-effects models.
Results
Eight randomized controlled trials including a total of 752 participants were retrieved. The BT group showed significantly improved overall physical functioning after HFS compared with the usual care group (overall standardized mean difference [SMD] = 0.390; 95% confidence interval [CI] = 0.114–0.667; p = .006). Both, balance and gait improved (SMD = 0.570; 95% CI = 0.149–0.992; p = .008 and SMD = 0.195; 95% CI = 0.043–0.347; p = .012, respectively) in the BT group. Lower limb strength, performance task, activity of daily living, and health-related quality of life also improved significantly in the BT group.
Conclusion
Our meta-analysis revealed that BT after HFS improved overall physical functioning. Positive effects on balance, gait, lower limb strength, performance task, activity of daily living, and health-related quality of life were evident. Therefore, BT should be specifically included in postoperative rehabilitation programs and balance must be thoroughly checked in elderly patients with hip fractures.
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Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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1255
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TEO SHAUNYM, KANALEY JILLA, GUELFI KYMJ, COOK SUMMERB, HEBERT JEFFREYJ, FORREST MITCHELLRL, FAIRCHILD TIMOTHYJ. Exercise Timing in Type 2 Diabetes Mellitus: A Systematic Review. Med Sci Sports Exerc 2018; 50:2387-2397. [DOI: 10.1249/mss.0000000000001732] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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1256
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Álvarez C, Ramírez-Campillo R, Cano-Montoya J, Ramírez-Vélez R, Harridge SDR, Alonso-Martínez AM, Izquierdo M. Exercise and glucose control in children with insulin resistance: prevalence of non-responders. Pediatr Obes 2018; 13:794-802. [PMID: 30207079 DOI: 10.1111/ijpo.12437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/18/2018] [Accepted: 05/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise training improves cardiometabolic outcomes in 'mean terms', but little information is available in children about the impact of the frequency/week and the wide inter-individual variability to exercise training reported in adults. OBJECTIVES We compared the effects of resistance training (RT) and high-intensity interval training (HIT), and 'high' and 'low' frequency of training/week, for their effectiveness in decreasing insulin resistance (IR) levels in schoolchildren. A second aim was to decscribe and compare the prevalence of non-responders (NRs) between the different frequencies of training protocol. METHODS Fifty-three schoolchildren with IR were randomly assigned into four groups: RT at high frequency (three times/week), HIT at high frequency, RT at a low frequency (two times/week) and HIT at low frequency. The intervention lasted 6 weeks. Blood samples and body composition, blood pressure and performance measurements were taken before and after the intervention. RESULTS The prevalence of NRs was similar between the RTHF and HITHF (25.0% vs. 25.0%, P > 0.05) and RTLF and HITLF groups (20.0% vs. 46.6%, P = 0.174) for decreasing homeostasis model assessment of IR. However, significant differences in the prevalence of NRs were detected between RTHF and HITHF groups in fasting glucose (FGL) (18.7% vs. 58.3%, P < 0.031). CONCLUSIONS Both RT and HIT improves the glucose control parameters in schoolchildren over 6 weeks, but only HIT is independent of a high or low frequency of training/week. The prevalence of NRs is similar for decreasing homeostasis model assessment of IR comparing each exercise mode in high vs. low frequency/week. However, both high- and low-frequency RT and HIT results in differences in the prevalence of NRs for FGL and other cardiometabolic and performance outcomes.
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Affiliation(s)
- C Álvarez
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile.,Quality of Life and Wellness Research Group, Universidad de Los Lagos, Osorno, Chile
| | - R Ramírez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile.,Quality of Life and Wellness Research Group, Universidad de Los Lagos, Osorno, Chile
| | - J Cano-Montoya
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - R Ramírez-Vélez
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - S D R Harridge
- Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - A M Alonso-Martínez
- Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES; CB16/10/00315), Navarrabiomed, Pamplona, Navarre, Spain
| | - M Izquierdo
- Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES; CB16/10/00315), Navarrabiomed, Pamplona, Navarre, Spain
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1257
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Michaliszyn SF, Higgins M, Faulkner MS. Patterns of Physical Activity Adherence by Adolescents With Diabetes or Obesity Enrolled in a Personalized Community-Based Intervention. THE DIABETES EDUCATOR 2018; 44:519-530. [PMID: 30306834 PMCID: PMC10826413 DOI: 10.1177/0145721718805693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of a personalized, 16-week community-based physical activity intervention for adolescents with diabetes or obesity and examine the weekly patterns of adherence to the intervention. METHODS Physical activity adherence was evaluated throughout the intervention using accelerometers in 46 adolescents with type 1 diabetes (N = 22), type 2 diabetes (N = 12), or obesity (N = 12) (age, 14.4 ± 1.5 years; 56.5% female; 61% Hispanic). Of these, 39 completed the intervention, and 7 did not. RESULTS There were no differences in baseline anthropometric characteristics or fitness between the completers versus noncompleters. Completers began above 1060 metabolic equivalent (MET) min/wk-1and stayed above 900 MET min/wk-1 for ~4 weeks and declined 39 MET min/wk-1 until end of study. Noncompleters began at 924 MET min/wk-1 yet dropped below 800 MET min/wk-1 by end of week 1 and declined an average of 151 MET min/wk-1. Interestingly, self-report of barriers to activity were higher in completers versus noncompleters. CONCLUSIONS Findings highlight that adolescents completing the intervention could sustain a prescribed level of personalized activity for at least 1 month but had steadfast declines in weekly activity. Even with individualized programs, factors other than barriers to activity need to be considered when designing approaches to physical activity adherence for adolescents with diabetes or obesity.
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Affiliation(s)
- Sara F Michaliszyn
- Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, Ohio
| | - Melinda Higgins
- Office of Nursing Research, Emory University, Atlanta, Georgia
| | - Melissa Spezia Faulkner
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia
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1258
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Shomaker LB, Gulley L, Hilkin AM, Clark E, Annameier S, Rao S, Rockette-Wagner B, Kriska A, Wright KP, Stice E, Nadeau KJ, Kelsey MM. Design of a randomized controlled trial to decrease depression and improve insulin sensitivity in adolescents: Mood and INsulin sensitivity to prevent Diabetes (MIND). Contemp Clin Trials 2018; 75:19-28. [PMID: 30342256 PMCID: PMC6249074 DOI: 10.1016/j.cct.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to β-cell failure and type 2 diabetes (T2D). OBJECTIVE To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving β-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics. DESIGN Randomized controlled trial of N = 150 12-17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ≥85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score > 20), and diabetes family history. METHODS Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and β-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol. SUMMARY Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and β-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States.
| | - Lauren Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Allison M Hilkin
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Emma Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Shelly Annameier
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, Fort Collins, CO 80523, United States
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Bonny Rockette-Wagner
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Kriska
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Eric Stice
- Oregon Research Institute, Eugene, OR, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
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1259
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Savvaki D, Taousani E, Goulis DG, Tsirou E, Voziki E, Douda H, Nikolettos N, Tokmakidis SP. Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones (Athens) 2018; 17:521-529. [PMID: 30511333 DOI: 10.1007/s42000-018-0085-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM). METHODS Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000-2018. RESULTS All guidelines recommend aerobic training from 60 to 150 min/week, with an upper limit of 30 min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg's Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman's age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes. CONCLUSION Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.
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Affiliation(s)
- Dimitra Savvaki
- School of Physical Education and Sports Science, Democritus University of Thrace, 69100, Komotini, Greece.
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Eleftheria Taousani
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Midwifery, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efrosini Tsirou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Voziki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Helen Douda
- School of Physical Education and Sports Science, Democritus University of Thrace, 69100, Komotini, Greece
| | - Nikolaos Nikolettos
- Physiology Laboratory, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Savvas P Tokmakidis
- School of Physical Education and Sports Science, Democritus University of Thrace, 69100, Komotini, Greece
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1260
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Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Röbl-Mathieu M, Schiffner U, Vetter K, Weißenborn A, Wöckel A. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd 2018; 78:1262-1282. [PMID: 30655650 PMCID: PMC6294644 DOI: 10.1055/a-0713-1058] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.
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Affiliation(s)
- Berthold Koletzko
- Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, LMU – Ludwig-Maximilians-Universität, München, Germany
- Deutsche Gesellschaft für Kinder- und Jugendheilkunde e. V. (DGKJ), Berlin, Germany
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Monika Cremer
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Maria Flothkötter
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Christine Graf
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Deutsche Sporthochschule Köln, Köln, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Claudia Hellmers
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Hochschule Osnabrück, Osnabrück, Germany
- Deutsche Gesellschaft für Hebammenwissenschaft e. V. (DGHWi), Münster, Germany
| | - Mathilde Kersting
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Forschungsdepartment Kinderernährung, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Krawinkel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Institut für Ernährungswissenschaft, Justus-Liebig-Universität Gießen, Gießen, Germany
- Deutsche Gesellschaft für Ernährung e. V. (DGE), Bonn, Germany
| | - Hildegard Przyrembel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Marianne Röbl-Mathieu
- Mitglied der Ständigen Impfkommission am Robert Koch-Institut (STIKO), Berlin, Germany
| | - Ulrich Schiffner
- Poliklinik für Zahnerhaltung und Präventive Zahnheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Deutsche Gesellschaft für Kinderzahnheilkunde e. V. (DGKiZ), Würzburg, Germany
| | - Klaus Vetter
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Nationale Stillkommission, Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Anke Weißenborn
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Achim Wöckel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Frauenklinik und Poliklinik Universitätsklinikum Würzburg, Würzburg, Germany
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Nomura T, Kawae T, Kataoka H, Ikeda Y. Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes. Phys Ther Res 2018; 21:33-38. [PMID: 30697507 DOI: 10.1298/ptr.r0002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022]
Abstract
Patients with type 2 diabetes may have motor dysfunctions such as loss of muscle strength. Compared with non-diabetic subjects, patients with diabetes show decreased lower extremity muscle strength. The aim of this review was to describe the influence of factors associated with loss of muscle strength in patients with type 2 diabetes. Aging promotes an accelerated loss of muscle strength in patients with diabetes. Physical inactivity may cause a decline in muscle strength in patients with diabetes. Gradual loss of muscle strength is related to the presence and severity of diabetic neuropathy. Diabetic nephropathy may be a factor contributing to loss of muscle strength, because decrease in skeletal muscle mass is a hallmark of end-stage renal disease. Resistance exercise is an essential component of diabetes treatment regimens and also plays a role in the prevention and management of sarcopenia. Intensive physical therapy intervention should be provided to patients with diabetes having decreased muscle strength.
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Affiliation(s)
- Takuo Nomura
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences
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1262
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Zakari M, Alsahly M, Koch LG, Britton SL, Katwa LC, Lust RM. Are There Limitations to Exercise Benefits in Peripheral Arterial Disease? Front Cardiovasc Med 2018; 5:173. [PMID: 30538994 PMCID: PMC6277525 DOI: 10.3389/fcvm.2018.00173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/08/2018] [Indexed: 12/25/2022] Open
Abstract
Substantial evidence exists indicating that inactivity contributes to the progression of chronic disease, and conversely, that regular physical activity can both prevent the onset of disease as well as delay the progression of existing disease. To that end "exercise as medicine" has been advocated in the broad context as general medical care, but also in the specific context as a therapeutic, to be considered in much the same way as other drugs. As there are non-responders to many medications, there also are non-responders to exercise; individual who participate but do not demonstrate appreciable improvement/benefit. In some settings, the stress induced by exercise may aggravate an underlying condition, rather than attenuate chronic disease. As personalized medicine evolves with ready access to genetic information, so too will the incorporation of exercise in the context of those individual genetics. The focus of this brief review is to distinguish between the inherent capacity to perform, as compared to adaptive response to active exercise training in relation to cardiovascular health and peripheral arterial disease.
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Affiliation(s)
- Madaniah Zakari
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
- Department of Physiology, College of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Musaad Alsahly
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Lauren G. Koch
- Department of Physiology and Pharmacology, University of Toledo, Toledo, OH, United States
| | - Steven L. Britton
- Departments of Anesthesiology and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Laxmansa C. Katwa
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Robert M. Lust
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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1263
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Borror A, Zieff G, Battaglini C, Stoner L. The Effects of Postprandial Exercise on Glucose Control in Individuals with Type 2 Diabetes: A Systematic Review. Sports Med 2018; 48:1479-1491. [PMID: 29396781 DOI: 10.1007/s40279-018-0864-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regulation of postprandial hyperglycemia is a major concern for individuals with type 2 diabetes. Exercise can reduce postprandial hyperglycemia by increasing contraction-mediated glucose uptake. However, there is no consensus with which to develop guidelines for optimal postprandial exercise timing and prescription. OBJECTIVE The current systematic review was conducted to consolidate the literature surrounding the effects of postprandial exercise on glucose regulation in individuals with type 2 diabetes. METHODS Electronic databases were searched on 17 February 2017. Inclusion criteria were: (1) trial was a randomized crossover trial; (2) subjects were diagnosed with type 2 diabetes; (3) a standardized meal was given; (4) exercise was initiated within three hours of the meal; (5) subjects were not treated with insulin. RESULTS Twelve studies met the inclusion criteria, involving 135 participants (108 males, 20 females, seven unknown). The included studies varied greatly in their timing, duration, intensity, modality, and glucose measures. Postprandial aerobic exercise (11 studies) decreased short-term glucose area under the curve by 3.4-26.6% and 24-h prevalence of hyperglycemia by 11.9-65%. Resistance exercise (two studies) decreased the short-term glucose area under the curve by 30% and 24-h prevalence of hyperglycemia by 35%. CONCLUSION Postprandial exercise may be an effective way to improve glucose control in individuals with type 2 diabetes. The most consistent benefits were seen in long-duration (≥ 45 min), moderate-intensity aerobic exercise. Resistance training also appears to be an effective modality. We recommend that individuals with type 2 diabetes focus on increasing energy expenditure after the largest meal of the day. More research is needed in this area to confirm the results of this systematic review and to provide clinicians with specific exercise recommendations.
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Affiliation(s)
- Andrew Borror
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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1264
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Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES). Sports Med 2018; 47:1769-1793. [PMID: 28393328 DOI: 10.1007/s40279-017-0724-0] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The health effects of light-intensity physical activity (PA) are not well known today. OBJECTIVE We conducted a systematic review to assess the association of accelerometer-measured light-intensity PA with modifiable health outcomes in adults and older adults. METHODS A systematic literature search up to March 2016 was performed in the PubMed, EMBASE, Web of Science and Google Scholar electronic databases, without language limitations, for studies of modifiable health outcomes in adults and older adults in the National Health and Nutrition Examination Survey accelerometer dataset. RESULTS Overall, 37 cross-sectional studies and three longitudinal studies were included in the analysis, with considerable variation observed between the studies with regard to their operationalization of light-intensity PA. Light-intensity PA was found to be beneficially associated with obesity, markers of lipid and glucose metabolism, and mortality. Few data were available on musculoskeletal outcomes and results were mixed. CONCLUSIONS Observational evidence that light-intensity PA can confer health benefits is accumulating. Currently inactive or insufficiently active people should be encouraged to engage in PA of any intensity. If longitudinal and intervention studies corroborate our findings, the revision of PA recommendations to include light-intensity activities, at least for currently inactive populations, might be warranted.
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1265
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Wangdi K, Jamtsho T. Risk factors for self-reported diabetes among Bhutanese adults: A nationally representative survey data analysis. PLoS One 2018; 13:e0206034. [PMID: 30439962 PMCID: PMC6237308 DOI: 10.1371/journal.pone.0206034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Bhutan, a small land-locked country in the eastern Himalayas has been undergoing an epidemiological and nutritional transition in the last two decades. The objective of this paper was to determine the prevalence and explore the risk factors of self-reported diabetes among Bhutanese adults. Methods We conducted a secondary data analysis among adults 18 years and older Bhutanese using the data from the National Health Survey 2012 (NHS, 2012) of Bhutan. The self-reported information on risk factors was obtained using standard protocols of the WHO STEPwise approach to Surveillance. The outcome of interest was self-reported diabetes on medication. Adjusted and unadjusted logistic regression analyses were performed to identify the risk factor of diabetes. Results A total of 31,066 participants aged 18 years and older were included for the analysis. The prevalence of self-reported hypertension was 1.8% (491). Risk factors for diabetes were: age groups: 35–44 years adjusted odds ratio (AOR) = 2.82 (95% CI, 1.07, 7.41), 45–54 years AOR = 6.02 (95% CI, 2.29, 15.83), 55–64 year AOR = 15.7 (95% CI 5.93, 41.55) and >65 years AOR = 19.60 (95% CI, 6.93, 55.71); high school and diploma/certificate education AOR = 2.57, (95% CI 1.62, 4.07) and AOR = 3.92 (95% CI 1.70, 9.07); and urban dwellers AOR = 2.37, (95% 1.58, 3.57); hypertension AOR = 3.3, (95% CI 2.47, 4.41); and fruit servings of 1–3 per week AOR = 1.63 (95% CI 1.15, 2.31). Conclusion The number of Bhutanese adults with diabetes and co-morbidities associated with it is likely to increase with the ageing of the population, nutrition transition, and high rural-urban migration in the near future. This calls for an urgent need to implement strategies to prevent diabetes in the Bhutanese population targeting risk factors including healthy lifestyle with increased physical activities and reduced smoking. At the same time treating other chronic morbidities including hypertension.
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Affiliation(s)
- Kinley Wangdi
- Phuentsholing General Hospital, Phuentsholing, Bhutan
- Department of Global Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
- * E-mail:
| | - Tshering Jamtsho
- School of Demography, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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1266
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Delevatti RS, Kanitz AC, Alberton CL, Marson EC, Pantoja PD, Pinho CD, Lisboa SC, Kruel LFM. Glycemic Threshold as an Alternative Method to Identify the Anaerobic Threshold in Patients With Type 2 Diabetes. Front Physiol 2018; 9:1609. [PMID: 30483156 PMCID: PMC6243106 DOI: 10.3389/fphys.2018.01609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: To analyze the agreement between the velocity, heart rate, and oxygen uptake values corresponding to second ventilatory threshold and glycemic threshold in patients with type 2 diabetes. Methods: Twenty-four untrained patients (55.1 ± 8.9 years) were evaluated. Three different parameters of training intensity corresponding to anaerobic threshold, one mechanical (velocity) and two physiological (heart rate and oxygen uptake) parameters, were identified by a classical method (second ventilatory threshold) and by an alternative method (glycemic threshold). To determine the threshold values, patients performed an incremental treadmill test, with an initial velocity of 3 km.h-1 for 3 min, that was then increased by 1 km.h-1 every 2 min. Comparisons between mean values and the degree of agreement between second ventilatory threshold and glycemic threshold were analyzed using the paired t-test and Bland-Altman test, respectively. Results: All patients performed the tests appropriately, and no adverse effects were recorded. Patients demonstrated similar mean velocity (p = 0.25), heart rate (p = 0.97) and oxygen uptake (p = 0.71) between the ventilatory threshold (6.4 ± 0.6 km.h-1, 130.1 ± 18.7 bpm, 15.2 ± 3.5 ml.kg.min-1) and the glycemic threshold (6.2 ± 0.9 km.h-1, 130.2 ± 12.8 bpm, 15.0 ± 3.8 ml.kg.min-1). Conclusion: The present study indicates an agreement between the glycemic and second ventilatory methods in determination of the anaerobic threshold of patients with type 2 diabetes; and thus, either method may be used for these patients.
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Affiliation(s)
- Rodrigo S. Delevatti
- Sports Center, Department of Physical Education, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Ana Carolina Kanitz
- Department of Physical Education, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Cristine L. Alberton
- Department of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elisa Corrêa Marson
- Exercise Research Laboratory, Department of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Patricia Dias Pantoja
- Exercise Research Laboratory, Department of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina DertzbocherFeil Pinho
- Exercise Research Laboratory, Department of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Salime Chedid Lisboa
- Exercise Research Laboratory, Department of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luiz Fernando M. Kruel
- Exercise Research Laboratory, Department of Physical Education, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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1267
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Onerup A, Arvidsson D, Blomqvist Å, Daxberg EL, Jivegård L, Jonsdottir IH, Lundqvist S, Mellén A, Persson J, Sjögren P, Svanberg T, Borjesson M. Physical activity on prescription in accordance with the Swedish model increases physical activity: a systematic review. Br J Sports Med 2018; 53:383-388. [DOI: 10.1136/bjsports-2018-099598] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 12/22/2022]
Abstract
ObjectivesThis study investigates the effects of the core elements of the Swedish model for physical activity on prescription (PAP) by evaluating studies that compared adults who received PAP with adults who did not receive PAP. All participants were adults identified by a healthcare professional as in need of increased physical activity. Primary outcome was level of physical activity.DesignSystematic review.Eligibility criteria(1) Published 1999. (2) Systematic review, randomised controlled trial (RCT), non-RCT or case series (for adverse events). (3) ≥12 weeks’ follow-up. (4) Performed in the Nordic countries. (5) Presented in English, Swedish, Norwegian or Danish.Data sourcesSystematic searches in PubMed, Embase, the Cochrane Library, AMED, CINAHL and SweMed+ in September 2017. Included articles were evaluated using checklists to determine risk of bias.ResultsNine relevant articles were included: seven RCTs, one cohort study and one case series. Primary outcome was reported in seven articles from six studies (five RCTs, one cohort study, 642 participants). Positive results were reported from three of the five RCTs and from the cohort study. No study reported any negative results. Swedish PAP probably results in an increased level of physical activity (GRADE⊕⊕⊕Ο).ConclusionsAlthough the number of the reviewed articles was relatively modest, this systematic review shows that PAP in accordance with the Swedish model probably increases the level of physical activity. As a model for exercise prescription, Swedish PAP may be considered as part of regular healthcare to increase physical activity in patients.
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1268
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Exercise in cirrhosis: Translating evidence and experience to practice. J Hepatol 2018; 69:1164-1177. [PMID: 29964066 DOI: 10.1016/j.jhep.2018.06.017] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
Abstract
Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, for some conditions, even by governmental funding of exercise programmes. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous pressure gradient, without adverse events. With strong emerging evidence surrounding the substantial risks of sarcopenia/frailty and our first-hand experiences with liver pre-transplant exercise programmes, we contend that routine patient care in cirrhosis should include an exercise prescription. Some clinicians may lack the resources and necessary background to translate the existing evidence into a practicable intervention. Our team, comprised of physiotherapists, exercise physiologists, hepatologists, transplant specialists, and knowledge translation experts from six North American centres, has distilled the essential background information, tools, and practices into a set of information ready for immediate implementation into clinics ranging from a family practice setting to specialty cirrhosis clinics. Augmenting the rationale and evidence are supplementary materials including video and downloadable materials for both patients and the physician. Supporting the exercising patient is a section regarding information about nutrition, providing practical tips suitable for all patients with cirrhosis.
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1269
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Keshawarz A, Piropato AR, Brown TL, Duca LM, Sippl RM, Wadwa RP, Snell-Bergeon JK. Lower objectively measured physical activity is linked with perceived risk of hypoglycemia in type 1 diabetes. J Diabetes Complications 2018; 32:975-981. [PMID: 29937138 DOI: 10.1016/j.jdiacomp.2018.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/02/2023]
Abstract
AIMS Compare physical activity (PA) levels in adults with and without type 1 diabetes and identify diabetes-specific barriers to PA. METHODS Forty-four individuals with type 1 diabetes and 77 non-diabetic controls in the Coronary Artery Calcification in Type 1 Diabetes study wore an accelerometer for 2 weeks. Moderate-to-vigorous physical activity (MVPA) was compared by diabetes status using multiple linear regression. The Barriers to Physical Activity in Type 1 Diabetes questionnaire measured diabetes-specific barriers to PA, and the Clarke hypoglycemia awareness questionnaire measured hypoglycemia frequency. RESULTS Individuals with type 1 diabetes engaged in less MVPA, fewer bouts of MVPA, and spent less time in MVPA bouts per week than individuals without diabetes (all p < 0.05), despite no difference in self-reported PA (p > 0.05). The most common diabetes-specific barrier to PA was risk of hypoglycemia. Individuals with diabetes reporting barriers spent less time in MVPA bouts per week than those not reporting barriers (p = 0.047). CONCLUSIONS Individuals with type 1 diabetes engage in less MVPA than those without diabetes despite similar self-reported levels, with the main barrier being perceived risk of hypoglycemia. Adults with type 1 diabetes require guidance to meet current PA guidelines and reduce cardiovascular risk.
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Affiliation(s)
- Amena Keshawarz
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States.
| | - Andrew R Piropato
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Talia L Brown
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Lindsey M Duca
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel M Sippl
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - R Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
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1270
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Oppert JM, Bellicha A, Roda C, Bouillot JL, Torcivia A, Clement K, Poitou C, Ciangura C. Resistance Training and Protein Supplementation Increase Strength After Bariatric Surgery: A Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:1709-1720. [PMID: 30358153 DOI: 10.1002/oby.22317] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/27/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Physical activity and dietary regimens to optimize health outcomes after bariatric surgery are not well known. This study aimed to determine whether resistance training with dietary protein supplementation is effective in maintaining body composition and physical fitness after obesity surgery. METHODS Seventy-six women with obesity undergoing Roux-en-Y gastric bypass were randomly assigned at the time of surgery to receive either usual care (controls [CON], n = 22), usual care and additional (whey) protein intake (PRO, n = 31), or usual care, additional protein intake, and supervised strength training for 18 weeks (PRO+EX, n = 23). The primary outcome was pre- to 6-month postsurgery change in lean body mass (by dual-energy x-ray absorptiometry). Secondary outcomes included changes in muscle strength (by one-repetition maximum testing). RESULTS Loss over time in lean body mass did not differ between groups (CON: mean,-8.8 kg; 95% CI: -10.1 to -7.5 kg; PRO: mean, -8.2 kg; 95% CI: -9.3 to -7.1 kg; PRO+EX: mean, -7.7 kg; 95% CI: -9.0 to -6.5 kg; P = 0.899). The increase in relative lower-limb muscle strength was higher in the PRO+EX group (+0.6 [0.3 to 0.8]) versus +0.1 (-0.1 to 0.4) and +0.2 (0.0 to 0.4) kg/kg body mass in CON and PRO groups, respectively (P = 0.021). CONCLUSIONS Loss in muscle strength observed after bariatric surgery can be overcome by resistance training with additional protein intake.
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Affiliation(s)
- Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Alice Bellicha
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Laboratory of Bioengineering, Tissues and Neuroplasticity (BIOTN), University Paris-Est, Créteil, France
| | - Celina Roda
- ISGlobal, The Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jean-Luc Bouillot
- Department of Visceral Surgery, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Versailles-Saint-Quentin, Boulogne, France
| | - Adriana Torcivia
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Karine Clement
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Nutriomics Team, INSERM, UMRS U1166, Paris, France
| | - Christine Poitou
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Nutriomics Team, INSERM, UMRS U1166, Paris, France
| | - Cecile Ciangura
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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1271
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Koh HCE, Ørtenblad N, Winding KM, Hellsten Y, Mortensen SP, Nielsen J. High-intensity interval, but not endurance, training induces muscle fiber type-specific subsarcolemmal lipid droplet size reduction in type 2 diabetic patients. Am J Physiol Endocrinol Metab 2018; 315:E872-E884. [PMID: 30016151 DOI: 10.1152/ajpendo.00161.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study compared the effects of moderate-intensity endurance training and high-intensity interval training on fiber type-specific subcellular volumetric content and morphology of lipid droplets and mitochondria in skeletal muscles of type 2 diabetic patients. Sixteen sedentary type 2 diabetic patients (57 ± 7 yr old) were randomized to complete 11 wk of either 40-min cycling at 50% peak workload (Endurance, n = 8) or 10 1-min cycling intervals at 95% peak workload separated by 1 min of recovery (High-Intensity Interval, n = 8), three times per week. Assessments for cardiorespiratory fitness, body composition, glycemic control, together with muscle biopsies were performed before and after the intervention. Morphometric analyses of lipid droplets and mitochondria were conducted in the subcellular fractions of biopsied muscle fibers using quantitative electron microscopy. The training intervention increased cardiorespiratory fitness, lowered fat mass, and improved nonfasting glycemic control ( P < 0.05), with no difference between training modalities. In the subsarcolemmal space, training decreased lipid droplet volume ( P = 0.003), and high-intensity interval, but not endurance, training reduced the size of lipid droplets, specifically in type 2 fibers ( P < 0.001). No training-induced change in intermyofibrillar lipid droplets was observed in both fiber types. Subsarcolemmal mitochondrial volume was increased by high-intensity interval ( P = 0.02), but not endurance, training ( P = 0.79). Along with improvement in glycemic control, low-volume high-intensity interval training is an alternative time-saving training modality that affects subcellular morphology and volumetric content of lipid droplets in skeletal muscle of type 2 diabetic patients.
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Affiliation(s)
- Han-Chow E Koh
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
| | - Niels Ørtenblad
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
| | - Kamilla M Winding
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen , Copenhagen , Denmark
| | - Stefan P Mortensen
- Department of Cardiovascular and Renal Research, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Joachim Nielsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
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1272
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Rippe JM. Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med 2018; 12:499-512. [PMID: 30783405 PMCID: PMC6367881 DOI: 10.1177/1559827618785554] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/29/2022] Open
Abstract
There is no longer any serious doubt that daily habits and actions profoundly affect both short-term and long-term health and quality of life. This concept is supported by literally thousands of research articles and incorporated in multiple evidence-based guidelines for the prevention and/or treatment of chronic metabolic diseases. The study of how habits and actions affect both prevention and treatment of diseases has coalesced around the concept of "lifestyle medicine." The purpose of this review is to provide an up-to-date summary of many of the modalities fundamental to lifestyle medicine, including physical activity, proper nutrition, weight management, and cigarette smoking cessation. This review will also focus specifically on how these modalities are employed both in the prevention and treatment of chronic diseases including coronary heart disease, diabetes, obesity, and cancer. The review concludes with a Call to Action challenging the medical community to embrace the modalities of lifestyle medicine in the daily practice of medicine.
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1273
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Effects of resistance training on neuromuscular parameters in elderly with type 2 diabetes mellitus: A randomized clinical trial. Exp Gerontol 2018; 113:141-149. [DOI: 10.1016/j.exger.2018.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022]
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1274
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Exercise Increases Adiponectin and Reduces Leptin Levels in Prediabetic and Diabetic Individuals: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Med Sci (Basel) 2018; 6:medsci6040097. [PMID: 30380802 PMCID: PMC6318757 DOI: 10.3390/medsci6040097] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
It is speculated that lifestyle interventions known to improve diabetic metabolic state may exert their effects via adipokines. The aim of this systematic review and meta-analysis was to evaluate the chronic effects of physical exercise on adiponectin and leptin levels in adult prediabetic and diabetic individuals. PubMed, Embase, Scopus, The Cochrane Library, clinicaltrials.gov, and WHO Clinical Trials Registry were searched for randomized controlled trials. Pooled effects of interventions were assessed as mean difference (MD) with random effects model. Sensitivity analysis was conducted to test data robustness and subgroup analysis for study heterogeneity. Twenty-two trials with 2996 individuals were included in the meta-analysis. Physical exercise increased levels of adiponectin (MD: 0.42 µg/mL; 95% confidence interval (CI), 0.23, 0.60, p < 0.00001, n = 19 trials) and reduced leptin levels (MD: −1.89 ng/mL; 95% CI, −2.64, −1.14, p < 0.00001, n = 14 trials). These results were robust and remained significant after sensitivity analysis. Study heterogeneity was generally high. As for physical exercise modalities, aerobic exercise, but not other modalities, increased adiponectin and reduced leptin levels. In conclusion, physical exercise and, specifically, aerobic exercise, leads to higher adiponectin and lower leptin levels in prediabetic and diabetic adults. However, cautious interpretation of current findings is warranted.
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1275
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Rempel M, Yardley JE, MacIntosh A, Hay JL, Bouchard D, Cornish S, Marks SD, Hai Y, Gordon JW, McGavock J. Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial. Sci Rep 2018; 8:15879. [PMID: 30367116 PMCID: PMC6203731 DOI: 10.1038/s41598-018-34342-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022] Open
Abstract
Adding vigorous-intensity intervals (VII) to moderate-intensity exercise prevents immediate declines in blood glucose in type 1 diabetes (T1D) however the intensity required to minimize post-exercise hypoglycemia is unknown. To examine this question, ten sedentary T1D individuals completed four treadmill exercise sessions: a control session of 45 minutes of walking at 45–55% of heart rate reserve (HRR) and three sessions consisting of 60 seconds (VII) at 70%, 80%, or 90% of HRR every 4 minutes during exercise at 45–55% of HRR. We used continuous glucose monitoring (CGM) to measure time ≤3.9 mmol/L, glucose variability, hypoglycemia frequency and area under the curve (AUC) for hypoglycemia and hyperglycemia for 12 hours post-exercise. We also examined growth hormone and cortisol responses during and following exercise. In the 12 hours post-exercise, the percentage of time ≤3.9 mmol/L, glucose variability, and AUC for hypoglycemia and hyperglycemia were similar across conditions. The frequency of hypoglycemic events was highest after the 90% intervals compared to the control arm (12 vs 3 events, p = 0.03). There was a trend towards elevated growth hormone with increasing exercise intensity but cortisol levels were similar across conditions. Adding VII to moderate intensity exercise may increase hypoglycemia risk at higher intensities.
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Affiliation(s)
- Meaghan Rempel
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jane E Yardley
- University of Alberta, Augustana Faculty, Camrose, Alberta, Canada.,University of Alberta, Faculty of Kinesiology, Sport and Recreation, Alberta, Canada
| | - Andrea MacIntosh
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline L Hay
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Danielle Bouchard
- Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada
| | - Stephen Cornish
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Seth D Marks
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Education and Resource for Children and Adolescents, Children's Hospital Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Yan Hai
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph W Gordon
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM), Winnipeg, Manitoba, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada. .,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada. .,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM), Winnipeg, Manitoba, Canada.
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1276
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Malone JJ, Bassami M, Waldron SC, Campbell IT, Hulton A, Doran D, MacLaren DP. Carbohydrate oxidation and glucose utilisation under hyperglycaemia in aged and young males during exercise at the same relative exercise intensity. Eur J Appl Physiol 2018; 119:235-245. [PMID: 30353450 DOI: 10.1007/s00421-018-4019-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the age-related carbohydrate oxidation and glucose utilisation rate response during exercise at the same relative intensity under hyperglycaemia in aged and young males. METHODS 16 endurance-trained aged (n = 8; 69.1 ± 5.2 year) and young (n = 8; 22.4 ± 2.9 year) males were studied during 40 min of cycling exercise (60% [Formula: see text]) under both hyperglycaemic and euglycaemic (control) conditions. Venous blood samples were collected at baseline, post-infusion, mid- and post-exercise. Carbohydrate and fat oxidation rates were determined at both 15 and 35 min during exercise, and glucose utilisation rates were calculated. RESULTS The aged group displayed significantly lower rates of carbohydrate oxidation during exercise during maintained hyperglycemia (15 min = 2.3 ± 0.4 vs. 1.6 ± 0.5 g min-1; 35 min = 2.3 ± 0.5 vs. 1.5 ± 0.5 g min-1) and control (15 min = 2.2 ± 0.4 vs. 1.6 ± 0.7 g min-1; 35 min = 1.9 ± 0.7 vs. 1.3 ± 0.7 g min-1) conditions (P = 0.01). The rate of glucose utilisation during exercise was also significantly reduced (85.76 ± 23.95 vs. 56.67 ± 15.09 μM kg-1 min-1). There were no differences between age groups for anthropometric measures, fat oxidation, insulin, glucose, NEFA, glycerol and lactate (P > 0.05) although hyperglycemia resulted in elevated glucose and insulin, and attenuated fat metabolite levels. CONCLUSION Our findings highlight that ageing results in a reduction in carbohydrate oxidation and utilisation rates during exercise at the same relative exercise intensity.
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Affiliation(s)
- James J Malone
- School of Health Sciences, Liverpool Hope University, Taggart Avenue, Liverpool, L16 9JD, UK.
| | - Minoo Bassami
- Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Sarah C Waldron
- Department of Anaesthesia, University Hospital of South Manchester, Manchester, UK
| | - Iain T Campbell
- Department of Anaesthesia, University Hospital of South Manchester, Manchester, UK
| | - Andrew Hulton
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Dominic Doran
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Don P MacLaren
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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1277
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Abstract
The objective of this review paper is to evaluate the impact of undertaking aerobic exercise in the overnight-fasted v. fed-state, in the context of optimising the health benefits of regular physical activity. Conducting a single bout of aerobic exercise in the overnight-fasted v. fed-state can differentially modulate the aspects of metabolism and energy balance behaviours. This includes, but is not limited to, increased utilisation of fat as a fuel source, improved plasma lipid profiles, enhanced activation of molecular signalling pathways related to fuel metabolism in skeletal muscle and adipose tissue, and reductions in energy intake over the course of a day. The impact of a single bout of overnight-fasted v. fed-state exercise on short-term glycaemic control is variable, being affected by the experimental conditions, the time frame of measurement and possibly the subject population studied. The health response to undertaking overnight-fasted v. fed-state exercise for a sustained period of time in the form of exercise training is less clear, due to a limited number of studies. From the extant literature, there is evidence that overnight-fasted exercise in young, healthy men can enhance training-induced adaptations in skeletal muscle metabolic profile, and mitigate against the negative consequences of short-term excess energy intake on glucose tolerance compared with exercising in the fed-state. Nonetheless, further long-term studies are required, particularly in populations at-risk or living with cardio-metabolic disease to elucidate if feeding status prior to exercise modulates metabolism or energy balance behaviours to an extent that could impact upon the health or therapeutic benefits of exercise.
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1278
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Stephens SK, Eakin EG, Clark BK, Winkler EAH, Owen N, LaMontagne AD, Moodie M, Lawler SP, Dunstan DW, Healy GN. What strategies do desk-based workers choose to reduce sitting time and how well do they work? Findings from a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2018; 15:98. [PMID: 30314505 PMCID: PMC6186123 DOI: 10.1186/s12966-018-0731-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
Background Large amounts of sitting at work have been identified as an emerging occupational health risk, and findings from intervention trials have been reported. However, few such reports have examined participant-selected strategies and their relationships with behaviour change. Methods The Stand Up Victoria cluster-randomised controlled trial was a workplace-delivered intervention comprising organisational, environmental and individual level behaviour change strategies aimed at reducing sitting time in desk-based workers. Sit-stand workstations were provided, and participants (n = 134; intervention group only) were guided by health coaches to identify strategies for the ‘Stand Up’, ‘Sit Less’, and ‘Move More’ intervention targets, including how long they would stand using the workstation. Three-month workplace sitting and activity changes (activPAL3-assessed total sitting, prolonged sitting (i.e., sitting ≥30 min continuously) and purposeful walking) were evaluated in relation to the number (regression analysis) and types of strategies (decision-tree analysis). Results Over 80 different strategies were nominated by participants. Each additional strategy nominated for the ‘Stand Up’ intervention target (i.e. number of strategies) was associated with a reduction in prolonged sitting of 27.6 min/8-h workday (95% CI: -53.1, − 2.1, p = 0.034). Types of strategies were categorised into 13 distinct categories. Strategies that were task-based and phone-based were common across all three targets. The decision tree models did not select any specific strategy category as predicting changes in prolonged sitting (‘Stand Up’), however four strategy categories were identified as important for total sitting time (‘Sit Less’) and three strategy categories for purposeful walking (‘Moving More’). The uppermost nodes (foremost predictors) were nominating > 3 h/day of workstation standing (reducing total workplace sitting) and choosing a ‘Move More’ task-based strategy (purposeful walking). Conclusions Workers chose a wide range of strategies, with both strategy choice and strategy quantity appearing relevant to behavioural improvement. Findings support a tailored and pragmatic approach to encourage a change in sitting and activity in the workplace. Evaluating participant-selected strategies in the context of a successful intervention serves to highlight options that may prove feasible and effective in other desk-based workplace environments. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials register (ACTRN12611000742976) on 15 July 2011, Electronic supplementary material The online version of this article (10.1186/s12966-018-0731-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Elizabeth G Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Bronwyn K Clark
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia
| | - Anthony D LaMontagne
- Work, Health & Wellbeing Unit, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Sheleigh P Lawler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - David W Dunstan
- School of Public Health, The University of Queensland, Brisbane, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia.,School of Sport Science, Exercise & Health, University of Western Australia, Perth, Australia.,School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Genevieve N Healy
- School of Public Health, The University of Queensland, Brisbane, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia.,School of Physiotherapy, Faculty of Health Sciences, Curtin University, Perth, Australia
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1279
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Dupas J, Feray A, Guernec A, Pengam M, Inizan M, Guerrero F, Mansourati J, Goanvec C. Effect of personalized moderate exercise training on Wistar rats fed with a fructose enriched water. Nutr Metab (Lond) 2018; 15:69. [PMID: 30305835 PMCID: PMC6171221 DOI: 10.1186/s12986-018-0307-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/24/2018] [Indexed: 12/15/2022] Open
Abstract
Background Metabolic Syndrom has become a public health problem. It mainly results from the increased consumption of fat and sugar. In this context, the benefits of personalized moderate exercise training were investigated on a metabolic syndrome male wistar rat model food with fructose drinking water (20–25% w/v). Different markers including body weight, metabolic measurements, blood biochemistry related to metabolic syndrome complications have been evaluated. Methods Male Wistar rats were randomly allocated to 4 groups: control (sedentary (C, n = 8) and exercise trained (Ex, n = 8)), fructose fed (sedentary (FF, n = 8) and exercise trained fructose fed rats (ExFF, n = 10)). ExFF and Ex rats were trained at moderate intensity during the last 6 weeks of the 12 weeks-long protocol of fructose enriched water. Metabolic control was determined by measuring body weight, fasting blood glucose, HOMA 2-IR, HIRI, MISI, leptin, adiponectin, triglyceridemia and hepatic dysfunction. Results After 12 weeks of fructose enriched diet, rats displayed on elevated fasting glycaemia and insulin resistance. A reduced food intake, as well as increased body weight, total calorie intake and heart weight were also observed in FF group. Concerning biochemical markers, theoretical creatinine clearance, TG levels and ASAT/ALAT ratio were also affected, without hepatic steatosis. Six weeks of 300 min/week of moderate exercise training have significantly improved overweight, fasting glycaemia, HOMA 2-IR, MISI without modify HIRI. Exercise also decreased the plasma levels of leptin, adiponectin and the ratio leptin/adiponectin. Regarding liver function and dyslipidemia, the results were less clear as the effects of exercise and fructose-enriched water interact together, and, sometimes counteract each other. Conclusion Our results indicated that positive health effects were achieved through a personalized moderate training of 300 min per week (1 h/day and 5 days/week) for 6 weeks. Therefore, regular practice of aerobic physical exercise is an essential triggering factor to attenuate MetS disorders induced by excessive fructose consumption.
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Affiliation(s)
- Julie Dupas
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Annie Feray
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,UFR Sciences du Sport et de l'Education, 20 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Anthony Guernec
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,UFR Sciences du Sport et de l'Education, 20 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Morgane Pengam
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Manon Inizan
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,2UFR Sciences et Techniques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29237 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - François Guerrero
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,UFR Sciences du Sport et de l'Education, 20 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Jacques Mansourati
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,4Département de Cardiologie, Centre Hospitalo-Universitaire de Brest, Boulevard Tanguy Prigent, 29200 Brest, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
| | - Christelle Goanvec
- 1EA 4324: Optimisation des Régulations Physiologiques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29238 Brest Cedex 3, France.,2UFR Sciences et Techniques, Université de Bretagne Occidentale, 6 avenue Le Gorgeu, 29237 Brest Cedex 3, France.,IBSAM: Institut Brestois Santé Agro Matière, UFR Médecine, avenue Camille Desmoulin, 29200 Brest, France
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1280
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Abstract
PURPOSE OF REVIEW The purpose of this review paper is to provide an overview of the recent research using physical activity monitors in rheumatic populations including those with osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia. RECENT FINDINGS Recent research demonstrates increased use of physical activity monitors in these populations, especially in those with osteoarthritis. Results from cross-sectional, longitudinal, and intervention studies highlight that physical activity levels are below recommended guidelines, yet evidence suggests benefits such as improving pain, fatigue, function, and overall well-being. While the use of physical activity monitors in rheumatic populations is increasing, more research is needed to better understand physical activity levels in these populations, the effects of activity on relevant clinical outcomes, and how monitors can be used to help more individuals reach physical activity guidelines.
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1281
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In vitro experimental models for examining the skeletal muscle cell biology of exercise: the possibilities, challenges and future developments. Pflugers Arch 2018; 471:413-429. [PMID: 30291430 DOI: 10.1007/s00424-018-2210-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
Abstract
Exercise provides a cornerstone in the prevention and treatment of several chronic diseases. The use of in vivo exercise models alone cannot fully establish the skeletal muscle-specific mechanisms involved in such health-promoting effects. As such, models that replicate exercise-like effects in vitro provide useful tools to allow investigations that are not otherwise possible in vivo. In this review, we provide an overview of experimental models currently used to induce exercise-like effects in skeletal muscle in vitro. In particular, the appropriateness of electrical pulse stimulation and several pharmacological compounds to resemble exercise, as well as important technical considerations, are addressed. Each model covered herein provides a useful tool to investigate different aspects of exercise with a level of abstraction not possible in vivo. That said, none of these models are perfect under all circumstances, and the choice of model (and terminology) used should be informed by the specific research question whilst accounting for the several inherent limitations of each model. Further work is required to develop and optimise the current experimental models used, such as combination with complementary techniques during treatment, and thereby improve their overall utility and impact within muscle biology research.
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1282
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Wróbel M, Rokicka D, Czuba M, Gołaś A, Pyka Ł, Greif M, Szymborska-Kajanek A, Strojek K, Gąsior M. Aerobic as well as resistance exercises are good for patients with type 1 diabetes. Diabetes Res Clin Pract 2018; 144:93-101. [PMID: 30121304 DOI: 10.1016/j.diabres.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
AIMS To assess whether aerobic or resistance training has greater benefits in non-physically active men with a long lasting type 1 diabetes. The effects of exercise were evaluated in terms of diabetes control and risk factors for cardiovascular complications. METHODS 21 male participants (mean age: 37 yrs, diabetes duration: 23 yrs, mean HbA1c: 7.4%) randomly assigned to 2 groups: 1-aerobic training (n = 10) and 2-resistance training (n = 11). All subjects participated in 60-min training sessions, either aerobic or resistance, twice a week for three months. At baseline and after 3 months: echocardiography, ECG and incremental exercise test, ECG and blood pressure monitoring, lipid profile, lactate and diabetes control parameters were assessed in all patients. RESULTS Baseline HbA1c was 7.44% in aerobic group and 7.36% in resistance group (p = 0.84). After 3 months there was no significant change in HbA1c value in any exercise group but a non-statistically significant downward trend was seen particularly in aerobic exercise group (p = 0.07) vs the resistance group (p = 0.15). There was no significant difference in body mass, risk of hypoglycemia and cardiovascular risk factors. CONCLUSIONS Both forms of exercise are safe in terms of glycemic control and cardiovascular risk factors in patients with quite well-controlled type 1 diabetes without advanced late complications.
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Affiliation(s)
- Marta Wróbel
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland.
| | - Dominika Rokicka
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Miłosz Czuba
- Department of Kinesiology, Institute of Sport, ul. Trylogii 2/16, 01-982 Warsaw, Poland
| | - Artur Gołaś
- Department of Sports Training, The Jerzy Kukuczka Academy of Physical Education, ul. Mikołowska 72 a, 40-065 Katowice, Poland
| | - Łukasz Pyka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Małgorzata Greif
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Aleksandra Szymborska-Kajanek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, ul. M. Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
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1283
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Corbin KD, Driscoll KA, Pratley RE, Smith SR, Maahs DM, Mayer-Davis EJ. Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms. Endocr Rev 2018; 39:629-663. [PMID: 30060120 DOI: 10.1210/er.2017-00191] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/21/2018] [Indexed: 02/07/2023]
Abstract
There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.
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Affiliation(s)
- Karen D Corbin
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - Kimberly A Driscoll
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado.,Barbara Davis Center for Diabetes, Aurora, Colorado
| | - Richard E Pratley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - David M Maahs
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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1284
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Song G, Chen C, Zhang J, Chang L, Zhu D, Wang X. Association of traditional Chinese exercises with glycemic responses in people with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. JOURNAL OF SPORT AND HEALTH SCIENCE 2018; 7:442-452. [PMID: 30450253 PMCID: PMC6226554 DOI: 10.1016/j.jshs.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/25/2018] [Accepted: 06/15/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is increasing evidence showing the health benefits of various forms of traditional Chinese exercises (TCEs) on the glycemic profile in people with type 2 diabetes. However, relatively little is known about the combined clinical effectiveness of these traditional exercises. This study was designed to perform a systematic review and meta-analysis of the overall effect of 3 common TCEs (Tai Ji Quan, Qigong, Ba Duan Jin) on glycemic control in adults with type 2 diabetes. METHODS We conducted an extensive database search in Cochrane Library, EMBASE, PubMed, Web of Science, EBSCO, and China National Knowledge Infrastructure on randomized controlled trials published between April 1967 and September 2017 that compared any of the 3 TCEs with a control or comparison group on glycemic control. Data extraction was performed by 2 independent reviewers. Study quality was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions, which assessed the risk of bias, including sequence generation, allocation concealment, blinding, completeness of outcome data, and selective outcome reporting. The resulting quality of the reviewed studies was characterized in 3 grades representing the level of bias: low, unclear, and high. All analyses were performed using random effects models and heterogeneity was quantified. We a priori specified changes in biomarkers of hemoglobin A1c (in percentage) and fasting blood glucose (mmol/L) as the main outcomes and triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein-cholesterol, 2-h plasma glucose, and fasting plasma glucose as secondary outcomes. RESULTS A total of 39 randomized, controlled trials (Tai Ji Quan = 11; Qigong = 6; Ba Duan Jin = 22) with 2917 type 2 diabetic patients (aged 41-80 years) were identified. Compared with a control or comparison group, pooled meta-analyses of TCEs showed a significant decrease in hemoglobin A1c (mean difference (MD) = -0.67%; 95% confidence interval (CI): -0.86% to -0.48%; p < 0.00001) and fasting blood glucose (MD = -0.66 mmol/L; 95%CI: -0.95 to -0.37 mmol/L; p < 0.0001). The observed effect was more pronounced for interventions that were medium range in duration (i.e., >3-<12 months). TCE interventions also showed improvements in the secondary outcome measures. A high risk of bias was observed in the areas of blinding (i.e., study participants and personnel, and outcome assessment). CONCLUSION Among patients with type 2 diabetes, TCEs were associated with significantly lower hemoglobin A1c and fasting blood glucose. Further studies to better understand the dose and duration of exposure to TCEs are warranted.
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Affiliation(s)
- Ge Song
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Changcheng Chen
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Juan Zhang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Lin Chang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Dong Zhu
- School of Wushu, Shanghai University of Sport, Shanghai 200438, China
| | - Xueqiang Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
- Corresponding author.
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1285
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Codella R, Ialacqua M, Terruzzi I, Luzi L. May the force be with you: why resistance training is essential for subjects with type 2 diabetes mellitus without complications. Endocrine 2018; 62:14-25. [PMID: 29730785 DOI: 10.1007/s12020-018-1603-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
Physical activity, together with diet and pharmacological therapy, represents one of the three cornerstones in type 2 diabetes mellitus treatment and care. The therapeutic appeal of regular physical activity stems from: (i) its non-pharmacological nature; (ii) its beneficial effects on the metabolic risk factors associated with diabetes complications; (iii) its low costs. Evidence accumulated in the last years suggests that aerobic training-endurance training-constitutes a safe modality of intervention, achievable, and effective in diabetes treatment, whenever it is not limited by comorbidities. Aerobic training exerts insulin-mimetic effects and has been shown to lower mortality risk too. Anaerobic, intense physical activity, such as that of strength or power sports disciplines, is not univocally recognized as safe and simple to realize, however, it is important in stimulating energy and glucose metabolism. According to recent evidence, high-intensity training may be prescribed even in the face of cardiovascular diseases, peripheral vascular disease, or osteoarthritis. Some studies have shown resistance training to be more efficient than aerobic exercise in improving glycemic control. This review explores the most up-to-date indications emerging from literature in support of the beneficial effects of strength stimulation and resistance training in patients with type 2 diabetes without complications.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Marta Ialacqua
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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1286
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Bock BC, Thind H, Fava JL, Dunsiger S, Guthrie KM, Stroud L, Gopalakrishnan G, Sillice M, Wu W. Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study. Complement Ther Med 2018; 42:125-131. [PMID: 30670230 DOI: 10.1016/j.ctim.2018.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study:Healthy Active and in Control (HA1C), examined the feasibility and acceptability of yoga as a complementary therapy for adults with Type-2 Diabetes (T2DM). DESIGN A 2-arm randomized clinical trial comparing Iyengar yoga with a supervised walking program. SETTING Hospital based gym-type facility and conference rooms. INTERVENTIONS Participants were randomized to a 12-week program of either; (1) a twice weekly Iyengar yoga, or (2) a twice-weekly program of standard exercise (SE). MAIN OUTCOME MEASURES Primary outcomes assessed feasibility and acceptability, including enrollment rates, attendance, study completion, and participant satisfaction. Secondary outcomes included HbA1c, physical activity, and measures of diabetes-related emotional distress, self-care and quality of life (QOL). Assessments were conducted at baseline, end of treatment, 6-months and 9-months post-enrollment. RESULTS Of 175 adults screened for eligibility, 48 (30 women, 18 men) were eligible and enrolled. The most common reasons for ineligibility were orthopedic restrictions, HbA1c levels <6.5 and BMI > 42. Session attendance was high (82% of sessions attended), as was follow-up completion rates (92%). Program satisfaction rated on a 5-point scale, was high among both Yoga (M = 4.63, SD = 0.57) and SE (M = 4.77, SD = 0.52) participants. Overall 44 adverse events (26 Yoga, 18 SE) were reported. Of these, six were deemed "possibly related" (e.g., neck strain, back pain), and 1 "probably related" (ankle pain after treadmill) to the study. Yoga produced significant reductions in HbA1c. Median HbA1c at 6 months was 1.25 units lower for Yoga compared to SE (95% CI: -2.54 -0.04). Greater improvements in diabetes self-care, quality of life, and emotional distress were seen among Yoga participants than among SE participants. Increases in mindfulness were seen in Yoga but not in SE. CONCLUSIONS The yoga intervention was highly feasible and acceptable, and produced improvements in blood glucose and psychosocial measures of diabetes management.
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Affiliation(s)
- B C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States.
| | - H Thind
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - J L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - S Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - K M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - L Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - G Gopalakrishnan
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - M Sillice
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - W Wu
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
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1287
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Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes 2018; 42 Suppl 1:S54-S63. [PMID: 29650112 DOI: 10.1016/j.jcjd.2017.10.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/15/2022]
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1288
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Lu K, Yang L, Seoane F, Abtahi F, Forsman M, Lindecrantz K. Fusion of Heart Rate, Respiration and Motion Measurements from a Wearable Sensor System to Enhance Energy Expenditure Estimation. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3092. [PMID: 30223429 PMCID: PMC6164120 DOI: 10.3390/s18093092] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 02/05/2023]
Abstract
This paper presents a new method that integrates heart rate, respiration, and motion information obtained from a wearable sensor system to estimate energy expenditure. The system measures electrocardiography, impedance pneumography, and acceleration from upper and lower limbs. A multilayer perceptron neural network model was developed, evaluated, and compared to two existing methods, with data from 11 subjects (mean age, 27 years, range, 21⁻65 years) who performed a 3-h protocol including submaximal tests, simulated work tasks, and periods of rest. Oxygen uptake was measured with an indirect calorimeter as a reference, with a time resolution of 15 s. When compared to the reference, the new model showed a lower mean absolute error (MAE = 1.65 mL/kg/min, R² = 0.92) than the two existing methods, i.e., the flex-HR method (MAE = 2.83 mL/kg/min, R² = 0.75), which uses only heart rate, and arm-leg HR+M method (MAE = 2.12 mL/kg/min, R² = 0.86), which uses heart rate and motion information. As indicated, this new model may, in combination with a wearable system, be useful in occupational and general health applications.
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Affiliation(s)
- Ke Lu
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 57 Huddinge, Sweden.
| | - Liyun Yang
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 57 Huddinge, Sweden.
- Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.
| | - Fernando Seoane
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hälsovägen 7, 141 57 Huddinge, Sweden.
- Swedish School of Textiles, University of Borås, Allégatan 1, 501 90 Borås, Sweden.
- Department of Biomedical Engineering, Karolinska University Hospital, 1, 171 76 Solna, Sweden.
| | - Farhad Abtahi
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 57 Huddinge, Sweden.
- Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.
| | - Mikael Forsman
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 57 Huddinge, Sweden.
- Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.
| | - Kaj Lindecrantz
- Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.
- Swedish School of Textiles, University of Borås, Allégatan 1, 501 90 Borås, Sweden.
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1289
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Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, Wolfsdorf JI, Schatz D. Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2026-2044. [PMID: 30093549 PMCID: PMC6105320 DOI: 10.2337/dci18-0023] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jane L Chiang
- McKinsey & Company and Diasome Pharmaceuticals, Inc., Palo Alto, CA
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Stuart A Weinzimer
- Pediatric Endocrinology & Diabetes, Yale School of Medicine, New Haven, CT
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Desmond Schatz
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
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1290
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Rickels MR, DuBose SN, Toschi E, Beck RW, Verdejo AS, Wolpert H, Cummins MJ, Newswanger B, Riddell MC, Rickels M, Peleckis A, Evangelisti M, Dalton-Bakes C, Fuller C, Toschi E, Wolpsert H, Middelbeek R, Cherng Jye LS, Shahar J, Slyne C, Edwards S, Castillo AA, DuBose SN, Beck RW, Verdejo AS, Cummins M, Newswanger B, Prestrelski S. Mini-Dose Glucagon as a Novel Approach to Prevent Exercise-Induced Hypoglycemia in Type 1 Diabetes. Diabetes Care 2018; 41:1909-1916. [PMID: 29776987 PMCID: PMC6463733 DOI: 10.2337/dc18-0051] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/25/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with type 1 diabetes who do aerobic exercise often experience a drop in blood glucose concentration that can result in hypoglycemia. Current approaches to prevent exercise-induced hypoglycemia include reduction in insulin dose or ingestion of carbohydrates, but these strategies may still result in hypoglycemia or hyperglycemia. We sought to determine whether mini-dose glucagon (MDG) given subcutaneously before exercise could prevent subsequent glucose lowering and to compare the glycemic response to current approaches for mitigating exercise-associated hypoglycemia. RESEARCH DESIGN AND METHODS We conducted a four-session, randomized crossover trial involving 15 adults with type 1 diabetes treated with continuous subcutaneous insulin infusion who exercised fasting in the morning at ∼55% VO2max for 45 min under conditions of no intervention (control), 50% basal insulin reduction, 40-g oral glucose tablets, or 150-μg subcutaneous glucagon (MDG). RESULTS During exercise and early recovery from exercise, plasma glucose increased slightly with MDG compared with a decrease with control and insulin reduction and a greater increase with glucose tablets (P < 0.001). Insulin levels were not different among sessions, whereas glucagon increased with MDG administration (P < 0.001). Hypoglycemia (plasma glucose <70 mg/dL) was experienced by six subjects during control, five subjects during insulin reduction, and none with glucose tablets or MDG; five subjects experienced hyperglycemia (plasma glucose ≥250 mg/dL) with glucose tablets and one with MDG. CONCLUSIONS MDG may be more effective than insulin reduction for preventing exercise-induced hypoglycemia and may result in less postintervention hyperglycemia than ingestion of carbohydrate.
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Affiliation(s)
- Michael R. Rickels
- Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | - Howard Wolpert
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | - Michael C. Riddell
- Muscle Health Research Centre, York University School of Kinesiology and Health Science, Toronto, Ontario, Canada
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1291
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Extremely short duration interval exercise improves 24-h glycaemia in men with type 2 diabetes. Eur J Appl Physiol 2018; 118:2551-2562. [PMID: 30171349 PMCID: PMC6244655 DOI: 10.1007/s00421-018-3980-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/25/2018] [Indexed: 12/16/2022]
Abstract
Purpose Reduced-exertion high-intensity interval training (REHIT) is a genuinely time-efficient exercise intervention that improves aerobic capacity and blood pressure in men with type 2 diabetes. However, the acute effects of REHIT on 24-h glycaemia have not been examined. Methods 11 men with type 2 diabetes (mean ± SD: age, 52 ± 6 years; BMI, 29.7 ± 3.1 kg/m2; HbA1c, 7.0 ± 0.8%) participated in a randomised, four-trial crossover study, with continual interstitial glucose measurements captured during a 24-h dietary-standardised period following either (1) no exercise (CON); (2) 30 min of continuous exercise (MICT); (3) 10 × 1 min at ~ 90 HRmax (HIIT; time commitment, ~ 25 min); and (4) 2 × 20 s ‘all-out’ sprints (REHIT; time commitment, 10 min). Results Compared to CON, mean 24-h glucose was lower following REHIT (mean ± 95%CI: − 0.58 ± 0.41 mmol/L, p = 0.008, d = 0.55) and tended to be lower with MICT (− 0.37 ± 0.41 mmol/L, p = 0.08, d = 0.35), but was not significantly altered following HIIT (− 0.37 ± 0.59 mmol/L, p = 0.31, d = 0.35). This seemed to be largely driven by a lower glycaemic response (area under the curve) to dinner following both REHIT and MICT (− 11%, p < 0.05 and d > 0.9 for both) but not HIIT (− 4%, p = 0.22, d = 0.38). Time in hyperglycaemia appeared to be reduced with all three exercise conditions compared with CON (REHIT: − 112 ± 63 min, p = 0.002, d = 0.50; MICT: -115 ± 127 min, p = 0.08, d = 0.50; HIIT − 125 ± 122 min, p = 0.04, d = 0.54), whilst indices of glycaemic variability were not significantly altered. Conclusion REHIT may offer a genuinely time-efficient exercise option for improving 24-h glycaemia in men with type 2 diabetes and warrants further study.
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1292
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Li Y, White K, O'Shields KR, McLain AC, Merchant AT. Light-Intensity Physical Activity and Cardiometabolic Risk Among Older Adults With Multiple Chronic Conditions. Am J Health Promot 2018; 33:507-515. [PMID: 30157668 DOI: 10.1177/0890117118796459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions. DESIGN Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012). SETTING Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults. PARTICIPANTS Adults aged 50 years and older (N = 14 996). MEASURES Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA1c], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions. ANALYSIS Weighted multivariate linear regression models. RESULTS Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA1c, or non-HDL-C. CONCLUSIONS Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.
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Affiliation(s)
- Yueyao Li
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Kellee White
- 2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Katherine R O'Shields
- 2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Alexander C McLain
- 2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- 2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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1293
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Pieralice S, Vigevano F, Del Toro R, Napoli N, Maddaloni E. Lifestyle Management of Diabetes: Implications for the Bone-Vascular Axis. Curr Diab Rep 2018; 18:84. [PMID: 30121859 DOI: 10.1007/s11892-018-1060-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To describe the main pathways involved in the interplay between bone and cardiovascular disease and to highlight the possible impact of physical activity and medical nutrition therapy on the bone-vascular axis. RECENT FINDINGS Diabetes increases the risk of both cardiovascular disease and bone fragility fractures, sharing common pathogenic pathways, including OPG/RANK/RANKL, the FGF23/Klotho axis, calciotropic hormones, and circulating osteogenic cells. This may offer new therapeutic targets for future treatment strategies. As lifestyle intervention is the cornerstone of diabetes treatment, there is potential for an impact on the bone-vascular axis. Evidence published suggests the bone-vascular axis encompasses key pathways for cardiovascular disease. This, along with studies showing physical activity plays a crucial role in the prevention of both bone fragility and cardiovascular disease, suggests that lifestyle intervention incorporating exercise and diet may be helpful in managing skeletal health decline in diabetes. Studies investigating the controversial role of high-fiber diet and dietary vitamin D/calcium on bone and cardiovascular health suggest an overall benefit, but further investigations are needed in this regard.
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Affiliation(s)
- Silvia Pieralice
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Francesca Vigevano
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Rossella Del Toro
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
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1294
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Geidl W, Gobster C, Streber R, Pfeifer K. A systematic critical review of physical activity aspects in clinical guidelines for multiple sclerosis. Mult Scler Relat Disord 2018; 25:200-207. [PMID: 30103172 DOI: 10.1016/j.msard.2018.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/04/2018] [Accepted: 07/20/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This paper aims to evaluate the quality of clinical guidelines (CGs) for MS and to critically appraise physical activity-related recommendations. DATA SOURCES Medical databases (MEDLINE, TRIP), clearinghouses, and guideline developers. An expert was asked to confirm if the list of CGs was complete. STUDY SELECTION Evidence-based CGs specific to MS with recommendations including aspects of rehabilitation or physical activity were included. DATA EXTRACTION Two reviewers independently first assessed the methodological quality of the CGs based on the 23 items of the Appraisal of Guidelines for Research and Evaluation Instrument version two (AGREE II) and second evaluated the physical activity-related content quality using an instrument containing 14 items that was used for the development of the National Recommendations for Physical Activity in Germany. DATA SYNTHESIS For the AGREE II domains and the criteria for content quality, standardized domain scores were calculated. RESULTS Three CGs were included. The average scores for the methodological quality of the domains were: scope and purpose (91%), stakeholder involvement (81%), rigor of development (78%), clarity of presentation (93%), applicability (53%), and editorial independence (83%). The mean scores for physical activity-related content quality did not exceed 56% for any criteria. CONCLUSIONS Overall, this critical review shows that the methodological quality of CGs were moderate to good but physical activity-related content quality was heterogeneous and low. Results emphasize the need for more specific physical activity recommendations that incorporate multiple aspects of physical activity prescription.
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Affiliation(s)
- Wolfgang Geidl
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstr. 123b, Erlangen D-91058, Germany.
| | - Chelsea Gobster
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstr. 123b, Erlangen D-91058, Germany
| | - René Streber
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstr. 123b, Erlangen D-91058, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstr. 123b, Erlangen D-91058, Germany
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1295
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Zaharieva DP, Riddell MC. Insulin Management Strategies for Exercise in Diabetes. Can J Diabetes 2018; 41:507-516. [PMID: 28942788 DOI: 10.1016/j.jcjd.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/16/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
There is no question that regular exercise can be beneficial and lead to improvements in overall cardiovascular health. However, for patients with diabetes, exercise can also lead to challenges in maintaining blood glucose balance, particularly if patients are prescribed insulin or certain oral hypoglycemic agents. Hypoglycemia is the most common adverse event associated with exercise and insulin therapy, and the fear of hypoglycemia is also the greatest barrier to exercise for many patients. With the appropriate insulin dose adjustments and, in some cases, carbohydrate supplementation, blood glucose levels can be better managed during exercise and in recovery. In general, insulin strategies that help facilitate weight loss with regular exercise and recommendations around exercise adjustments to prevent hypoglycemia and hyperglycemia are often not discussed with patients because the recommendations can be complex and may differ from one individual to the next. This is a review of the current published literature on insulin dose adjustments and starting-point strategies for patients with diabetes in preparation for safe exercise.
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Affiliation(s)
- Dessi P Zaharieva
- School of Kinesiology & Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Michael C Riddell
- School of Kinesiology & Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, Toronto, Ontario, Canada; LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
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1296
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Archer E, Pavela G, McDonald S, Lavie CJ, Hill JO. Cell-Specific "Competition for Calories" Drives Asymmetric Nutrient-Energy Partitioning, Obesity, and Metabolic Diseases in Human and Non-human Animals. Front Physiol 2018; 9:1053. [PMID: 30147656 PMCID: PMC6097573 DOI: 10.3389/fphys.2018.01053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
Abstract
The mammalian body is a complex physiologic “ecosystem” in which cells compete for calories (i.e., nutrient-energy). Axiomatically, cell-types with competitive advantages acquire a greater number of consumed calories, and when possible, increase in size and/or number. Thus, it is logical and parsimonious to posit that obesity is the competitive advantages of fat-cells (adipocytes) driving a disproportionate acquisition and storage of nutrient-energy. Accordingly, we introduce two conceptual frameworks. Asymmetric Nutrient-Energy Partitioning describes the context-dependent, cell-specific competition for calories that determines the partitioning of nutrient-energy to oxidation, anabolism, and/or storage; and Effective Caloric Intake which describes the number of calories available to constrain energy-intake via the inhibition of the sensorimotor appetitive cells in the liver and brain that govern ingestive behaviors. Inherent in these frameworks is the independence and dissociation of the energetic demands of metabolism and the neuro-muscular pathways that initiate ingestive behaviors and energy intake. As we demonstrate, if the sensorimotor cells suffer relative caloric deprivation via asymmetric competition from other cell-types (e.g., skeletal muscle- or fat-cells), energy-intake is increased to compensate for both real and merely apparent deficits in energy-homeostasis (i.e., true and false signals, respectively). Thus, we posit that the chronic positive energy balance (i.e., over-nutrition) that leads to obesity and metabolic diseases is engendered by apparent deficits (i.e., false signals) driven by the asymmetric inter-cellular competition for calories and concomitant differential partitioning of nutrient-energy to storage. These frameworks, in concert with our previous theoretic work, the Maternal Resources Hypothesis, provide a parsimonious and rigorous explanation for the rapid rise in the global prevalence of increased body and fat mass, and associated metabolic dysfunctions in humans and other mammals inclusive of companion, domesticated, laboratory, and feral animals.
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Affiliation(s)
| | - Gregory Pavela
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Carl J Lavie
- School of Medicine, John Ochsner Heart and Vascular Institute, The University of Queensland, New Orleans, LA, United States
| | - James O Hill
- Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, CO, United States
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1297
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Houlder SK, Yardley JE. Continuous Glucose Monitoring and Exercise in Type 1 Diabetes: Past, Present and Future. BIOSENSORS-BASEL 2018; 8:bios8030073. [PMID: 30081478 PMCID: PMC6165159 DOI: 10.3390/bios8030073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/29/2022]
Abstract
Prior to the widespread use of continuous glucose monitoring (CGM), knowledge of the effects of exercise in type 1 diabetes (T1D) was limited to the exercise period, with few studies having the budget or capacity to monitor participants overnight. Recently, CGM has become a staple of many exercise studies, allowing researchers to observe the otherwise elusive late post-exercise period. We performed a strategic search using PubMed and Academic Search Complete. Studies were included if they involved adults with T1D performing exercise or physical activity, had a sample size greater than 5, and involved the use of CGM. Upon completion of the search protocol, 26 articles were reviewed for inclusion. While outcomes have been variable, CGM use in exercise studies has allowed the assessment of post-exercise (especially nocturnal) trends for different exercise modalities in individuals with T1D. Sensor accuracy is currently considered adequate for exercise, which has been crucial to developing closed-loop and artificial pancreas systems. Until these systems are perfected, CGM continues to provide information about late post-exercise responses, to assist T1D patients in managing their glucose, and to be useful as a tool for teaching individuals with T1D about exercise.
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Affiliation(s)
- Shaelyn K Houlder
- Augustana Faculty, University of Alberta, 4901-46 Ave, Camrose, AB T4V 2R3, Canada.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, 4901-46 Ave, Camrose, AB T4V 2R3, Canada.
- Alberta Diabetes Institute, 112 St. NW, Edmonton, AB T6G 2T9, Canada.
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1298
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Hu P, Li Y, Zhou X, Zhang X, Zhang F, Ji L. Association between physical activity and abnormal glucose metabolism-A population-based cross-sectional study in China. J Diabetes Complications 2018; 32:746-752. [PMID: 30017433 DOI: 10.1016/j.jdiacomp.2018.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/26/2018] [Accepted: 05/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Association between physical activity and abnormal glucose metabolism (AGM) remains unclear. METHODS Data were collected from a random sample of the Chinese population aged 26-77 years. Participants were classified into an AGM group or a normal glucose tolerance (NGT) group. Total physical activity energy expenditure (PAEE), sedentary time, and ratios of PAEE in different domains to the total PAEE were calculated according to the International Physical Activity Questionnaire. Logistic regression was used to analyze the associations between total PAEE, ratios of PAEE under different domains to total PAEE, sedentary time, and AGM. RESULTS Data from 3510 participants aged 50 ± 12 years were analyzed; 1390 (39.6%) were diagnosed with AGM. In the multivariate logistic regression analysis, total PAEE (1000 MET-min/week) was significantly associated with AGM [OR (95% CI) 0.96 (0.94, 0.99)]. After stratification by sex and BMI, total PAEE was negatively associated with AGM in men and overweight people. The ratios of PAEE in different domains to total PAEE or sedentary time were not associated with AGM. CONCLUSIONS Total PAEE was negatively associated with AGM. Ratios of PAEE in different domains to total PAEE and sedentary time were not associated with AGM in this Chinese population.
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Affiliation(s)
- Ping Hu
- Peking University People's Hospital, Endocrine & Metabolism, Beijing, China
| | - Yufeng Li
- Beijing Pinggu Hospital, Endocrinology and Metabolism, Beijing, China
| | - Xianghai Zhou
- Peking University People's Hospital, Endocrine & Metabolism, Beijing, China.
| | - Xiuying Zhang
- Peking University People's Hospital, Endocrine & Metabolism, Beijing, China
| | - Fang Zhang
- Peking University People's Hospital, Endocrine & Metabolism, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Endocrine & Metabolism, Beijing, China.
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1299
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Abstract
The prevalence of obesity is increasing world-wide. Obesity is associated with a plethora of metabolic and clinical constraints, which result in a higher risk for the development of cardiovascular complications and metabolic disease, particularly insulin resistance and type 2 diabetes. Obesity is an acknowledged determinant of glycemic control in patients with type 1 diabetes and accounts for the majority of premature death due to cardiovascular events. Physical exercise is generally recommended in patients with diabetes in order to prevent the development of or reduce existing obesity, as adopted by every international treatment guideline so far. Regular physical exercise has a beneficial impact on body composition, cardiovascular integrity, insulin sensitivity and quality of life. However, only a minority of patients participates in regular physical exercise, due to individual or disease-related barriers. In type 2 diabetes, there is robust evidence for beneficial effects of physical exercise on glycemic control, cardiovascular health and the development of diabetes-related long-term complications. In type 1 diabetes and patients treated with insulin, a higher risk for exercise-related hypoglycemia has to be considered, which requires certain prerequisites and adequate adaptions of insulin dosing. Current treatment guidelines do only incompletely address the development of exercise-related hypoglycemia. However, every patient with diabetes should participate in regular physical exercise in order to support and enable sufficient treatment and optimal glycemic control.
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Affiliation(s)
- Andreas Melmer
- 1 Universitätsklinik für Diabetes, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital Bern
| | - Patrick Kempf
- 1 Universitätsklinik für Diabetes, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital Bern
| | - Markus Laimer
- 1 Universitätsklinik für Diabetes, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital Bern
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1300
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Benedini S, Codella R, Caumo A, Terruzzi I, Luzi L. Single bout of low-intensity exercise produces modestly favorable changes in glycemic and lipidemic profiles after ingestion of non-isoglucidic breakfasts. Nutrition 2018; 58:57-64. [PMID: 30296709 DOI: 10.1016/j.nut.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the acute effects of low-intensity exercise on the postprandial hormonal and metabolic milieu induced by breakfast consumption. METHODS Exercise began 100 min after the initiation of breakfast consumption and consisted of cycling at 40% of maximum oxygen uptake for 20 min. Three different breakfasts were used to elicit the postprandial state: B1 = skimmed milk (125 mL) and 30g corn flakes; B2 = skimmed milk (220 mL), 200 g apple, 30 g cocoa cream-filled sponge cake; B3 = skimmed milk (125 mL), 50 g bread, 150 g apple, and 15 g hazelnut and cocoa spread. Nineteen young healthy participants (8 M/11 F; body mass index 22.7 ± 0.5 kg/m2; age 31 ± 0.7 y) consumed the three breakfasts, as well as an oral glucose load (50-g oral glucose tolerance test), under either resting or exercise conditions, in a randomized-crossover fashion. Blood glucose, insulinemia, ghrelinemia, lipidemia, and satiety were measured throughout the studies. To evaluate the metabolic effects of exercise, the changes that glucose, insulin, ghrelin, free fatty acid exhibited in the interval 90 to 120 min were analyzed with a two-way repeated measures analysis of variance (factor 1: type of oral test; factor 2: resting/exercise condition). RESULTS No interaction between the two factors was found for any of the examined variables. Light exercise produced a modest, significant decrease in blood glucose levels (P = 0.004) and a modest, significant increase in free fatty acid levels (P = 0.002) with respect to the resting condition. CONCLUSIONS These findings suggest that short, mild exercise has beneficial effects on postprandial metabolism and this may have direct bearing on the issue of counteracting the epidemic rising of sedentary lifestyle of the general population.
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Affiliation(s)
- Stefano Benedini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Metabolism Research Center, Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, San Donato Milanese, Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Metabolism Research Center, Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, San Donato Milanese, Italy
| | - Andrea Caumo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Division of Metabolic and Cardiovascular Science, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Metabolism Research Center, Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, San Donato Milanese, Italy.
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