Plasma glucose metabolism during exercise: effect of endurance training in humans

Continuous Glucose Monitoring in Endurance Athletes: Interpretation and Relevance of Measurements for Improving Performance and Health

Blood glucose regulation has been studied for well over a century as it is intimately related to metabolic health. Research in glucose transport and uptake has also been substantial within the field of exercise physiology as glucose delivery to the working muscles affects exercise capacity and athletic achievements. However, although exceptions exist, less focus has been on blood glucose as a parameter to optimize training and competition outcomes in athletes with normal glucose control. During the last years, measuring glucose has gained popularity within the sports community and successful endurance athletes have been seen with skin-mounted sensors for continuous glucose monitoring (CGM). The technique offers real-time recording of glucose concentrations in the interstitium, which is assumed to be equivalent to concentrations in the blood. Although continuous measurements of a parameter that is intimately connected to metabolism and health can seem appealing, there is no current consensus on how to interpret measurements within this context. Well-defined approaches to use glucose monitoring to improve endurance athletes' performance and health are lacking. In several studies, blood glucose regulation in endurance athletes has been shown to differ from that in healthy controls. Furthermore, endurance athletes regularly perform demanding training sessions and can be exposed to high or low energy and/or carbohydrate availability, which can affect blood glucose levels and regulation. In this current opinion, we aim to discuss blood glucose regulation in endurance athletes and highlight the existing research on glucose monitoring for performance and health in this population.

Metabolomic analysis of long-term spontaneous exercise in mice suggests increased lipolysis and altered glucose metabolism when animals are at rest

Exercise has been associated with several beneficial effects and is one of the major modulators of metabolism. The working muscle produces and releases substances during exercise that mediate the adaptation of the muscle but also improve the metabolic flexibility of the complete organism, leading to adjustable substrate utilization. Metabolomic studies on physical exercise are scarce and most of them have been focused on the effects of intense exercise in professional sportsmen. The aim of our study was to determine plasma metabolomic adaptations in mice after a long-term spontaneous exercise intervention study (18 mo). The metabolic changes induced by long-term spontaneous exercise were sufficient to achieve complete discrimination between groups in the principal component analysis scores plot. We identified plasma indicators of an increase in lipolysis (elevated unsaturated fatty acids and glycerol), a decrease in glucose and insulin plasma levels and in heart glucose consumption (by PET), and altered glucose metabolism (decreased alanine and lactate) in the wheel running group. Collectively these data are compatible with an increase in skeletal muscle insulin sensitivity in the active mice. We also found an increase in amino acids involved in catecholamine synthesis (tyrosine and phenylalanine), in the skeletal muscle pool of creatine phosphate and taurine, and changes in phospholipid metabolism (phosphocholine and choline in lipids) between the sedentary and the active mice. In conclusion, long-term spontaneous wheel running induces significant plasma and tissue (heart) metabolic responses that remain even when the animal is at rest.

Quercetin's effect on cycling efficiency and substrate utilization

Previous evidence suggests that quercetin supplementation increases performance in humans. We examined the effects of 3 weeks of quercetin supplementation on fuel utilization, gross efficiency (GE), and perceived effort during 3 h of cycling over 3 successive days. Forty cyclists were randomized into quercetin and placebo groups and tested for maximal oxygen consumption (53.2 +/- 1.2 and 54.7 +/- 1.1 mL.kg(-1).min(-1)). For 3 weeks following maximal oxygen consumption testing, subjects supplemented either 1000 mg.day(-1) quercetin or placebo during normal training. Following supplementation, subjects cycled at 57% maximum power for 3 h, on 3 successive days, using their own bicycles fitted to CompuTrainer Pro Model trainers (RacerMate, Seattle, Wash.). Metabolic measurements were taken every 30 min for each 3-h ride. Muscle biopsies obtained from the vastus lateralis immediately pre-exercise and postexercise on days 1 and 3 were analyzed for muscle glycogen content. Power output remained constant for all 3 exercise trials, but significant decreases over time were measured for GE, cadence, respiratory exchange ratio, blood glucose, and muscle glycogen. Significant increases were measured for heart rate and volume of oxygen consumption over time. No quercetin treatment effect was observed for any of the outcome measures in this study. These data indicate that GE is reduced during an exhausting 3-h bout of exercise. However, quercetin did not significantly affect any outcomes in these already well-trained subjects.

The scientific basis for high-intensity interval training: optimising training programmes and maximising performance in highly trained endurance athletes

While the physiological adaptations that occur following endurance training in previously sedentary and recreationally active individuals are relatively well understood, the adaptations to training in already highly trained endurance athletes remain unclear. While significant improvements in endurance performance and corresponding physiological markers are evident following submaximal endurance training in sedentary and recreationally active groups, an additional increase in submaximal training (i.e. volume) in highly trained individuals does not appear to further enhance either endurance performance or associated physiological variables [e.g. peak oxygen uptake (VO2peak), oxidative enzyme activity]. It seems that, for athletes who are already trained, improvements in endurance performance can be achieved only through high-intensity interval training (HIT). The limited research which has examined changes in muscle enzyme activity in highly trained athletes, following HIT, has revealed no change in oxidative or glycolytic enzyme activity, despite significant improvements in endurance performance (p < 0.05). Instead, an increase in skeletal muscle buffering capacity may be one mechanism responsible for an improvement in endurance performance. Changes in plasma volume, stroke volume, as well as muscle cation pumps, myoglobin, capillary density and fibre type characteristics have yet to be investigated in response to HIT with the highly trained athlete. Information relating to HIT programme optimisation in endurance athletes is also very sparse. Preliminary work using the velocity at which VO2max is achieved (V(max)) as the interval intensity, and fractions (50 to 75%) of the time to exhaustion at V(max) (T(max)) as the interval duration has been successful in eliciting improvements in performance in long-distance runners. However, V(max) and T(max) have not been used with cyclists. Instead, HIT programme optimisation research in cyclists has revealed that repeated supramaximal sprinting may be equally effective as more traditional HIT programmes for eliciting improvements in endurance performance. Further examination of the biochemical and physiological adaptations which accompany different HIT programmes, as well as investigation into the optimal HIT programme for eliciting performance enhancements in highly trained athletes is required.

Postexercise fat intake repletes intramyocellular lipids but no faster in trained than in sedentary subjects

The hypotheses that postexercise replenishment of intramyocellular lipids (IMCL) is enhanced by endurance training and that it depends on fat intake were tested. Trained and untrained subjects exercised on a treadmill for 2 h at 50% peak oxygen consumption, reducing IMCL by 26-22%. During recovery, they were fed 55% (high fat) or 15% (low fat) lipid energy diets. Muscle substrate stores were estimated by (1)H (IMCL)- and (13)C (glycogen)-magnetic resonance spectroscopy in tibialis anterior muscle before and after exercise. Resting IMCL content was 71% higher in trained than untrained subjects and correlated significantly with glycogen content. Both correlated positively with indexes of insulin sensitivity. After 30 h on the high-fat diet, IMCL concentration was 30-45% higher than preexercise, whereas it remained 5-17% lower on the low-fat diet. Training status had no significant influence on IMCL replenishment. Glycogen was restored within a day with both diets. We conclude that fat intake postexercise strongly promotes IMCL repletion independently of training status. Furthermore, replenishment of IMCL can be completed within a day when fat intake is sufficient.

Oxidative stress, acute and regular exercise: are they really harmful in the diabetic patient?

Oxidative stress has been involved in the pathogenic process of a variety of diseases including diabetes mellitus. The production of oxidative reactive products has been involved in biochemical changes in bio-molecules that might produce tissue damage directly related to some of the main vascular complications in the diabetic patient. On the other hand, exercise, paradoxically, is a well-recognized model of oxidative stress and also an important therapeutic tool in diabetes management. Therefore, the relationship between oxidative stress and exercise in diabetic patients implies an interesting biochemical paradox due to some of the negative effects of exercise principally by the increase of oxidative species in plasma. The effect of oxidative stress during an acute exercise and after an aerobic training period on those patients remains unknown and needs to be studied.

Effects of aerobic training on lactate and catecholaminergic exercise responses in mitochondrial myopathies

The aim of this study was to evaluate the effects of an aerobic training program on the metabolic and sympathetic responses to exercise in 12 patients with mitochondrial myopathies. A 10-week course of aerobic training, consisting of supervised exercise every other day on an electrically braked pedal-rate bicycle ergometer was prescribed to each patient and four healthy controls. Venous lactate, epinephrine (EP) and norepinephrine (NEP) levels were assessed at baseline and after the aerobic training by means of constant-workload exercise performed at near lactate threshold (LT). In patients, a decrease in exercise peak values, significant for lactate (-38.6%, P < 0.01) but not for catecholamines (EP: -26.0%, NEP: -22.1%) was observed after training, findings confirmed by the lactate/EP and lactate/NEP area ratios. The results show that lactate accumulation during exercise is decreased after aerobic training in mitochondrial myopathies and that the effect is partially dissociated from the catecholaminergic response. This in turn suggests that the lactate decrease can be explained, at least in part, by the improved muscle oxidative metabolism consequent to the proposed training program.

Relative insensitivity of avian skeletal muscle glycogen to nutritive status

Previous studies in avian species have reported time-dependent losses in muscle glycogen with prolonged feed withdrawal (FW). However, cervical dislocation was used to collect tissues, a method that results in significant involuntary muscle convulsions. In this study, cervical dislocation alone was found to reduce muscle glycogen by 23%, therefore, barbiturate overdose was used to collect tissue samples before and after FW, at the end of refeeding, and from continuously fed controls at each interval. Additionally, plasma samples from 6-wk-old male chickens were taken at the initiation and end of a 24-hr feed withdrawal, and at various times during refeeding. After 24 hr of FW, liver glycogen decreased markedly (77%; P < 0.05), whereas muscle glycogen decreased slightly and transiently, such that it returned to and remained at control levels, even after prolonged (72 hr) FW. Plasma glucose was decreased, whereas glucagon was elevated after a 24-hr feed withdrawal (P < 0.05), when compared with control concentrations. Muscle glycogen levels were not significantly increased over control levels after refeeding, but liver glycogen was increased by 380% (P < 0.05). Feed deprivation followed by refeeding resulted in increased circulating insulin and glucose levels when compared with control levels. Therefore, by using methods of tissue collection that ensure that muscle glycogen determinations are not confounded by artifactual degradation, these results verify that regulation of avian muscle glycogen stores is similar to that in mammals.

Glucose kinetics during prolonged exercise in highly trained human subjects: effect of glucose ingestion

1. The objectives of this study were (1) to investigate whether glucose ingestion during prolonged exercise reduces whole body muscle glycogen oxidation, (2) to determine the extent to which glucose disappearing from the plasma is oxidized during exercise with and without carbohydrate ingestion and (3) to obtain an estimate of gluconeogenesis. 2. After an overnight fast, six well-trained cyclists exercised on three occasions for 120 min on a bicycle ergometer at 50 % maximum velocity of O2 uptake and ingested either water (Fast), or a 4 % glucose solution (Lo-Glu) or a 22 % glucose solution (Hi-Glu) during exercise. 3. Dual tracer infusion of [U-13C]-glucose and [6,6-2H2]-glucose was given to measure the rate of appearance (Ra) of glucose, muscle glycogen oxidation, glucose carbon recycling, metabolic clearance rate (MCR) and non-oxidative disposal of glucose. 4. Glucose ingestion markedly increased total Ra especially with Hi-Glu. After 120 min Ra and rate of disappearance (Rd) of glucose were 51-52 micromol kg-1 min-1 during Fast, 73-74 micromol kg-1 min-1 during Lo-Glu and 117-119 micromol kg-1 min-1 during Hi-Glu. The percentage of Rd oxidized was between 96 and 100 % in all trials. 5. Glycogen oxidation during exercise was not reduced by glucose ingestion. The vast majority of glucose disappearing from the plasma is oxidized and MCR increased markedly with glucose ingestion. Glucose carbon recycling was minimal suggesting that gluconeogenesis in these conditions is negligible.

The glucose crossover concept is not an important new concept in exercise metabolism

1. The basic premise of the 'crossover' concept (i.e. that the balance of carbohydrate (CHO) and fat utilization during exercise depends on the interaction between exercise intensity and the individual's endurance training status) has been accepted since at least the 1930s. 2. The crossover concept differs from earlier perspectives mostly in its greater emphasis on the absolute exercise intensity as an important determinant of substrate selection during exercise. Because of this emphasis, it is argued that while trained subjects may utilize less CHO than their untrained counterparts during low- or moderate-intensity exercise, this is not true during high-intensity exercise, because during such exercise even trained persons must 'crossover' to CHO dependency. In fact, the crossover concept predicts that utilization of at least one CHO source (i.e. plasma-borne glucose) should be greater in trained subjects during intense exercise. This increase in glucose utilization is hypothesized to be supported by an enhanced rate of gluconeogenesis. 3. In direct contradiction of the crossover concept, the literature consistently shows that, compared with untrained individuals, trained subjects rely less on CHO for fuel, even during high-intensity exercise. In particular, it has been shown that the rate of glucose utilization is lower in trained subjects under these conditions. Recent data from Dr Brooks' own laboratory support this conclusion and also show that this reduction in glucose use is associated with a decrease in the rate of gluconeogenesis. These recent observations confirm prior studies of moderate-intensity exercise. 4. Based on the above, it is clear that the crossover concept cannot be considered an important new concept in exercise metabolism. Instead, the crossover concept actually serves to hinder understanding in this area.