Mechanisms for Combined Hypoxic Conditioning and Divergent Exercise Modes to Regulate Inflammation, Body Composition, Appetite, and Blood Glucose Homeostasis in Overweight and Obese Adults: A Narrative Review

Effects of exercise modality combined with moderate hypoxia on blood glucose regulation in adults with overweight

Purpose: This study aimed to investigate the combined effects of moderate hypoxia with three different exercise modes on glucose regulation in healthy overweight adults. Methods: Thirteen overweight males (age: 31 ± 4 years; body fat 26.3 ± 3.2%) completed three exercise trials in a randomized crossover design involving 60 min cycling exercise at 90% lactate threshold (LOW), sprint interval training (20 × 4 s all-out; SIT) and lower limb functional bodyweight exercises (8 sets of 4 × 20 s; FEX) under moderate hypoxia (FiO2 = 16.5%). Post-exercise oral glucose tolerance test (OGTT) was performed following each trial. Heart rate, oxygen saturation (SpO2), physical activity enjoyment scale (PACES), and perceptual measures were recorded during each exercise session. Venous blood was collected pre-, immediately post-, and 24 h post-exercise and analysed for plasma glucose and insulin, incremental area under curve (iAUC), and circulating microRNA expression (c-miRs-486-5p, -126-5p, and -21-5p). Interstitial glucose concentrations were measured using continuous glucose monitoring (CGM). Results: Post-exercise OGTT iAUC for plasma glucose and insulin concentration were lower in SIT and LOW vs. control (p < 0.05) while post-exercise interstitial glucose iAUC and c-miRs were not different between exercise modes. Heart rate was greater in SIT vs. LOW and FEX, and FEX vs. LOW (p < 0.05), SpO2 was lower in SIT, while PACES was not different between exercise modes. Perceptual measures were greater in SIT vs. LOW and FEX. Conclusion: Acute SIT and LOW under moderate hypoxia improved post-exercise plasma insulin compared to FEX exercises. Considering SIT was also time-efficient, well tolerated, and enjoyable for participants, this may be the preferred exercise modality for improving glucose regulation in adult males with overweight when combined with moderate hypoxia.

Effect of dry dynamic apnea on aerobic power in elite rugby athletes: a warm-up method

Objective: While long-term dynamic breath-holding training has been extensively studied to enhance cardiopulmonary function in athletes, limited research has explored the impact of a single breath-holding session on subsequent athletic capacity. In addition, Dry Dynamic Apnea (DA) has a more immediate physiological response than wet and static breath-holding. This study aims to assess the immediate effects of a single session of DA on the aerobic power and hematological parameters of elite athletes. Methods: Seventeen elite male rugby athletes (average age 23.5 ± 1.8) participated in this study. Two warm-up protocols were employed prior to incremental exercise: a standard warm-up (10 min of no-load pedaling) and a DA warm-up (10 min of no-load pedaling accompanied by six maximum capacity breath holds, with 30 s between each breath hold). Fingertip blood indicators were measured before and after warm-up. The incremental exercise test assessed aerobic parameters with self-regulation applied throughout the study. Results: Compared to the baseline warm-up, the DA warm-up resulted in a significant increase in VO2peak from 3.14 to 3.38 L/min (7.64% change, p < 0.05). HRmax increased from 170 to 183 bpm (7.34% change, p < 0.05), and HRpeak increased from 169 to 182 bpm (7.52% change, p < 0.05). Hematocrit and hemoglobin showed differential changes between the two warm-up methods (PHematocrit = 0.674; Phemoglobin = 0.707). Conclusion: This study investigates how DA influences physiological factors such as spleen contraction, oxygen uptake, and sympathetic nerve activation compared to traditional warm-up methods. Immediate improvements in aerobic power suggest reduced vagus nerve stimulation, heightened sympathetic activity, and alterations in respiratory metabolism induced by the voluntarily hypoxia-triggered warm-up. Further research is warranted to comprehensively understand these physiological responses and optimize warm-up strategies for elite athletic performance.

Ginsenoside Rb1 Interfered with Macrophage Activation by Activating PPARγ to Inhibit Insulin Resistance in Obesity

Type 2 diabetes (T2D) is characterized by insulin resistance (IR), often accompanied by inflammation. Macrophage activation acts as an inflammatory response, which is characterized by macrophage recruitment in the initial stage. Ginsenoside Rb1 (Rb1) is a main active ingredient, which is known for its fat-reducing, anti-inflammatory effects. To clarify that Rb1 regulates macrophage activation in adipose tissue and improves tissue inflammation, network pharmacology and molecular docking were used for target prediction and preliminary validation. By constructing the co-culture model of adipose-derived stem cells (ADSC) and primary macrophage (PM), the body adipose tissue microenvironment was simulated to observe the adipogenesis degree of adipocytes under the effect of Rb1. The levels of cytokines, macrophage polarization, and protein or RNA expression in the inflammatory signaling pathway were finally detected. The results showed that 89 common targets of T2D-Rb1 were obtained after their intersection. Furthermore, according to the results of the KEGG pathway and PPI analysis, PTGS2 (COX-2) is the downstream protein of PPARγ-NF-κB. The molecular binding energy of PPARγ-Rb1 is -6.8 kcal/mol. Rb1 significantly inhibited the increase in MCP-1, TNF-α, and IL-1β induced by hypertrophic adipocytes supernatant and promoted the expression of IL-10. Rb1 inhibited the activation of inflammatory macrophages and PM migration and upregulated PPARγ expression with the blocking of NF-κB activation. Additionally, Rb1 promoted the expression of IRS1 and PI3K in the insulin signal pathway, which had a similar effect with ROS. Therefore, Rb1 might affect macrophage activation through PPARγ, which might alleviate obese insulin resistance in T2D early stage.

Combined effects of exercise and different levels of acute hypoxic severity: A randomized crossover study on glucose regulation in adults with overweight

Purpose: The aim of this study was to investigate the influence of manipulating hypoxic severity with low-intensity exercise on glucose regulation in healthy overweight adults. Methods: In a randomized crossover design, 14 males with overweight (age: 27 ± 5 years; body mass index (BMI) 27.1 ± 1.8 kg⋅m²) completed three exercise trials involving 60 min aerobic exercise cycling at 90% lactate threshold in normoxia (NM, FiO₂ = 20.9%), moderate hypoxia (MH, FiO₂ = 16.5%) and high hypoxia (HH, FiO₂ = 14.8%). A post-exercise oral glucose tolerance test (OGTT) was performed. Venous blood samples were analyzed for incremental area under the curve (iAUC), plasma glucose and insulin, as well as exerkine concentrations (plasma apelin and fibroblast growth factor 21 [FGF-21]) pre- and post-exercise. A 24-h continuous glucose monitoring (CGM) was used to determine interstitial glucose concentrations. Heart rate, oxygen saturation (SpO₂) and perceptual measures were recorded during exercise. Results: Post-exercise OGTT iAUC for plasma glucose and insulin concentrations were lower in MH vs. control (p = 0.02). Post-exercise interstitial glucose iAUC, plasma apelin and FGF-21 were not different between conditions. Heart rate was higher in HH vs. NM and MH, and MH vs. NM (p < 0.001), while SpO₂ was lower in HH vs. NM and MH, and MH vs. NM (p < 0.001). Overall perceived discomfort and leg discomfort were higher in HH vs. NM and MH (p < 0.05), while perceived breathing difficulty was higher in HH vs. NM only (p = 0.003). Conclusion: Compared to higher hypoxic conditions, performing acute aerobic-based exercise under moderate hypoxia provided a more effective stimulus for improving post-exercise glucose regulation while concomitantly preventing excessive physiological and perceptual stress in healthy overweight adults.