Carbohydrate utilization by exercising muscle following pre-exercise glucose ingestion

Role of prior feeding status in mediating the effects of exercise on blood glucose kinetics

Changes in blood glucose concentrations are underpinned by blood glucose kinetics (endogenous and exogenous glucose appearance rates and glucose disappearance rates). Exercise potently alters blood glucose kinetics and can thereby be used as a tool to control blood glucose concentration. However, most studies of exercise-induced changes in glucose kinetics are conducted in a fasted state, and therefore less is known about the effects of exercise on glucose kinetics when exercise is conducted in a postprandial state. Emerging evidence suggests that food intake prior to exercise can increase postprandial blood glucose flux compared with when meals are consumed after exercise, whereby both glucose appearance rates and disappearance rates are increased. The mechanisms underlying the mediating effect of exercise conducted in the fed versus the fasted state are yet to be fully elucidated. Current evidence demonstrates that exercise in the postprandial state increased glucose appearance rates due to both increased exogenous and endogenous appearance and may be due to changes in splanchnic blood flow, intestinal permeability, and/or hepatic glucose extraction. On the other hand, increased glucose disappearance rates after exercise in the fed state have been shown to be associated with increased intramuscular AMPK signaling via a mismatch between carbohydrate utilization and delivery. Due to differences in blood glucose kinetics and other physiological differences, studies conducted in the fasted state cannot be immediately translated to the fed state. Therefore, conducting studies in the fed state could improve the external validity of data pertaining to glucose kinetics and intramuscular signaling in response to nutrition and exercise.

REducing SEDENTary Behavior Among Mild to Moderate Cognitively Impaired Assisted Living Residents: A Pilot Randomized Controlled Trial (RESEDENT Study)

Older adults in assisted living spend most of their day in sedentary behaviors, which may be detrimental to cognitive function. The primary purpose of this pilot study was to assess the feasibility of using a prompting device to reduce sitting time with light walking among older adults with mild to moderate cognitive impairment residing in an assisted living setting. A secondary purpose was to examine the effectiveness of the intervention on the residents' cognitive function, physical function, and quality of life. The participants (n = 25, mean age = 86.7 [5.3] years) were assigned in clusters into a two-arm 10-week single-site pilot randomized controlled trial. The intervention group was prompted with a watch to interrupt sedentary behaviors and partake in 10 min of light physical activity (i.e., walking) three times a day after a meal. The assessments included hip-worn accelerometers (Actical) and diaries, the Alzheimer's disease assessment scale-cognitive, Timed Up and Go, and the short-form 36 health survey. Adherence was high, as there were no dropouts, and over 70% of the participants completed over 80% of the prescribed physical activity bouts. Significant effects favoring the intervention were shown for all outcomes.

Effects of Acute Dietary Polyphenols and Post-Meal Physical Activity on Postprandial Metabolism in Adults with Features of the Metabolic Syndrome

Approximately 22% of U.S. adults and 25% of adults globally have metabolic syndrome (MetS). Key features, such as dysglycemia and dyslipidemia, predict type 2 diabetes, cardiovascular disease, premature disability, and death. Acute supplementation of dietary polyphenols and post-meal physical activity hold promise in improving postprandial dysmetabolism. To our knowledge, no published review has described the effects of either intervention on postprandial glucose, insulin, lipids, and markers of oxidative damage and inflammation in adults with features of MetS. Thus, we conducted this review of controlled clinical trials that provided dietary polyphenols from oils, fruits, teas, and legumes during a dietary challenge, or implemented walking, cycling, and stair climbing and descending after a dietary challenge. Clinical trials were identified using ClinicalTrials.gov, PubMed, and Google Scholar and were published between 2000 and 2019. Dietary polyphenols from extra virgin olive oil, grapes, blackcurrants, strawberries, black tea, and black beans improved postprandial glucose, insulin, and markers of oxidative damage and inflammation, but results were not consistent among clinical trials. Freeze-dried strawberry powder distinctly improved postprandial insulin and markers of oxidative damage and inflammation. Post-meal physical activity attenuated postprandial glucose, but effects on postprandial lipids and markers of oxidative damage and inflammation were inconclusive. Consuming dietary polyphenols with a meal and completing physical activity after a meal may mitigate postprandial dysmetabolism in adults with features of MetS.

Nighttime feeding likely alters morning metabolism but not exercise performance in female athletes

The timing of morning endurance competition may limit proper pre-race fueling and resulting performance. A nighttime, pre-sleep nutritional strategy could be an alternative method to target the metabolic and hydrating needs of the early morning athlete without compromising sleep or gastrointestinal comfort during exercise. Therefore, the purpose of this investigation was to examine the acute effects of pre-sleep chocolate milk (CM) ingestion on next-morning running performance, metabolism, and hydration status. Twelve competitive female runners and triathletes (age, 30 ± 7 years; peak oxygen consumption, 53 ± 4 mL·kg(-1)·min(-1)) randomly ingested either pre-sleep CM or non-nutritive placebo (PL) ∼30 min before sleep and 7-9 h before a morning exercise trial. Resting metabolic rate (RMR) was assessed prior to exercise. The exercise trial included a warm-up, three 5-min incremental workloads at 55%, 65%, and 75% peak oxygen consumption, and a 10-km treadmill time trial (TT). Physiological responses were assessed prior, during (incremental and TT), and postexercise. Paired t tests and magnitude-based inferences were used to determine treatment differences. TT performances were not different ("most likely trivial" improvement with CM) between conditions (PL: 52.8 ± 8.4 min vs CM: 52.8 ± 8.0 min). RMR was "likely" increased (4.8%) and total carbohydrate oxidation (g·min(-1)) during exercise was "possibly" or likely increased (18.8%, 10.1%, 9.1% for stage 1-3, respectively) with CM versus PL. There were no consistent changes to hydration indices. In conclusion, pre-sleep CM may alter next-morning resting and exercise metabolism to favor carbohydrate oxidation, but effects did not translate to 10-km running performance improvements.

Effects of a Pre-Exercise Meal on Plasma Growth Hormone Response and Fat Oxidation during Walking

The purpose of this study was to determine the effects of a pre-exercise meal on the plasma human growth hormone (hGH) response and fat oxidation during walking. Subjects (n=8) were randomly provided with either 1 g/kg body weight of glucose in 200 mL water (CHO) or 200 mL water alone (CON) 30 min prior to exercise and subsequently walked on a treadmill at 50% of VO2max for 60 min. Plasma hGH concentrations were significantly higher in subjects who received CHO compared to those who received CON at 15 and 30 min. The fat oxidation rate in the CHO was significantly lower than the CON while walking for 5~15, 25~35 and 45~55 min. Plasma FFA levels were also significantly lower in the CHO compared to the CON at 30, 45 and 60 min. Plasma glucose levels in the CHO were significantly lower while plasma insulin levels were significantly higher than in the CON at 15 and 30 min. Therefore, the results of this study suggest that the elevation of plasma hGH levels due to the intake of a pre-exercise meal may not be strongly related to fat oxidation and plasma free fatty acid (FFA) levels during low-intensity exercise.

Exercise, GLUT4, and skeletal muscle glucose uptake

Glucose is an important fuel for contracting muscle, and normal glucose metabolism is vital for health. Glucose enters the muscle cell via facilitated diffusion through the GLUT4 glucose transporter which translocates from intracellular storage depots to the plasma membrane and T-tubules upon muscle contraction. Here we discuss the current understanding of how exercise-induced muscle glucose uptake is regulated. We briefly discuss the role of glucose supply and metabolism and concentrate on GLUT4 translocation and the molecular signaling that sets this in motion during muscle contractions. Contraction-induced molecular signaling is complex and involves a variety of signaling molecules including AMPK, Ca(2+), and NOS in the proximal part of the signaling cascade as well as GTPases, Rab, and SNARE proteins and cytoskeletal components in the distal part. While acute regulation of muscle glucose uptake relies on GLUT4 translocation, glucose uptake also depends on muscle GLUT4 expression which is increased following exercise. AMPK and CaMKII are key signaling kinases that appear to regulate GLUT4 expression via the HDAC4/5-MEF2 axis and MEF2-GEF interactions resulting in nuclear export of HDAC4/5 in turn leading to histone hyperacetylation on the GLUT4 promoter and increased GLUT4 transcription. Exercise training is the most potent stimulus to increase skeletal muscle GLUT4 expression, an effect that may partly contribute to improved insulin action and glucose disposal and enhanced muscle glycogen storage following exercise training in health and disease.

Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance

OBJECTIVE

The purpose of this study was to compare the effectiveness of three 15-min bouts of postmeal walking with 45 min of sustained walking on 24-h glycemic control in older persons at risk for glucose intolerance.

RESEARCH DESIGN AND METHODS

Inactive older (≥60 years of age) participants (N=10) were recruited from the community and were nonsmoking, with a BMI<35 kg/m2 and a fasting blood glucose concentration between 105 and 125 mg dL(-1). Participants completed three randomly ordered exercise protocols spaced 4 weeks apart. Each protocol comprised a 48-h stay in a whole-room calorimeter, with the first day serving as the control day. On the second day, participants engaged in either 1) postmeal walking for 15 min or 45 min of sustained walking performed at 2) 10:30 a.m. or 3) 4:30 p.m. All walking was on a treadmill at an absolute intensity of 3 METs. Interstitial glucose concentrations were determined over 48 h with a continuous glucose monitor. Substrate utilization was measured continuously by respiratory exchange (VCO2/VO2).

RESULTS

Both sustained morning walking (127±23 vs. 118±14 mg dL(-1)) and postmeal walking (129±24 vs. 116±13 mg dL(-1)) significantly improved 24-h glycemic control relative to the control day (P<0.05). Moreover, postmeal walking was significantly (P<0.01) more effective than 45 min of sustained morning or afternoon walking in lowering 3-h postdinner glucose between the control and experimental day.

CONCLUSIONS

Short, intermittent bouts of postmeal walking appear to be an effective way to control postprandial hyperglycemia in older people.

Optimizing fat oxidation through exercise and diet

Interventions aimed at increasing fat metabolism could potentially reduce the symptoms of metabolic diseases such as obesity and type 2 diabetes and may have tremendous clinical relevance. Hence, an understanding of the factors that increase or decrease fat oxidation is important. Exercise intensity and duration are important determinants of fat oxidation. Fat oxidation rates increase from low to moderate intensities and then decrease when the intensity becomes high. Maximal rates of fat oxidation have been shown to be reached at intensities between 59% and 64% of maximum oxygen consumption in trained individuals and between 47% and 52% of maximum oxygen consumption in a large sample of the general population. The mode of exercise can also affect fat oxidation, with fat oxidation being higher during running than cycling. Endurance training induces a multitude of adaptations that result in increased fat oxidation. The duration and intensity of exercise training required to induce changes in fat oxidation is currently unknown. Ingestion of carbohydrate in the hours before or on commencement of exercise reduces the rate of fat oxidation significantly compared with fasted conditions, whereas fasting longer than 6 h optimizes fat oxidation. Fat oxidation rates have been shown to decrease after ingestion of high-fat diets, partly as a result of decreased glycogen stores and partly because of adaptations at the muscle level.

Glucose ingestion blunts hormone-sensitive lipase activity in contracting human skeletal muscle

To examine the effect of attenuated epinephrine and elevated insulin on intramuscular hormone sensitivity lipase activity (HSLa) during exercise, seven men performed 120 min of semirecumbent cycling (60% peak pulmonary oxygen uptake) on two occasions while ingesting either 250 ml of a 6.4% carbohydrate (GLU) or sweet placebo (CON) beverage at the onset of, and at 15 min intervals throughout, exercise. Muscle biopsies obtained before and immediately after exercise were analyzed for HSLa. Blood samples were simultaneously obtained from a brachial artery and a femoral vein before and during exercise, and leg blood flow was measured by thermodilution in the femoral vein. Net leg glycerol and lactate release and net leg glucose and free fatty acid (FFA) uptake were calculated from these measures. Insulin and epinephrine were also measured in arterial blood before and throughout exercise. During GLU, insulin was elevated (120 min: CON, 11.4 +/- 2.4, GLU, 35.3 +/- 6.9 pM, P < 0.05) and epinephrine suppressed (120 min: CON, 6.1 +/- 2.5, GLU, 2.1 +/- 0.9 nM; P < 0.05) compared with CON. Carbohydrate feeding also resulted in suppressed (P < 0.05) HSLa relative to CON (120 min: CON, 1.71 +/- 0.18, GLU, 1.27 +/- 0.16 mmol.min-1.kg dry mass-1). There were no differences in leg lactate or glycerol release when trials were compared, but leg FFA uptake was lower (120 min: CON, 0.29 +/- 0.06, GLU, 0.82 +/- 0.09 mmol/min) and leg glucose uptake higher (120 min: CON, 3.16 +/- 0.59, GLU, 1.37 +/- 0.37 mmol/min) in GLU compared with CON. These results demonstrate that circulating insulin and epinephrine play a role in HSLa in contracting skeletal muscle.

The effect of pre-exercise carbohydrate feedings on the intensity that elicits maximal fat oxidation

The aim of the present study was to examine the effect of ingesting 75 g of glucose 45 min before the start of a graded exercise test to exhaustion on the determination of the intensity that elicits maximal fat oxidation (Fatmax). Eleven moderately trained individuals (VO2max: 58.9 +/- 1.0 ml x kg(-1) x min(-1); mean +/- sx), who had fasted overnight, performed two graded exercise tests to exhaustion, one 45 min after ingesting a placebo drink and one 45 min after ingesting 75 g of carbohydrate in the form of glucose. The tests started at 95 W and the workload was increased by 35 W every 3 min. Gas exchange measures and heart rate were recorded throughout exercise. Fat oxidation rates were calculated using stoichiometric equations. Blood samples were collected at rest and at the end of each stage of the test. Maximal fat oxidation rates decreased from 0.46 +/- 0.06 to 0.33 +/- 0.06 g min(-1) when carbohydrate was ingested before the start of exercise (P < 0.01). There was also a decrease in the intensity which elicited maximal fat oxidation (60.1 +/- 1.9% vs 52.0+3.4% VO2max) after carbohydrate ingestion (P < 0.05). Maximal power output was higher in the carbohydrate than in the placebo trial (346 +/- 12 vs 332 +/- 12 W) (P < 0.05). In conclusion, the ingestion of 75 g of carbohydrate 45 min before the onset of exercise decreased Fatmax by 14%, while the maximal rate of fat oxidation decreased by 28%.

Effects of a longitudinal training program on responses to exercise in overweight men

OBJECTIVE

The aim of this study was to determine how training modifies metabolic responses and lipid oxidation in overweight young male subjects.

RESEARCH METHODS AND PROCEDURES

Eleven overweight subjects were selected for a 4-month endurance training program. Before and after the training period, they cycled for 60 minutes at 50% of their VO(2)max after an overnight fast or 3 hours after eating a standardized meal. Various metabolic and endocrine parameters, and respiratory exchange ratio values were evaluated.

RESULTS

Exercise-induced plasma norepinephrine concentration increases were similar before and after training in fasted or fed conditions. After food intake, exercise promoted a decrease in plasma glucose and a higher increase in epinephrine than in fasting conditions. The increase in epinephrine after the meal was more marked after training (264 +/- 32 vs. 195 +/- 35 pg/mL). Training lowered the resting plasma nonesterified fatty acids. During exercise, changes in glycerol were similar to those found before training. Lipid oxidation during exercise was higher in fasting than in fed conditions (15.5 +/- 1.4 vs. 22.3 +/- 1.7 g/h). Training did not significantly increase fat oxidation when exercise was performed in fed conditions, but it did in fasting conditions (18.6 +/- 1.4 vs. 27.2 +/- 1.8 g/h).

DISCUSSION

Endurance training decreased plasma nonesterified fatty acids, cholesterol, and insulin concentrations. Training increased lipid oxidation during exercise, in fasting conditions, and not when exercise was performed after the meal. During exercise in overweight subjects, the fasting condition seems more suited to oxidizing fat and maintaining glucose homeostasis than a 3-hour wait after a standard meal.

Epinephrine inhibits exogenous glucose utilization in exercising horses

This study examined the effects of preexercise glucose administration, with and without epinephrine infusion, on carbohydrate metabolism in horses during exercise. Six horses completed 60 min of treadmill exercise at 55 +/- 1% maximum O(2) uptake 1) 1 h after oral administration of glucose (2 g/kg; G trial); 2) 1 h after oral glucose and with an intravenous infusion of epinephrine (0.2 micromol. kg(-1). min(-1); GE trial) during exercise, and 3) 1 h after water only (F trial). Glucose administration (G and GE) caused hyperinsulinemia and hyperglycemia ( approximately 8 mM). In GE, plasma epinephrine concentrations were three- to fourfold higher than in the other trials. Compared with F, the glucose rate of appearance was approximately 50% and approximately 33% higher in G and GE, respectively, during exercise. The glucose rate of disappearance was approximately 100% higher in G than in F, but epinephrine infusion completely inhibited the increase in glucose uptake associated with glucose administration. Muscle glycogen utilization was higher in GE [349 +/- 44 mmol/kg dry muscle (dm)] than in F (218 +/- 28 mmol/kg dm) and G (201 +/- 35 mmol/kg dm). We conclude that 1) preexercise glucose augments utilization of plasma glucose in horses during moderate-intensity exercise but does not alter muscle glycogen usage and 2) increased circulating epinephrine inhibits the increase in glucose rate of disappearance associated with preexercise glucose administration and increases reliance on muscle glycogen for energy transduction.

Lipolytic suppression following carbohydrate ingestion limits fat oxidation during exercise

This study determined if the suppression of lipolysis after preexercise carbohydrate ingestion reduces fat oxidation during exercise. Six healthy, active men cycled 60 min at 44 +/- 2% peak oxygen consumption, exactly 1 h after ingesting 0.8 g/kg of glucose (Glc) or fructose (Fru) or after an overnight fast (Fast). The mean plasma insulin concentration during the 50 min before exercise was different among Fast, Fru, and Glc (8 +/- 1, 17 +/- 1, and 38 +/- 5 microU/ml, respectively; P < 0.05). After 25 min of exercise, whole body lipolysis was 6.9 +/- 0.2, 4.3 +/- 0.3, and 3.2 +/- 0.5 micromol x kg(-1) x min(-1) and fat oxidation was 6.1 +/- 0.2, 4.2 +/- 0.5, and 3.1 +/- 0.3 micromol x kg(-1) x min(-1) during Fast, Fru, and Glc, respectively (all P < 0.05). During Fast, fat oxidation was less than lipolysis (P < 0.05), whereas fat oxidation approximately equaled lipolysis during Fru and Glc. In an additional trial, the same subjects ingested glucose (0.8 g/kg) 1 h before exercise and lipolysis was simultaneously increased by infusing Intralipid and heparin throughout the resting and exercise periods (Glc+Lipid). This elevation of lipolysis during Glc+Lipid increased fat oxidation 30% above Glc (4.0 +/- 0.4 vs. 3.1 +/- 0.3 micromol x kg(-1) x min(-1); P < 0.05), confirming that lipolysis limited fat oxidation. In summary, small elevations in plasma insulin before exercise suppressed lipolysis during exercise to the point at which it equaled and appeared to limit fat oxidation.

The influence of pre-exercise glucose ingestion on endurance running capacity

Drinking a concentrated glucose solution less than 1 h before the start of prolonged submaximal exercise has been reported to reduce endurance capacity during cycling. The purpose of this study was to re-examine the influence of pre-exercise ingestion of a concentrated glucose solution on endurance running capacity. Nine recreational runners (five men and four women) ran to exhaustion on a level treadmill, at speeds equivalent to 70% VO2max, on two occasions separated by at least 1 week. The runners ingested either a solution containing 75 g of glucose in 300 ml of water (G trial), or 300 ml of sweetened water (P trial) 30 min before each trial. As a consequence, the blood glucose concentrations were 55% higher at the beginning of the G trial compared with those recorded for the P trial (G trial, mean(s.e.) blood glucose = 6.3(0.7) mmol l-1 versus P trial, mean(s.e.) blood glucose = 4.1(0.3) mmol l-1; P < 0.01). Nevertheless, there were no differences in the running times to exhaustion between the two trials (G trial, mean(s.e.) 133.79(11.0) min versus P trial, mean(s.e.) 121.16(8.1) min). The results of this study show that ingesting a 25% glucose solution 30 min before exercise does not reduce the endurance capacity of recreational runners when the exercise intensity is equivalent to 70% VO2max.

Glycemic and insulinemic response to preexercise carbohydrate feedings

The effects of preexercise hyperinsulinemia on exercising plasma glucose, plasma insulin, and metabolic responses were assessed during 50 min cycling at 62% VO2max. Subjects were fed a 6% sucrose/glucose solution (LCHO) or a 20% maltodextrin/glucose solution (HCHO) to induce changes in plasma insulin. During exercise, subjects assessed perceived nauseousness and light-headedness. By the start of exercise, plasma glucose and plasma insulin had increased. In the LCHO trial, plasma glucose values significantly decreased below the baseline value at 30 min of exercise. However, by 40 min, exercise plasma glucose and insulin values were similar to the baseline value. Exercise plasma glucose and insulin did not differ from baseline values in the HCHO trial. Ingestion of LCHO or HCHO was not associated with nausea or lightheadedness. It was concluded that the hyperinsulinemia induced by preexercise feedings of CHO did not result in frank hypoglycemia or adversely affect sensory or physiological responses during 50 min of moderate-intensity cycling.

Timing and method of increased carbohydrate intake to cope with heavy training, competition and recovery

Based upon the fact that fatigue during intense prolonged exercise is commonly due to depletion of muscle and liver glycogen which limits both training and competitive performance, this paper has proposed extraordinary dietary practices which generally advocate high carbohydrate intake at all times before, during and after exercise. The simple goal is to have as much carbohydrate in the body as possible during the latter stages of prolonged intense exercise when the ability for intense exercise usually becomes limiting to performance. This theory is put into practice by recommending that carbohydrate intake after exhaustive exercise should average 50 g per 2 h of mostly moderate and high glycaemic carbohydrate foods. The aim should be to ingest a total of about 600 g in 24 h. Carbohydrate intake should not be avoided during the 4 h period before exercise and in fact it is best to eat at least 200 g during this time. When possible, carbohydrate should be ingested during exercise, generally in the form of solutions containing glucose/sucrose/maltodextrins, at a rate of 30-60 g h-1. Emphasis has been placed upon eating the optimal amount and best type of carbohydrate at the proper times because these practices demand a large amount of food. When diet is not carefully planned according to these guidelines, endurance athletes tend to consume too little carbohydrate because they become satiated with high fat in their diet and they go through periods in the day when recovery of glycogen stores is suboptimal and thus precious time is wasted.

Possible involvement of alanine and pyruvate in the regulation of glucose transport in heart muscle cells

In isolated rat heart muscle cells, addition of L-alanine (1.5 mmol/l) or of L-valine (3 mmol/l) resulted in either a ca 1.5- or 1.3-fold increase in glucose transport, resp. half-maximal stimulation was observed in the presence of L-alanine, but not of L-valine, within a physiological plasmatic range of concentrations. D-Alanine (1.5 mmol/l) was ineffective and the stimulating effect of L-alanine could be prevented by an excess of L-serine (15-30 mmol/l). L-Alanine produced an increase in 3-O-methyl-D-glucose transport Vmax (from 44.6 to 81.5 pmol.s-1.mg protein-1) without affecting the Km (12.2 in control vs 12.8 mmol/l in alanine-treated cells). Pyruvate (1.5 mmol/l) inhibited glucose transport by 20% and prevented the stimulating action of L-alanine (1.5 mmol/l). These results suggest that the effect of L-alanine in cardiac myocytes occurs through the interaction with an intracellular site and that both alanine and pyruvate may play a role in the regulation of glucose transport in these cells.