Biomarkers and genetic polymorphisms associated with maximal fat oxidation during physical exercise: implications for metabolic health and sports performance

Circadian Regulation of Fatty Acid Metabolism in Humans: Is There Evidence of an Optimal Time Window for Maximizing Fat Oxidation During Exercise?

Exercise training performed at the intensity that elicits maximal fat oxidation improves cardiovascular function and metabolic health while simultaneously reducing visceral adipose tissue in patients with obesity and type 2 diabetes. Indeed, it is currently considered an efficient non-pharmacological approach for the prevention and treatment of cardiometabolic disorders. Over the last 5 years, several studies have reported a diurnal variation in both resting fat oxidation as well as maximal fat oxidation recorded during submaximal intensity exercise. Higher fat oxidation has been recorded during the evening in comparison with the early morning, although this has not been universally observed. If evening exercise increases fat oxidation, then this timing of exercise may be preferable for the reversal of cardiometabolic diseases. However, the physiological and molecular mechanisms behind the circadian regulation of fatty acid metabolism have not yet been fully elucidated. The present review thus aims to describe the circadian rhythmicity of several hormones, metabolites, and enzymes involved in fatty acid mobilization and oxidation. Furthermore, we discuss the relevance of circadian mitochondrial dynamics and oxidative phosphorylation to fatty acid metabolism. To conclude our discussion, we highlight those biological (e.g., age and sex) and lifestyle factors (e.g., sleep quality/disturbances or physical activity) that potentially influence the circadian regulation of fatty metabolism and which therefore should be considered for a tailored exercise prescription.

Impact of Exercise Training at Maximal Fat Oxidation Intensity on Metabolic and Epigenetic Parameters in Patients with Overweight and Obesity: Study Protocol of a Randomized Controlled Trial

Background: Exercise is an essential pillar for human health, as it contributes to physical, mental, and emotional well-being. Well-recognized international organizations, such as the World Health Organization, advocate for integrating exercise into healthy lifestyles, recognizing its importance in disease prevention and improving quality of life. However, despite the consensus on its value, there is no universal agreement on specific prescriptions for vulnerable groups, highlighting the need for personalized approaches that consider the unique characteristics and needs of everyone. Emerging studies have demonstrated that exercise training performed at the intensity that elicits maximal fat oxidation improves insulin sensitivity, cardiorespiratory fitness, and body composition in patients with obesity, making it a highly effective strategy for long-term weight management and metabolic health in this specific population. Methods: The present study protocol settles the basis for a 16-week randomized clinical trial based on exercise prescription at the maximal fat oxidation rate combined with resistance training in young individuals with overweight and obesity. Expected Results: This study will elucidate how FatMax, with or without resistance exercises, can enhance metabolic flexibility, increase fat oxidation, and improve body composition, evaluating changes in biochemical parameters (cholesterol, glucose, triglycerides, and inflammatory markers), metabolic biomarkers (determination of fat and carbohydrate utilization rates during rest and exercise), and epigenetic indicators (focusing on microRNAs associated with adipogenesis, inflammation, and fat metabolism). ClinicalTrials.gov identification number: NCT06553482 (FatMax Training on Metabolic and Epigenetic Parameters).

Reliability of the Metabolic Response During Steady-State Exercise at FATmax in Young Men with Obesity

Purpose: In this study we evaluated the reliability of blood lactate levels (BLa), energy expenditure and substrate utilization during prolonged exercise at the intensity that elicits maximal fat oxidation (FATmax). Furthermore, we investigated the accuracy of a single graded exercise test (GXT) for predicting energy metabolism at FATmax. Methods: Seventeen young men with obesity (26 ± 6 years; 36.4 ± 7.2 %body fat) performed a GXT on a treadmill in a fasted state (10-12 h) for the assessment of FATmax and cardiorespiratory fitness. Afterward, each subject performed two additional prolonged FATmax trials (102 ± 11 beats·min-1; 60-min) separated by 7 days. Indirect calorimetry was used for the assessment of energy expenditure and substrate utilization kinetics whereas capillary blood samples were taken for the measurement of BLa. Results: The BLa (limits of agreement (LoA): -1.2 to 0.8 mmol∙L-1; p = 1.0), fat utilization (LoA: -8.0 to 13.4 g∙h-1; p = 0.06), and carbohydrate utilization (LoA: -27.6 to 22.4 g∙h-1; p = 0.41) showed a good agreement whereas a modest systematic bias was found for energy expenditure (LoA: -16811 to 33355 kJ∙h-1; p < 0.05). All the aforementioned parameters showed a moderate to good reliability (Intraclass correlation coefficient: 0.67-0.92). The GXT overestimated fat (~46%) and carbohydrate (~26%) utilization as well as energy expenditure (36%) during steady-state exercise at FATmax. Conversely the GXT underestimated BLa (~28%). Conclusion: a single GXT cannot be used for an accurate prediction of energy metabolism during prolonged exercise in men with obesity. Thus, an additional steady-state FATmax trial (40-60 min) should be performed for a tailored and precise exercise prescription.

The Current State of Knowledge Regarding the Genetic Predisposition to Sports and Its Health Implications in the Context of the Redox Balance, Especially Antioxidant Capacity

The significance of physical activity in sports is self-evident. However, its importance is becoming increasingly apparent in the context of public health. The constant desire to improve health and performance suggests looking at genetic predispositions. The knowledge of genes related to physical performance can be utilized initially in the training of athletes to assign them to the appropriate sport. In the field of medicine, this knowledge may be more effectively utilized in the prevention and treatment of cardiometabolic diseases. Physical exertion engages the entire organism, and at a basic physiological level, the organism's responses are primarily related to oxidant and antioxidant reactions due to intensified cellular respiration. Therefore, the modifications involve the body adjusting to the stresses, especially oxidative stress. The consequence of regular exercise is primarily an increase in antioxidant capacity. Among the genes considered, those that promote oxidative processes dominate, as they are associated with energy production during exercise. What is missing, however, is a look at the other side of the coin, which, in this case, is antioxidant processes and the genes associated with them. It has been demonstrated that antioxidant genes associated with increased physical performance do not always result in increased antioxidant capacity. Nevertheless, it seems that maintaining the oxidant-antioxidant balance is the most important thing in this regard.

Advancing athletic assessment by integrating conventional methods with cutting-edge biomedical technologies for comprehensive performance, wellness, and longevity insights

In modern athlete assessment, the integration of conventional biochemical and ergophysiologic monitoring with innovative methods like telomere analysis, genotyping/phenotypic profiling, and metabolomics has the potential to offer a comprehensive understanding of athletes' performance and potential longevity. Telomeres provide insights into cellular functioning, aging, and adaptation and elucidate the effects of training on cellular health. Genotype/phenotype analysis explores genetic variations associated with athletic performance, injury predisposition, and recovery needs, enabling personalization of training plans and interventions. Metabolomics especially focusing on low-molecular weight metabolites, reveal metabolic pathways and responses to exercise. Biochemical tests assess key biomarkers related to energy metabolism, inflammation, and recovery. Essential elements depict the micronutrient status of the individual, which is critical for optimal performance. Echocardiography provides detailed monitoring of cardiac structure and function, while burnout testing evaluates psychological stress, fatigue, and readiness for optimal performance. By integrating this scientific testing battery, a multidimensional understanding of athlete health status can be achieved, leading to personalized interventions in training, nutrition, supplementation, injury prevention, and mental wellness support. This scientifically rigorous approach hereby presented holds significant potential for improving athletic performance and longevity through evidence-based, individualized interventions, contributing to advances in the field of sports performance optimization.

Toward Exercise Guidelines for Optimizing Fat Oxidation During Exercise in Obesity: A Systematic Review and Meta-Regression

BACKGROUND

Exercise training performed at maximal fat oxidation (FATmax) is an efficient non-pharmacological approach for the management of obesity and its related cardio-metabolic disorders.

OBJECTIVES

Therefore, this work aimed to provide exercise intensity guidelines and training volume recommendations for maximizing fat oxidation in patients with obesity.

METHODS

A systematic review of original articles published in English, Spanish or French languages was carried out in EBSCOhost, PubMed and Scopus by strictly following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Those studies that analyzed maximal fat oxidation (MFO) and FATmax in patients with obesity (body fat > 25% for men; > 35% for women) by calculating substrate oxidation rates through indirect calorimetry during a graded exercise test with short-duration stages (< 10 min) were selected for quantitative analysis. The accuracy of relative oxygen uptake (% peak oxygen uptake [%[Formula: see text]O2peak]) and relative heart rate (% peak heart rate [%HRpeak]) for establishing FATmax reference values was investigated by analyzing their intra-individual and inter-study variation. Moreover, cluster analysis and meta-regression were used for determining the influence of biological factors and methodological procedures on MFO and FATmax.

RESULTS

Sixty-four manuscripts were selected from 146 records; 23 studies only recruited men (n = 465), 14 studies only evaluated women (n = 575), and 27 studies included individuals from both sexes (n = 6434). The majority of the evaluated subjects were middle-aged adults (aged 40-60 y; 84%) with a poor cardiorespiratory fitness (≤ 43 mL·kg-1·min-1; 81%), and the reported MFO ranged from 0.27 to 0.33 g·min-1. The relative heart rate at FATmax (coefficient of variation [CV]: 8.8%) showed a lower intra-individual variation compared with relative oxygen uptake (CV: 17.2%). Furthermore, blood lactate levels at FATmax ranged from 1.3 to 2.7 mmol·L-1 while the speed and power output at FATmax fluctuated from 4 to 5.1 km·h-1 and 42.8-60.2 watts, respectively. Age, body mass index, cardiorespiratory fitness, FATmax, the type of ergometer and the stoichiometric equation used to calculate the MFO independently explained MFO values (R2 = 0.85; p < 0.01). The MFO in adolescents was superior in comparison with MFO observed in young and middle-aged adults. On the other hand, the MFO was higher during treadmill walking in comparison with stationary cycling. Body fat and MFO alone determined 29% of the variation in FATmax (p < 0.01), noting that individuals with body fat > 35% showed a heart rate of 61-66% HRpeak while individuals with < 35% body fat showed a heart rate between 57 and 64% HRpeak. Neither biological sex nor the analytical procedure for computing the fat oxidation kinetics were associated with MFO and FATmax.

CONCLUSION

Relative heart rate rather than relative oxygen uptake should be used for establishing FATmax reference values in patients with obesity. A heart rate of 61-66% HRpeak should be recommended to patients with > 35% body fat while a heart rate of 57-64% HRpeak should be recommended to patients with body fat < 35%. Moreover, training volume must be higher in adults to achieve a similar fat oxidation compared with adolescents whereas exercising on a treadmill requires a lower training volume to achieve significant fat oxidation in comparison with stationary cycling.

Pulmonary functions and anthropometric parameters of young male and female adults participating in moderate aerobic exercise

Respiratory disorders may be one of the adverse effects of sedentary lifestyle. This study investigated respiratory functions (FEV1, FVC and PEFR) and anthropometric parameters (body weight and body mass index) of healthy young males and females participating in moderate aerobic exercise. Forty young healthy untrained non-athletes, twenty males and twenty females (age, 25 ± 5.6 years; body weight, 65 ± 4.0 kg; body height, 176.9 ± 2.5 cm) volunteered to participate in this study. The exercise regimen was of moderate intensity lasting for 20 min daily on a treadmill consistently at the speed of 13 km/h for 14 days. The weight and height of participants were measured using medical scale and wall-mounted stadiometer respectively. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were assessed using digital spirometer. The results showed a significant (p < 0.05) decrease in body weight and body mass index of female participants after 14 days of exercise regimen. The FEV1, FVC and PEFR were significantly increased (p < 0.05) in both male and female subjects after exercise. The Pearson correlation showed a significant (p < 0.05) positive correlation between BMI with FEVI/FVC% in female participants. There was an increase in calories burnt from day 4 of the study in both male and female participants. It is concluded that moderate aerobic exercise improved respiratory functions (FEV1, FVC and PEFR) in both male and female subjects with greater improvement in females while reducing body weight and body mass index in females.

The role of sex in the relationship between fasting adipokines levels, maximal fat oxidation during exercise, and insulin resistance in young adults with excess adiposity

AIM

Previous evidence suggest that a sexual dimorphism in exercise fat oxidation and adipokines levels may explain a lower risk of cardio-metabolic disorders in women. Therefore, we investigated the role of sex in the relationship between adipokines levels, maximal fat oxidation (MFO) during exercise and insulin resistance.

METHODS

Fifty young adults with excess adiposity (31 women; body fat: 38.7 ± 5.3%) were included in this study. The fasting levels of leptin, adiponectin, glucose and insulin were determined from blood samples and the homeostatic model assessment of insulin resistance index (HOMA-IR) subsequently calculated. Body fat percentage and visceral adipose tissue (VAT) were assessed through dual-energy X-ray absorptiometry whereas MFO was estimated during an incremental-load exercise test after an overnight fasting through indirect calorimetry.

RESULTS

Men had lower levels of body fat (d = 1.80), adiponectin (d = 1.35), leptin (d = 0.43) and MFO (d = 1.25) than women. Conversely, men showed higher VAT (d = 0.85) and fasting glucose levels (d = 0.89). No sex differences were observed in HOMA-IR (d = 0.34). Adipokines levels were not associated with MFO in both sexes (r < 0.30), whereas adiponectin levels were inversely related with HOMA-IR in both men (r = -0.58) and women (r = -0.50). Leptin concentration was associated to HOMA-IR only in men (r = 0.41), while no statistically significant relationships were observed between MFO and HOMA-IR in both sexes (r < 0.44).

CONCLUSION

Insulin resistance was similar between sexes regardless of superior levels of adipokines and MFO during exercise in women. Therefore, adiponectin and leptin may regulate glucose homeostasis without altering whole body fat oxidation rate during exercise.

Skeletal muscle proteins involved in fatty acid transport influence fatty acid oxidation rates observed during exercise

Several proteins are implicated in transmembrane fatty acid transport. The purpose of this study was to quantify the variation in fatty acid oxidation rates during exercise explained by skeletal muscle proteins involved in fatty acid transport. Seventeen endurance-trained males underwent a (i) fasted, incremental cycling test to estimate peak whole-body fatty acid oxidation rate (PFO), (ii) resting vastus lateralis microbiopsy, and (iii) 2 h of fed-state, moderate-intensity cycling to estimate whole-body fatty acid oxidation during fed-state exercise (FO). Bivariate correlations and stepwise linear regression models of PFO and FO during 0-30 min (early FO) and 90-120 min (late FO) of continuous cycling were constructed using muscle data. To assess the causal role of transmembrane fatty acid transport in fatty acid oxidation rates during exercise, we measured fatty acid oxidation during in vivo exercise and ex vivo contractions in wild-type and CD36 knock-out mice. We observed a novel, positive association between vastus lateralis FATP1 and PFO and replicated work reporting a positive association between FABPpm and PFO. The stepwise linear regression model of PFO retained CD36, FATP1, FATP4, and FABPpm, explaining ~87% of the variation. Models of early and late FO explained ~61 and ~65% of the variation, respectively. FATP1 and FATP4 emerged as contributors to models of PFO and FO. Mice lacking CD36 had impaired whole-body and muscle fatty acid oxidation during exercise and muscle contractions, respectively. These data suggest that substantial variation in fatty acid oxidation rates during exercise can be explained by skeletal muscle proteins involved in fatty acid transport.

Walking 200 min per day keeps the bariatric surgeon away

Exercise and increased physical activity are vital components of the standard treatment guidelines for many chronic diseases such as diabetes, obesity and cardiovascular disease. Although strenuous exercise cannot be recommended to people with numerous chronic conditions, walking is something most people can perform. In comparison to high-intensity training, the metabolic consequences of low-intensity walking have been less well studied. We present here a feasibility study of a subject who performed an exercise intervention of low-intensity, non-fatiguing walking on a deskmill/treadmill for 200 min daily, approximately the average time a German spends watching television per day. This low-impact physical activity has the advantages that it can be done while performing other tasks such as reading or watching TV, and it can be recommended to obese patients or patients with heart disease. We find that this intervention led to substantial weight loss, comparable to that of bariatric surgery. To study the metabolic changes caused by this intervention, we performed an in-depth metabolomic profiling of the blood both directly after walking to assess the acute changes, as well as 1.5 days after physical activity to identify the long-term effects that persist. We find changes in acylcarnitine levels suggesting that walking activates fatty acid beta oxidation, and that this mitochondrial reprogramming is still visible 1.5 days post-walking. We also find that walking mildly increases gut permeability, leading to increased exposure of the blood to metabolites from the gut microbiome. Overall, these data provide a starting point for designing future intervention studies with larger cohorts.