Catecholamines and pancreatic hormones during autonomic blockade in exercising man

Autonomic response to a short and long bout of high-intensity functional training

The evaluation of Autonomic Nervous System (ANS) recovery following exercise provides insight into the transient stress placed on the cardiovascular system. High-Intensity Functional Training (HIFT) is a form of intense exercise that is prescribed in various modalities and durations; however, little is known about the influence of HIFT duration on ANS recovery. Ten apparently healthy males (28.1 ± 5.4 yrs) performed two HIFT sessions (<5-minute and 15-minute) in a crossover fashion. ANS activity was measured using plasma Epinephrine (E) and Norepineprine (NE); Heart Rate Variability markers of the log transformed Root Mean Square of Successive Differences (lnRMSSD) and High-Frequency power (lnHF). No trial dependent differences were observed in lnRMSSD (p = 0.822), lnHF (p = 0.886), E (p = 0.078), or NE (p = 0.194). A significant main time effect was observed in both trials with a depression in lnRMSSD and lnHF following the trials (p < 0.05) and recovering by 2-hours post (p = 0.141, p > 0.999) respectively. A trial dependent increase in E and NE occurred immediately post (p < 0.05) and recovered by 1-hour post (p > 0.999, p > 0.999) respectively. The HIFT bouts examined within this study demonstrated similar transient strain of the ANS.

Skeletal Muscle to Pancreatic β-Cell Cross-talk: The Effect of Humoral Mediators Liberated by Muscle Contraction and Acute Exercise on β-Cell Apoptosis

CONTEXT

Mechanisms explaining exercise-induced β-cell health are unknown.

OBJECTIVE

This study aimed to define the role of muscle contraction and acute exercise-derived soluble humoral mediators on β-cell health.

DESIGN

In vitro models were used.

SETTING

University.

PARTICIPANTS

Healthy subjects.

INTERVENTION(S)

Conditioned media (CM) were collected from human skeletal muscle (HSkM) cells treated with or without electrical pulse stimulation (EPS). Antecubital and femoral venous blood serum were collected before and after an exercise bout. CM and sera with or without IL-6 neutralization were used to incubate insulin-producing INS-1 cells and rat islets for 24 h in the presence or absence of proinflammatory cytokines (IL-1β+IFN-γ).

MAIN OUTCOME MEASURE(S)

INS-1 and islet apoptosis and accumulated insulin secretion.

RESULTS

IL-1β+IFN-γ increased INS-1 and islet apoptosis and decreased insulin secretion. EPS-treated HSkM cell CM did not affect these variables. Exercise-conditioned antecubital but not femoral sera prevented IL-1β+IFN-γ-induced INS-1 and islet apoptosis. Femoral sera reduced insulin secretion under normal and proinflammatory conditions in INS-1 but not islet cells. EPS increased HSkM cell IL-6 secretion and exercise increased circulating IL-6 levels in antecubital and femoral serum. IL-6 neutralization demonstrated that muscle-derived IL-6 prevents INS-1 and islet apoptosis in the absence of IL-1β+IFN-γ, but augments apoptosis under proinflammatory conditions, and that muscle-derived IL-6 supports islet insulin secretion in the absence of IL-1β+IFN-γ.

CONCLUSIONS

Unidentified circulating humoral mediators released during exercise prevent proinflammatory cytokine-induced β-cell apoptosis. Muscle-derived mediators released during exercise suppress β-cell insulin secretion. Furthermore, muscle-derived IL-6 seems to prevent β-cell apoptosis under normal conditions but contributes to β-cell apoptosis under proinflammatory conditions.

Half-time strategies to enhance second-half performance in team-sports players: a review and recommendations

A number of intermittent team sports require that two consecutive periods of play (lasting for ~30-45 min) are separated by a 10-20 min half-time break. The half-time practices employed by team-sports players generally include returning to the changing rooms, temporarily relaxing from the cognitive and physical demands of the first half, rehydration and re-fuelling strategies, addressing injury or equipment concerns, and receiving tactical instruction and coach feedback. However, the typically passive nature of these actions has been associated with physiological changes that impair performance during the second half. Both physical and cognitive performances have been found to decline in the initial stages of subsequent exercise that follows half-time. An increased risk of injury has also been observed during this period. Therefore, half-time provides sports scientists and strength and conditioning coaches with an opportunity to optimise second-half performance. An overview of strategies thought to benefit team-sports athletes is presented; specifically, the efficacy of heat maintenance strategies (including passive and active methods), post-activation potentiation, hormonal priming, and modified hydro-nutritional practices are discussed. A theoretical model of applying these strategies in a manner that compliments current practice is also offered.

Exercise and ghrelin. A narrative overview of research

Since its discovery in 1999, ghrelin has been implicated in a multiplicity of physiological activities. Most notably, ghrelin has an important influence on energy metabolism and after the identification of its potent appetite stimulating effects ghrelin has been termed the 'hunger hormone'. Exercise is a stimulus which has a significant impact on energy homeostasis and consequently a substantial body of research has investigated the interaction between exercise and ghrelin. This narrative review provides an overview of research relating to the acute and chronic effects of exercise on circulating ghrelin (acylated, unacylated and total). To enhance study comparability, the scope of this review is limited to research undertaken in adult humans and consequently studies involving children and animals are not discussed. Although there is significant ambiguity within much of the early research, our review suggests that acute exercise transiently interferes with the production of acylated ghrelin. Furthermore, the consensus of evidence indicates that exercise training does not influence circulating ghrelin independent of weight loss. Additional research is needed to verify and extend the available literature, particularly by uncovering the mechanisms governing acute exercise-related changes and characterising responses in other populations such as females, older adults, and the obese.

Normal insulin response to short-term intense exercise is abolished in Type 2 diabetic patients treated with gliclazide

BACKGROUND

Physical activity is an essential component of diabetes management; however, exercise is associated with the risk for metabolic decompensation. The aim of the study was to analyze insulin response to the short-term intense exercise in middle-aged Type 2 diabetic patients treated with gliclazide.

MATERIALS AND METHODS

Fourteen Type 2 diabetic patients (47.9+/-1.6 years, mean+/-S.E.M.), treated with gliclazide, and 14 healthy controls (45.1+/-1.0 years) were submitted to standard graduated submaximal (90% HR(max)) exercise treadmill testing at 2 h after standardized breakfast. Serum glucose, insulin, proinsulin, C peptide, growth hormone, insulin-like growth factor-1, and cortisol concentrations; and plasma lactate, glucagon, epinephrine, and norepinephrine concentrations were measured during the periexercise period up to the 60th min of the recovery period.

RESULTS

Significant hemodynamic (heart rate, systolic, and diastolic blood pressure), metabolic (lactate concentration), and hormonal (epinephrine and norepinephrine levels) responses to the exercise were similar in patients and healthy subjects. Glucose, insulin, and proinsulin levels were higher in the diabetic group at the preexercise and at all the next analyzed time points. The insulin concentration increased during the postprandial period in both groups and decreased subsequently during the exercise only in the control group, without concurrent C peptide decline. The C peptide-to-insulin ratio increased during the exercise and decreased immediately postexercise only in the control group.

CONCLUSIONS

The initial decrease of the insulin serum concentration during short-term intense exercise in normal middle-aged men is primarily related to the increased clearance of the hormone. Normal insulin response to the exercise was abolished in Type 2 diabetic patients treated with gliclazide.

Catecholamines and the effects of exercise, training and gender

Stress hormones, adrenaline (epinephrine) and noradrenaline (norepinephrine), are responsible for many adaptations both at rest and during exercise. Since their discovery, thousands of studies have focused on these two catecholamines and their importance in many adaptive processes to different stressors such as exercise, hypoglycaemia, hypoxia and heat exposure, and these studies are now well acknowledged. In fact, since adrenaline and noradrenaline are the main hormones whose concentrations increase markedly during exercise, many researchers have worked on the effect of exercise on these amines and reported 1.5 to >20 times basal concentrations depending on exercise characteristics (e.g. duration and intensity). Similarly, several studies have shown that adrenaline and noradrenaline are involved in cardiovascular and respiratory adjustments and in substrate mobilization and utilization. Thus, many studies have focused on physical training and gender effects on catecholamine response to exercise in an effort to verify if significant differences in catecholamine responses to exercise could be partly responsible for the different performances observed between trained and untrained subjects and/or men and women. In fact, previous studies conducted in men have used different types of exercise to compare trained and untrained subjects in response to exercise at the same absolute or relative intensity. Their results were conflicting for a while. As research progressed, parameters such as age, nutritional and emotional state have been found to influence catecholamine concentrations. As a result, most of the recent studies have taken into account all these parameters. Those studies also used very well trained subjects and/or more intense exercise, which is known to have a greater effect on catecholamine response so that differences between trained and untrained subjects are more likely to appear. Most findings then reported a higher adrenaline response to exercise in endurance-trained compared with untrained subjects in response to intense exercise at the same relative intensity as all-out exercise. This phenomenon is referred to as the 'sports adrenal medulla'. This higher capacity to secrete adrenaline was observed both in response to physical exercise and to other stimuli such as hypoglycaemia and hypoxia. For some authors, this phenomenon can partly explain the higher physical performance observed in trained compared with untrained subjects. More recently, these findings have also been reported in anaerobic-trained subjects in response to supramaximal exercise. In women, studies remain scarce; the results are more conflicting than in men and the physical training type (aerobic or anaerobic) effects on catecholamine response remain to be specified. Conversely, the works undertaken in animals are more unanimous and suggest that physical training can increase the capacity to secrete adrenaline via an increase of the adrenal gland volume and adrenaline content.

Tyramine-mediated activation of sympathetic nerves inhibits insulin secretion in humans

CONTEXT

Older studies have shown that high doses of norepinephrine infused into human subjects can inhibit insulin secretion. Similar inhibition during electrical stimulation of sympathetic nerves in animals raises the possibility that the suppression of insulin secretion seen in humans could reflect a physiological effect of sympathetic nerves on islet beta-cells. However, a direct test of the hypothesis that moderate and selective activation of these nerves is sufficient to inhibit insulin secretion in humans is lacking.

OBJECTIVE

We sought to test this hypothesis by releasing moderate amounts of endogenous norepinephrine selectively from the sympathetic nerves of normal human subjects by infusing them with low doses of the indirect sympathomimetic agent tyramine.

METHODS

During a single study visit, 11 healthy subjects received iv injections of arginine either alone or in combination with a low-dose tyramine infusion. Physiological (blood pressure) and biochemical (insulin, glucose, and norepinephrine) parameters were measured.

RESULTS

The acute insulin response to arginine was significantly reduced during tyramine compared with that seen in the absence of tyramine (P = 0.036).

CONCLUSIONS

These data suggest that moderate and selective activation of sympathetic nerves inhibits insulin release in humans.

Impact of the short-term, intense exercise on postprandial glycemia in type 2 diabetic patients treated with gliclazide

BACKGROUND

Physical activity is crucial for treatment of diabetes. However, intensive exercise brings the risk for metabolic decompensation; therefore, predicting its effect on glycemia is of great importance.

MATERIALS AND METHODS

Fourteen type 2 diabetic patients (47.9+/-1.6 years; mean+/-S.E.M.), treated with gliclazide, and 14 healthy controls (45.1+/-1.0 years) were subjected to standard graded submaximal (90% HR(max)) exercise treadmill testing for 2 h after standardized breakfast. Blood glucose, lactate, insulin, and proinsulin concentrations were measured on fasting and during the periexercise period up to 120 min after the effort. Glucagon, growth hormone, cortisol, and catecholamines were determined up to 60 min of the recovery period.

RESULTS

After exercise, glycemia decreased from the preexercise value of 11.3+/-1.4 to 8.0+/-1.1 mmol/l at 120 min (P<.001) in the diabetic group, while in controls, it did not change significantly. Shift in glycemia during and after exercise in the diabetic group was dependent on preexercise glycemia, according to the quadratic polynomial regression model, whereas a simple negative correlation between these indices was found in the control group. Insulinemia tended to decrease from the midexercise maximum of 488+/-116 to 261+/-71 pmol/l at the 120th min in diabetic patients. Neither hypoglycemia nor deficit in response of counterregulatory hormones was observed.

CONCLUSIONS

In the type 2 diabetic patients treated with gliclazide, short-term, intensive, submaximal exercise, performed 2 h after a meal, causes reduction of hyperglycemia during the recovery period. Preexercise glycemia was found to be a primary predictor of the shift in glycemia under the exercise, according to the polynomial regression model.

Smoking impairs muscle recovery from exercise

Cigarette smoking is a leading cause of many adverse health consequences. Chronic nicotine exposure leads to insulin resistance and may increase the risk of developing non-insulin-dependent diabetes mellitus in young otherwise healthy smokers. To evaluate smoking-induced effects on carbohydrate metabolism, we studied muscle glycogen recovery from exercise in a young healthy population of smokers. The study used 31P-13C NMR spectroscopy to compare muscle glycogen and glucose 6-phosphate levels during recovery in exercised gastrocnemius muscles of randomized cohorts of healthy male smokers (S) and controls (C). Data for the two groups were as follows: S, > or =20 cigarettes/day (n = 8), 24 +/- 2 yr, 173 +/- 3 cm, 70 +/- 4 kg and age- and weight-matched nonsmoking C (n = 10), 23 +/- 1 yr, 175 +/- 3 cm, 67 +/- 3 kg. Subjects performed single-leg toe raises to deplete glycogen to approximately 20 mmol/l, and glycogen resynthesis was measured during the first 4 h of recovery. Plasma samples were assayed for glucose and insulin at rest and during recovery. Test subjects were recruited from the general community surrounding Yale University. Glycogen was depleted to similar levels in the two groups [23.5 +/- 1.2 (S) and 19.1 +/- 1.3 (C) mmol/l]. During the 1st h of recovery, glycogen synthesis rates were similar [13.8 +/- 1.1 (S) and 15.3 +/- 1.3 (C) mmol x l-1 x h-1]. Between hours 1 and 4, glycogen synthesis was impaired in smokers [0.8 +/- 0.2 (S) and 4.5 +/- 0.5 (C) mmol x l-1 x h-1, P = 0.0002] compared with controls. Glucose 6-phosphate was reduced in smokers during hours 1-4 [0.105 +/- 0.006 (S) and 0.217 +/- 0.019 (C) mmol/l, P = 0.0212]. We conclude that cigarette smoking impairs the insulin-dependent portion of muscle recovery from glycogen-depleting exercise. This impairment likely results from a reduction in glucose uptake.

Insulin secretion and glucose kinetics during exercise with and without pharmacological alpha(1)- and alpha(2)-receptor blockade

The mechanism behind exercise-induced decreases in plasma insulin concentrations was examined in eight healthy young men. In addition, the influence of specific alpha(1)- and alpha(2)-adrenoceptor blockade on glucose kinetics during exercise was studied. To test the hypothesis that exercise-induced decreases in insulin secretion are mediated via alpha(2)-adrenoceptors, all subjects exercised for 60 min on separate occasions under four conditions: with and without alpha(1)-receptor blockade (1 mg prazosin) and with and without or alpha(2)-receptor blockade (15 mg yohimbine). Glucose kinetics were measured using [3-(3)H]glucose. During exercise with alpha(2)-receptor blockade, the insulin concentration initially increased (first 20 min) then decreased, whereas it continually decreased in the corresponding control experiment. The C-peptide concentration did not change during exercise with alpha(2)-receptor blockade but decreased in the control experiment. During exercise with alpha(1)-receptor blockade and corresponding control experiments, insulin and C-peptide levels always decreased. With alpha(1)-receptor blockade, the glucose concentration increased (first 30 min) and then decreased, whereas it slightly decreased in all other experiments. In addition, with alpha(1)-receptor blockade, the glucose rate of appearance (Ra) increased rapidly (because of higher catecholamine concentrations in alpha(1)-receptor blockade versus control) and the glucose rate of disappearance (Rd) was higher compared with control. During exercise with alpha(2)-receptor blockade, the Ra and Rd were always lower compared with control. Therefore, we conclude that exercise-induced decreases in insulin secretion are mediated via alpha(2)-adrenoceptors and that blockade of alpha(1)- and alpha(2)-adrenoceptors during exercise elicits opposite responses in glucose Ra and Rd.

Hepatic alpha- and beta-adrenergic receptors are not essential for the increase in R(a) during exercise in diabetes

The purpose of this study was to determine the role of direct hepatic adrenergic stimulation in the control of endogenous glucose production (R(a)) during moderate exercise in poorly controlled alloxan-diabetic dogs. Chronically catheterized and instrumented (flow probes on hepatic artery and portal vein) dogs were made diabetic by administration of alloxan. Each study consisted of a 120-min equilibration, 30-min basal, 150-min moderate exercise, 30-min recovery, and 30-min blockade test period. Either vehicle (control; n = 6) or alpha (phentolamine)- and beta (propranolol)-adrenergic blockers (HAB; n = 6) were infused in the portal vein. In both groups, epinephrine (Epi) and norepinephrine (NE) were infused in the portal vein during the blockade test period to create suprapharmacological levels at the liver. Isotopic ([3-(3)H]glucose, [U-(14)C]alanine) and arteriovenous difference methods were used to assess hepatic function. Arterial plasma glucose was similar in controls (345 +/- 24 mg/dl) and HAB (336 +/- 23 mg/dl) and was unchanged by exercise. Basal arterial insulin was 5 +/- 1 mU/ml in controls and 4 +/- 1 mU/ml in HAB and fell by approximately 50% during exercise in both groups. Basal arterial glucagon was similar in controls (56 +/- 10 pg/ml) and HAB (55 +/- 7 pg/ml) and rose similarly, by approximately 1.4-fold, with exercise in both groups. Despite greater arterial Epi and NE levels in HAB compared with controls during the basal and exercise periods, exercise-induced increases in catecholamines from basal were similar in both groups. Gluconeogenic conversion from alanine and lactate and the intrahepatic efficiency of this process were increased by twofold during exercise in both groups. R(a) rose similarly by 2.9 +/- 0.7 and 2.7 +/- 1.0 mg. kg(-1). min(-1) at time = 150 min during exercise in controls and HAB. During the blockade test period, arterial plasma glucose and R(a) rose to 454 +/- 43 mg/dl and 11.3 mg. kg(-1). min(-1) in controls, respectively, but were essentially unchanged in HAB. The attenuated response to the blockade test in HAB substantiates the effectiveness of the hepatic adrenergic blockade. In conclusion, these results demonstrate that direct hepatic adrenergic stimulation does not play a role in the stimulation of R(a) during exercise in poorly controlled diabetes.

Pancreatic innervation is not essential for exercise-induced changes in glucagon and insulin or glucose kinetics

The purpose of this study was to determine the role of pancreatic innervation in mediating exercise-induced changes in pancreatic hormone secretion and glucose kinetics. Dogs underwent surgery >16 days before an experiment, at which time flow probes were implanted on the portal vein and the hepatic artery, and Silastic catheters were inserted in the carotid artery, portal vein, and hepatic vein for sampling. In one group of dogs (DP) all nerves and plexuses to the pancreas were sectioned during surgery. A second group of dogs underwent sham denervation (SHAM). Pancreatic tissue norepinephrine was reduced by >98% in DP dogs. Each study consisted of basal (-30 to 0 min) and moderate exercise (0 to 150 min, 100 m/min, 12% grade) periods. Isotope ([3-(3)H]glucose) dilution and arteriovenous differences were used to assess hepatic function. Arterial and portal vein glucagon and insulin concentrations and the rate of net extrahepatic splanchnic glucagon release (NESGR) were similar in DP and SHAM during the basal period. Arterial and portal vein glucagon and NESGR increased similarly in DP and SHAM during exercise. Arterial and portal vein insulin were similar during exercise. Arterial glucose, tracer-determined endogenous glucose production, and net hepatic glucose output were similar in DP and SHAM during the basal and exercise periods. These results demonstrate that pancreatic nerves are not essential to pancreatic hormone secretion or glucose homeostasis during rest or moderate exercise.

Role of fats in exercise. Types and quality

Plasma TGs, FFAs, and muscle TG are oxidizable lipid fuel sources for skeletal muscle metabolism during prolonged exercise. Plasma FFAs are a major fuel oxidized by skeletal muscle, and their rate of use by muscle depends on several factors, including plasma FFA availability, transport from plasma to the mitochondria, and intracellular metabolism. Mobilization of FFAs from adipose tissue is the first committed step in FFA metabolism, and it depends on the rate of adipose tissue lipolysis. Adipose tissue lipolysis increases with exercise duration and exercise intensity up to intensities of approximately 60% to 65%. Evidence suggests that FFAs are transported from plasma to the mitochondria by FFA transporter proteins that include the plasma membrane and cytosolic FABPPM and FABPC. Plasma FFA use can also be regulated at the mitochondrial transport step by changing the activity of carnitine palmitoyltransferase (CPT-1). Although results from biopsy and tracer studies indicate that muscle TG contribute to skeletal muscle oxidative metabolism during exercise, their exact contribution is difficult to ascertain. Evidence shows that muscle TG use depends on exercise intensity, duration, and mode. The contribution of plasma TG to skeletal muscle metabolism is small. The rate of use of plasma TG is dependent on lipoprotein lipase activity, which is correlated with the oxidative capacity of the muscle fibers. Dietary manipulations can modulate substrate use during exercise and can potentially affect exercise performance. High carbohydrate availability before exercise is associated with an increase in blood glucose and plasma insulin concentrations, which can ultimately decrease the rate of adipose tissue lipolysis and the availability of plasma FFAs. Increased glucose flux has also been shown to decrease lipid oxidation by directly inhibiting the transport of FFAs across the mitochondrial membranes. High lipid availability can be changed by short-term or long-term exposure to high-fat diets. Because carbohydrate reserves are diminished with exposure to high-fat diets, improvements in exercise performance have been difficult to measure under these conditions.

Effect of intravenous infusion of an alpha-adrenergic blocking agent on the haemodynamic changes in human masseter muscle induced by cold pressor stimulation

This study evaluated the effect of intravenous infusion of a non-selective alpha-adrenergic blocking agent on masseter muscle haemodynamics induced by 4 degrees C cold pressor stimulation (CPS) of the right foot and ankle, which reportedly evokes a rapidly increasing sympathetic nerve activity in human skeletal muscle. Nine healthy non-smoking males (mean age 23.7+/-2.1 year) with no history of chronic muscle pain or migraine participated. The haemoglobin (Hb) concentration in the right masseter was continuously recorded by non-invasive, near-infrared spectroscopy. Heart rate and blood pressure were also recorded. The experiment involved the following sequence: (1) a placebo (physiological saline) with a CPS trial; (2) a 30-sec maximal voluntary clenching (MVC)-only trial; and (3) an alpha-adrenergic blocking agent with a CPS trial. The saline and drug trials each involved continuous recording for 1 min before, 2 min during and 5 min after the CPS. Physiological saline (20 ml) or phentolamine mesylate (20 ml) were infused at the rate of 2 ml/min. This infusion was begun 15 min before baseline recording and participants were not aware which solution (saline or phentolamine) was being infused. For the MVC trial, each participant performed a 30-sec MVC of his jaw-closing muscles followed by a 15-min rest between each trial. The individual Hb data were adjusted so that the baseline at the beginning of the experiment was equal to zero and all data were normalized as a percentage of the individual's highest absolute Hb change seen after the MVC. The mean baseline Hb concentrations 1 min before CPS were significantly higher in the alpha-blocker trial (83.6%) than in the placebo saline trial (P < 0.001). The change in mean Hb concentration from baseline during CPS in the alpha-blocker trial was significantly less than in the placebo trial (P = 0.006). Mean heart rate before CPS was also significantly higher in the alpha-blocker trial (85.2 beats/min) than in the placebo trial (69.6 beats/min) (P < 0.001). There were no significant differences in the mean systolic and diastolic blood pressures between the placebo and alpha-blocker trials in any time period. The results suggest that non-selective alpha-adrenoceptor blockade increases the blood volume in the masseter muscle. This change might be due to a combination of peripheral vasodilation and an increase in cardiac output.

Exercise and organ transplantation

Life-saving treatment of disease by organ transplantation has become increasingly important. Annually over 35,000 transplantations of vital organs are carried out world-wide and the demand for knowledge regarding exercise in daily life for transplant recipients is growing. The present review describes whole-body and organ reactions to both acute exercise and regular physical training in persons who have undergone heart, lung, liver, kidney, pancreas or bone marrow transplantation. In response to acute exercise, the majority of cardiovascular, hormonal and metabolic changes are maintained after transplantation. However, in heart transplant recipients organ denervation reduces the speed of heart rate increase in response to exercise. Furthermore, lack of sympathetic nerves to transplanted organs impairs the normal insulin and renin responses to exercise in pancreas and kidney transplant recipients, respectively. In contrast, surgical removal of sympathetic liver nerves does not inhibit hepatic glucose production during exercise, and denervation of the lungs does not impair the ability to increase ventilation during physical exertion. Most studies show that physical training results in an improved endurance and strength capacity in almost all groups of transplant recipients, which is of importance for their daily life. With a little precaution, organ transplant recipients can perform exercise and physical training and obtain effects comparable with those achieved in the healthy population of similar age.

Oral [13C]glucose oxidation during prolonged exercise after high- and low-carbohydrate diets

The effect of a diet either high or low in carbohydrates (CHO) on exogenous 13C-labeled glucose oxidation (200 g) during exercise (ergocycle: 120 min at 64.0 +/- 0.5% maximal oxygen uptake) was studied in six subjects. Between 40 and 80 min, exogenous glucose oxidation was significantly higher after the diet low in CHO (0.63 +/- 0.05 vs. 0.52 +/- 0.04 g/min), but this difference disappeared between 80 and 120 min (0.71 +/- 0.03 vs. 0.69 +/- 0.04 g/min). The oxidation rate of plasma glucose, computed from the volume of 13CO2 produced the 13C-to-12C ratio in plasma glucose at 80 min, and of glucose released from the liver, computed from the difference between plasma glucose and exogenous glucose oxidation, was higher after the diet low in CHO (1.68 +/- 0.26 vs. 1.41 +/- 0.17 and 1.02 +/- 0.20 vs. 0.81 +/- 0.14 g/min, respectively). In contrast the oxidation rate of glucose plus lactate from muscle glycogen (computed from the difference between total CHO oxidation and plasma glucose oxidation) was lower (0.31 +/- 0.35 vs. 1.59 +/- 0.20 g/min). After a diet low in CHO, the oxidation of exogenous glucose and of glucose released from the liver is increased and partly compensates for the reduction in muscle glycogen availability and oxidation.

Arginine-induced pancreatic hormone secretion during exercise in rats

The aim of the present investigation was to 1) determine whether arginine-induced pancreatic hormone secretion can be modified during an exercise bout, and 2) verify whether the sectioning of the hepatic branch of the vagus nerve can alter the arginine-induced insulin and glucagon secretion during exercise in rats. To this end, we studied the effects of an intraperitoneal injection of arginine (1 g/kg body mass) during an exercise bout (30 min, 26 m/min, 0% grade) on the pancreatic hormone responses. These effects were determined in one group of sham-operated exercising rats and compared with three control groups: one group of resting rats, one group of saline-injected exercising rats, and one group of hepatic-vagotomized exercising rats. Five minutes after the injection of arginine, significant (P < 0.05) increases in insulin, glucagon, and C-peptide concentrations were observed in exercising as well as in resting rats. These responses were not, however, altered by the hepatic vagotomy and/or by the exercise bout. It is concluded that arginine is a potent stimulus of pancreatic hormone secretion during exercise, even though the sympathoadrenal system is activated. These results also indicate that a hepatic vagotomy does not seem to influence arginine-induced hormonal pancreatic responses and question the role of the putative hepatic arginoreceptors in the control of the pancreatic hormone secretion during exercise.

Fuel selection, muscle fibre

The fuel selection of muscle fibres at rest is dependent on substrate availability. Increased lipid availability results in an increase citrate concentration with inhibition of glycolysis. Fat utilization also increases the concentration ratio acetyl-CoA:CoASH, with inhibition of PDH transformation to the active form. The result is an inhibition of carbohydrate utilization in conformity with the classical glucose-fatty acid style. During exercise fuel selection is dependent on the intensity of exercise, the recruitment pattern of fibre type and the availability of fuels. During exercise at maximum intensity the main fuels are PCr and muscle glycogen, the highest energy release occurring with type II fibres. At exercise intensities between 70 and 100% VO2max carbohydrate is the main fuel after the intake of normal mixed or carbohydrate-rich diets. No inhibition of PDHa formation was observed by increased concentration ratio acetyl-CoA:CoASH during the exercise, but the activation and transport of fatty-acyl groups from NEFA may be inhibited by a decrease in the concentration of CoASH. This mechanism may limit the contribution of fat to metabolism during exercise at intensities above 60% VO2max, after an intake of carbohydrate-rich diets. After carbohydrate starvation or an infusion of a fat emulsion, there was a substantial increase in the utilization of fat which, after the infusion, was concomitant with a high PDHa and a high lactate production. This is thought to be due to a decrease in glycolysis and in the catalytic activity of PDHa, especially in type I fibres, while lactate production continues in type II fibres. When exercise intensities fall below 60% VO2max, fat becomes the dominant fuel during prolonged exercise. At the same time the recruitment pattern is shifted toward type I fibres which have the lowest activation threshold and the highest oxidative capacity.

Exercise prescription for individuals with metabolic disorders. Practical considerations

Regular exercise has been recognised as an important component in the management of patients with diabetes mellitus. In addition to acutely lowering blood glucose, exercise training improves glucose tolerance and peripheral insulin sensitivity, contributes to weight loss and reduces several risk factors for cardiovascular disease. When proper precautions are taken to prevent hypoglycaemia, individuals with diabetes can enjoy the same benefits from exercise as nondiabetic healthy individuals. As a guideline, moderate intensity, aerobic endurance activities should be performed for 20 to 40 minutes at least 3 times a week. Blood glucose should be monitored, and insulin dose and carbohydrate intake adjusted based on the blood glucose response to the type and duration of exercise. This review will summarise current understanding of the therapeutic role of exercise in the treatment of diabetes and will present guidelines for prescribing exercise in diabetic patients.

Quantitative evaluation of the effect of low-intensity exercise on insulin secretion in man

We studied insulin secretion rates (ISR) during low-intensity exercise (40% peak aerobic capacity [VO2]) in 12 normal subjects to assess the contribution of altered insulin secretion to the reduction in peripheral insulin concentrations associated with exercise. ISR were calculated by a previously validated method of two-compartment analysis of peripheral C-peptide concentrations using individual parameters derived following a bolus injection of biosynthetic human C-peptide. In addition, the effect of low-intensity exercise on kinetic parameters of C-peptide was evaluated. The results showed that low-intensity exercise did not significantly affect C-peptide kinetics. Peripheral insulin concentrations and ISR decreased to a similar degree throughout exercise. There was a mean maximum decrease in serum insulin concentrations from 42 +/- 5.4 pmol/L basally to 24 +/- 2.6 pmol/L, constituting a 51% +/- 5.9% decrease (P < .001), and ISR decreased from 85.7 +/- 11.9 pmol/min to a nadir of 45.6 +/- 10.6 pmol/min (P < .001), a 48% +/- 8.4% decline. Plasma glucose and glucagon concentrations did not change significantly either during or after exercise, although there was a matched twofold increase in glucose utilization and disposal rates. We suggest that the reduction in peripheral insulin concentrations during exercise is due to reduced insulin secretion.

Effects of alpha-adrenoceptor and of combined sympathetic and parasympathetic blockade on cardiac performance and vascular resistance

1. Cardiac performance and vascular resistance was studied in seven healthy men by radionuclide cardiography and venous plethysmography before and after alpha-adrenoceptor blockade with phentolamine and after combined alpha-adrenoceptor, beta-adrenoceptor (propranolol) and parasympathetic (atropine) blockade. 2. During alpha-adrenoceptor blockade heart rate and cardiac output increased considerably and left ventricular ejection fraction increased because of increased contractility. Systemic vascular resistance fell both during alpha-adrenoceptor blockade alone and during combined blockade. The increase in calf blood flow was of the same magnitude after combined blockade and after alpha-adrenoceptor blockade alone, and was considerably higher than the fall in systemic vascular resistance. Plasma catecholamine concentrations increased after phentolamine, but the changes were blunted when propranolol and atropine were added. 3. These results indicate that peripheral vasoconstriction especially that exerted by alpha-adrenoceptor nervous tone in skeletal muscle restricts left ventricular emptying of the intact heart. During pharmacologic blockade of the sympathetic and parasympathetic nervous system at rest the chronotropic state is augmented, whereas preload and inotropy are unaffected.

Evaluation of clonidine suppression and various provocation tests in the diagnosis of pheochromocytoma

Recent investigations have shown that the widely used clonidine suppression test is sometimes fallible for the diagnosis of pheochromocytoma. A comparative assessment was made of the following suppression and provocation tests, the clonidine suppression test, and the glucagon, metoclopramide, and naloxone provocation tests. The assessment was performed in 6 patients with pheochromocytoma and in 19 patients without pheochromocytoma who were initially suspected of harboring a tumor. BP response did not predict the presence of pheochromocytoma in any test. Plasma norepinephrine (NE) concentrations determined at 120 and 180 min after oral 150 micrograms of clonidine gave false negative results in 2 of the 5 patients with pheochromocytoma tested. Both plasma NE and epinephrine (E) concentrations were measured before and sequentially after each provocative agent. Neither NE nor E responded to 1 mg of glucagon iv in 2 of the 4 patients with pheochromocytoma tested. Determination of the peak level, peak increment, and % peak increment of NE and E following 10 mg of naloxone iv did not distinguish the two groups. The % peak increments of both NE and E in all 4 patients with pheochromocytoma given 5 mg of metoclopramide iv exceeded the mean + 3 SD values of the patients without pheochromocytoma (25 + 28% for NE, and 25 + 42% for E). These results suggested that, when performed with judicious patient selection (ambiguous plasma or urinary catecholamine levels), the measurement of plasma catecholamines in response to metoclopramide can be a useful adjunctive tool in the diagnosis of pheochromocytoma.

Physiologic responses of elite paraplegic road racers to prolonged exercise

The purpose of this study was to determine cardiopulmonary and selected metabolic responses in spinal cord injured (SCI) paraplegics during prolonged arm crank exercise (ACE). Six male and one female elite SCI paraplegic (T4-12 lesions) road racers performed 40 continuous minutes of ACE at 60% of peak ACE oxygen uptake (VO2). Blood samples (30 ml) were collected via antecubital venipuncture at rest and minutes 20 and 40 of ACE for determinations of hemoglobin, hematocrit, serum free fatty acid (FFA), and blood lactate (LA) concentrations. No significant differences were observed over time for VO2 or pulmonary ventilation. Heart rate recorded at minutes 30 and 40 was significantly elevated above HR at minutes 10 and 20 of ACE indicating the presence of an upward drift in HR in paraplegics performing prolonged ACE. Compared to rest, LA concentration was significantly higher at minute 20 and remained relatively stable thereafter. A significant increase in FFA concentration at minute 40 combined with a significant decline in the respiratory exchange ratio suggested a preference for lipid substrate utilization by exercising muscle as ACE continued. The data indicate that the autonomic sympathetic nervous system impairment associated with paraplegia had no apparent adverse effects on cardiopulmonary or metabolic adjustments to prolonged ACE in these well-trained subjects.

Insulin and glucagon secretion in swimming mice: effects of autonomic receptor antagonism

To study the regulation of islet hormone secretion in exercise-stress, we developed a swimming mouse model. Mice swam for 2, 6, or 10 minutes whereafter blood was sampled for analysis of plasma levels of insulin, glucagon, and glucose. Plasma insulin levels, which were not different from resting controls after 2 or 6 minutes of swimming, were slightly lower after 10 minutes of swimming (P less than .05). Plasma glucagon levels were increased after 2, 6, and 10 minutes of swimming (P less than .001), and plasma glucose levels were lower after 6 and 10 minutes of swimming (P less than .05). Glucose (5.6 mmol/kg)-stimulated insulin secretion was inhibited by 52% +/- 9% by the swimming (P less than .001). The mechanisms behind this inhibition of glucose-stimulated insulin secretion and the increase in basal plasma glucagon levels induced during 2 minutes of swimming were investigated by the use of autonomic receptor antagonists, administered intraperitoneally 20 minutes before the swimming period. The ganglionic antagonist hexamethonium (56 mumols/kg) prevented the swimming-induced inhibition of glucose-stimulated insulin secretion, indicating involvement of nerves in the inhibition. Also the nonselective alpha-adrenoceptor antagonist phentolamine (6.0 mumols/kg) and the alpha 2-adrenoceptor antagonist yohimbine (3.6 mumols/kg) prevented the inhibition of glucose-stimulated insulin secretion induced by swimming, whereas the beta-adrenoceptor antagonist L-propranolol (9.6 mumols/kg) had no effect. The swimming-induced increase in plasma glucagon levels was partially inhibited by hexamethonium by (58% +/- 24%, P less than .05). Phentolamine and yohimbine totally prevented the increase in plasma glucagon levels, whereas L-propranolol had no effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise options for persons with diabetic complications

Exercise is a cornerstone in the management of diabetes, yet many persons with diabetes fail to participate in basic physical activity due to secondary diabetic complications. This inactivity can lead to disuse syndrome--a deterioration of functional capacity. Disuse syndrome, coupled with diabetes, can produce significant physiological problems and further disability. This review provides the health educator with information about the pathology and role of exercise for persons with diabetic complications. Examples of exercise to minimize disuse syndrome are given for individuals with peripheral vascular disease, retinopathy, neuropathies, and nephropathy.

Impaired plasma catecholamine response to submaximal treadmill exercise in obese women

After an overnight fast, blood samples were obtained from seven obese women (50% +/- 3% body fat) and from seven control women (25% +/- 1% body fat) before, during, and after 10 minutes of treadmill exercise at 70% of each individual's maximal oxygen uptake (VO2max). During exercise, peak plasma epinephrine (E), norepinephrine (NE), and glucagon concentrations in the control group significantly exceeded corresponding peak values in the obese group by 1.4-fold to twofold, whereas lactate responses did not differ. After 5 minutes of rest, peak plasma glucose, free fatty acid (FFA), and growth hormone (GH) concentrations in the control group also were significantly higher than in the obese women, but the plasma cortisol responses were comparable. Although plasma insulin concentrations decreased during exercise and rose to maximum values at 5-minute recovery in all individuals, levels were more than 3.5-fold higher in the obese group throughout the study. We conclude that the combination of heightened plasma insulin and diminished catecholamine and other counterregulatory hormone responses may account for subnormal plasma substrate increments that distinguish obese from non-obese women during exercise at comparable work intensities.

Abnormal glucoregulation during exercise in type II (non-insulin-dependent) diabetes

We studied the effects of exercise on the levels of plasma glucose and glucoregulatory hormones before and after 6 weeks of thrice-weekly physical training in 20 sedentary type II (non-insulin-dependent) diabetic patients and 11 control subjects matched for previous physical activity. Parameters were measured at rest, after 30 minutes of bicycle exercise at 70% to 75% of maximal oxygen uptake, and after 30 minutes of recovery. In the untrained state exercise resulted in a decrease in plasma glucose levels in diabetics but not in controls (-12 +/- 5 v + 4 +/- 2 mg/dL, P less than .01) and the expected drop in plasma insulin level was absent in diabetics. These differences in glucose and insulin response persisted after physical training. There was a tendency for patients with diabetes to have a smaller R-R interval variation during deep breathing, an abnormal resting heart rate response to physical training, and a lesser increment in plasma epinephrine levels following exercise, findings consistent with autonomic dysfunction. Physical training resulted in a blunting of the exercise-induced increment of plasma epinephrine, growth hormone, and lactate levels in control subjects, but not in diabetics. Our data demonstrate a hypoglycemic effect of exercise in mildly hyperglycemic nonobese type II diabetics. Possible causative factors include: hyperglycemia per se, a lack of physiologic suppression of plasma insulin, and abnormalities of autonomic or hypothalamic regulatory function.

Glucoregulation during exercise: hypoglycemia is prevented by redundant glucoregulatory systems, sympathochromaffin activation, and changes in islet hormone secretion

During mild or moderate nonexhausting exercise, glucose utilization increases sharply but is normally matched by increased glucose production such that hypoglycemia does not occur. To test the hypothesis that redundant glucoregulatory systems including sympathochromaffin activation and changes in pancreatic islet hormone secretion underlie this precise matching, eight young adults exercised at 55-60% of maximal oxygen consumption for 60 min on separate occasions under four conditions: (a) control study (saline infusion); (b) islet clamp study (insulin and glucagon held constant by somatostatin infusion with glucagon and insulin replacement at fixed rates before, during and after exercise with insulin doses determined individually and shown to produce normal and stable plasma glucose concentrations prior to each study); (c) adrenergic blockage study (infusions of the alpha- and beta-adrenergic antagonists phentolamine and propranolol); (d) adrenergic blockade plus islet clamp study. Glucose production matched increased glucose utilization during exercise in the control study and plasma glucose did not fall (92 +/- 1 mg/dl at base line, 90 +/- 2 mg/dl at the end of exercise). Plasma glucose also did not fall during exercise when changes in insulin and glucagon were prevented in the islet clamp study. In the adrenergic blockade study, plasma glucose declined initially during exercise because of a greater initial increase in glucose utilization, then plateaued with an end-exercise value of 74 +/- 3 mg/dl (P less than 0.01 vs. control). In contrast, in the adrenergic blockade plus islet clamp study, exercise was associated with glucose production substantially lower than control and plasma glucose fell progressively to 58 +/- 7 mg/dl (P less than 0.001); end-exercise plasma glucose concentrations ranged from 34 to 72 mg/dl. Thus, we conclude that: (a) redundant glucoregulatory systems are involved in the precise matching of increased glucose utilization and glucose production that normally prevents hypoglycemia during moderate exercise in humans. (b) Sympathochromaffin activation, perhaps sympathetic neural norepinephrine release, plays a primary glucoregulatory role by limiting glucose utilization as well as stimulating glucose production. (c) Changes in pancreatic islet hormone secretion (decrements in insulin, increments in glucagon, or both) are not normally critical but become critical when catecholamine action is deficient. (d) Glucoregulation fails, and hypoglycemia can develop, both when catecholamine action is deficient and when changes in islet hormones do not occur during exercise in humans.

Catecholamine modulation of rapid potassium shifts during exercise

Plasma potassium rises during muscular exercise and falls rapidly when exercise is stopped. Since the sympathoadrenal system is stimulated with exertion and both alpha- and beta-adrenergic agonists affect internal potassium homeostasis, we studied the influence of catecholamines on potassium shifts during and after exercise. Six healthy subjects were given maximal exercise stress tests under three conditions: with no medication (control), during beta-blockade with propranolol, and during alpha-blockade with phentolamine. Compared with a peak rise in plasma potassium of 1.23 +/- 0.27 mmol per liter (mean +/- S.E.M.) during the control study, propranolol caused a rise of 1.89 +/- 0.35 (P less than 0.01) and a sustained elevation during recovery. Phentolamine diminished the rise of potassium (0.70 +/- 0.21 mmol per liter; P less than 0.01) and lowered the potassium level throughout recovery. These effects of catecholamines were independent of the venous pH, the plasma bicarbonate and serum glucose levels, and urinary potassium excretion, and they did not appear to be due to insulin. High norepinephrine and epinephrine levels confirmed the release of catecholamines capable of stimulating alpha- and beta-receptors. Exercise work did not differ among the groups. beta-Adrenergic receptors appear to moderate the acute hyperkalemia of exercise, whereas alpha-adrenergic receptors act to enhance hyperkalemia and may protect against hypokalemia when exertion ceases.

Nutrition and exercise

The nutritional aspects of exercise are topics of popular interest, misconception, and active research. In this article, the authors review basic concepts of muscle metabolism; information concerning the role of exercise in weight loss; dietary supplements for athletes, including nutrition for competition; and eating disorders among those performing vigorous exercise.

Interactions between glucagon and other counterregulatory hormones during normoglycemic and hypoglycemic exercise in dogs

Somatostatin (ST)-induced glucagon suppression results in hypoglycemia during rest and exercise. To further delineate the role of glucagon and interactions between glucagon and the catecholamines during exercise, we compensated for the counterregulatory responses to hypoglycemia with glucose replacement. Five dogs were run (100 m/min, 12 degrees) during exercise alone, exercise plus ST infusion (0.5 micrograms/kg-min), or exercise plus. ST plus glucose replacement (3.5 mg/kg-min) to maintain euglycemia. During exercise alone there was a maximum increase in immunoreactive glucagon (IRG), epinephrine (E), norepinephrine (NE), FFA, and lactate (L) of 306 +/- 147 pg/ml, 360 +/- 80 pg/ml, 443 +/- 140 pg/ml, 541 +/- 173 mu eq/liter, and 6.3 +/- 0.7 mg/dl, respectively. Immunoreactive insulin (IRI) decreased by 10.2 +/- 4 micro/ml and cortisol (C) increased only slightly (2.1 +/- 0.3 micrograms/dl). The rates of glucose production (Ra) and glucose uptake (Rd) rose markedly by 6.6 +/- 2.2 mg/kg-min and 6.2 +/- 1.5 mg/kg-min. In contrast, when ST was given during exercise, IRG fell transiently by 130 +/- 20 pg/ml, Ra rose by only 3.6 +/- 0.5 mg/kg-min, and plasma glucose decreased by 29 +/- 6 mg/dl. The decrease in IRI was no different than with exercise alone (10.2 +/- 2.0 microU/ml). As plasma glucose fell, C, FFA, and L rose excessively to peaks of 5.4 +/- 1.3 micrograms/dl, 1,166 +/- 182 mu eq/liter and 15.5 +/- 7.0 mg/dl. The peak increment in E (765 +/- 287 pg/ml) coincided with the nadir in plasma glucose and was four times greater than during normoglycemic exercise. Hypoglycemia did not affect the rise in NE. The increase in Rd was attenuated and reached a peak of only 3.7 +/- 0.8 mg/kg-min. During glucose replacement, IRG decreased by 109 +/- 30 pg/ml and the IRI response did not differ from the response to normal exercise. Ra rose minimally by 1.5 +/- 0.3 mg/kg-min. The changes in E, C, Rd, and L were restored to normal, whereas the FFA response remained excessive. In all protocols increments in Ra were directly correlated to the IRG/IRI molar ratio while no correlation could be demonstrated between epinephrine or norepinephrine and Ra. In conclusion, (a) glucagon controlled approximately 70% of the increase of Ra during exercise. This became evident when counterregulatory responses to hypoglycemia (E and C) were obviated by glucose replacement; (b) increments in Ra were strongly correlated to the IRG/IRI molar ratio but not the plasma catecholamine concentration; (c) the main role of E in hypoglycemia was to limit glucose uptake by the muscle; (d) with glucagon suppression, glucose production was deficient but a further decline of glucose was prevented through the peripheral effects of E, (e) the hypoglycemic stimulus for E secretion was facilitated by exercise; and (f) we hypothesize that an important role of glucagons during exercise could be to spare muscle glycogen by stimulating glucose production by the liver.

Islet function and stress hyperglycemia: plasma glucose and epinephrine interaction

Catecholamines and a number of other hormones released during stress states contribute to the development of hyperglycemia by directly stimulating glucose production and interfering with tissue disposal of glucose. However, hyperglycemia stimulates the secretion of insulin and inhibits the secretion of glucagon, effects that will diminish the degree of hyperglycemia resulting from direct actions of stress hormones on glucose production and disposal. The key additional role of catecholamines in the development of stress hyperglycemia is interference with the normal feedback control of insulin and glucagon secretion by circulating glucose levels. Although pancreatic islet responses to hyperglycemia may be modulated by catecholamines, any increase of insulin secretion or suppression of glucagon secretion that does occur may be important for limiting the degree of elevation of circulating glucose that results. Thus, plasma insulin and glucagon levels during stress states will reflect the interaction between the opposing effects of hyperglycemia and catecholamines. Diabetic patients who have impaired islet responses to glucose will be particularly prone to the development of marked hyperglycemia during stress states because they may be unable to respond to the influence of hyperglycemia in counteracting adrenergic inhibition of insulin secretion and stimulation of glucagon secretion.

Adrenergic blockade alters glucose kinetics during exercise in insulin-dependent diabetics

We investigated the effects of alpha and/or beta adrenergic blockade (with phentolamine and/or propranolol) on glucose homeostasis during exercise in six normal subjects and in seven Type I diabetic subjects. The diabetics received a low dose insulin infusion (0.07 mU/kg X min) designed to maintain plasma glucose at approximately 150 mg/dl. In normals, neither alpha, beta, nor combined alpha and beta adrenergic blockade altered glucose production, glucose uptake, or plasma glucose concentration during exercise. In diabetics, exercise alone produced a decline in glucose concentration from 144 to 116 mg/dl. This was due to a slightly diminished rise in hepatic glucose production in association with a normal increase in glucose uptake. When exercise was performed during beta adrenergic blockade, the decline in plasma glucose was accentuated. An exogenous glucose infusion (2.58 mg/kg X min) was required to prevent glucose levels from falling below 90 mg/dl. The effect of beta blockade was accounted for by a blunted rise in hepatic glucose production and an augmented rise in glucose utilization. These alterations were unrelated to changes in plasma insulin and glucagon levels, which were similar in the presence and absence of propranolol. In contrast, when the diabetics exercised during alpha adrenergic blockade, plasma glucose concentration rose from 150 to 164 mg/dl. This was due to a significant increase in hepatic glucose production and a small decline in exercise-induced glucose utilization. These alterations also could not be explained by differences in insulin and glucagon levels. We conclude that the glucose homeostatic response to exercise in insulin-dependent diabetics, in contrast to healthy controls, is critically dependent on the adrenergic nervous system.

Relationship between muscle morphology and metabolism in obese women: the effects of long-term physical training

To evaluate the relationships between changes in muscle morphology and metabolic adaptation to physical training in obesity, twenty obese women were subjected to a physical training programme with three sessions a week for 3 months. Physical training resulted in lowering of plasma insulin and improved glucose tolerance. Neither body weight nor body fat changed. With physical training the percentage distribution of fast twitch oxidative (FTa) muscle fibres (m vastus lateralis) increased (from 30.3 +/- 5.1% to 35.2 +/- 4.8%, P less than 0.05) and that of fast twitch glycolytic fibres decreased (from 18.3 +/- 6.6 to 5.8 +/- 4.8%, P less than 0.05). The number of capillaries increased, mainly around slow twitch (ST) fibres (from 4.5 +/- 0.6 to 5.8 +/- 0.8, P less than 0.01) and fast twitch oxidative (FTa) fibres (from 3.9 +/- 0.7 to 4.7 +/- 0.8, P less than 0.01). The activities of oxidative enzymes (cytochrome-c-oxidase and citrate synthase) increased (P less than 0.05) while those of glycolytic enzymes (phosphofructokinase and hexokinase) decreased after physical training (P less than 0.01). Significant negative correlations between plasma insulin and number of capillaries in contact with ST fibres (r = 0.80, P less than 0.001) and FTa fibres (r = 0.62, P less than 0.001) were found before training. The capillary density around those fibres could predict 80% of the explained variance of plasma insulin levels (P less than 0.001). The changes of glucose concentration after training could be predicted by observed changes in enzyme activities. The strong associations between muscle morphology and capillarization and enzyme activities and glucose and insulin concentrations and their changes after training suggest an important regulatory role of muscle which warrants further studies.

Effects of adrenergic blockade on the release of insulin, glucagon and somatostatin from the pancreas in response to splanchnic nerve stimulation in cats

The effects of alpha-, beta- or alpha + beta-adrenergic blockade on arterial plasma concentrations of insulin, glucagon and somatostatin in response to splanchnic nerve stimulation were studied in anesthetized cats. In control experiments splanchnic nerve stimulation caused a marked rise in plasma glucose and glucagon concentrations and a marked fall in insulin but somatostatin was unaffected. Pretreatment with phentolamine significantly increased basal plasma insulin concentration but the response pattern to splanchnic nerve stimulation was not altered. Propranolol attenuated both the glucose and insulin responses. Combined alpha-and beta-blockade abolished the hyperglycemia and hypoinsulinemia induced by splanchnic nerve stimulation, whereas the rise in plasma glucagon was not affected. It is concluded that insulin release from the pancreas and glucose release from the liver is controlled by adrenergic mechanisms whereas pancreatic glucagon and somatostatin secretion is relatively insensitive to splanchnic nerve stimulation in cats.

Lack of suppression of insulin secretion by exercise in patients with insulinoma

Serum glucose, insulin and glucagon concentrations were measured in three patients with insulin-producing tumours of the pancreas while performing an exercise test. In contrast to the normal adrenergic inhibition of insulin release in response to exercise, plasma insulin concentration remained at a constant and high level during exercise in patients with insulinomas. Their plasma glucose concentrations fell during exercise and in the post-exercise period. No significant changes occurred in plasma glucagon concentration. An exercise test may be a useful new diagnostic tool in organic hyperinsulinism.

Influence of the sympatho-adrenal system and somatostatin on the secretion of insulin in the rat

1. The effects of somatostatin on insulin secretion in anaesthetized rats subjected to different manipulations of the sympatho-adrenal system have been investigated.2. Somatostatin (0.1 mug/min) inhibited the secretion of insulin in intact rats both in the basal state and after inducing an enhanced insulin release by infusion of the alpha-adrenoceptor-blocker phentolamine.3. Combined surgical splanchnicotomy and adrenalectomy caused an increase in the basal plasma insulin concentration. Somatostatin (0.1 mug/min) inhibited basal insulin release also in these rats. After infusion of phentolamine, however, the dose of somatostatin had to be raised five fold (0.5 mug/min) to achieve a comparable inhibition of insulin release. On the other hand, a similar rate of insulin secretion induced by glucose in intact rats could be inhibited by the lower dose of somatostatin.4. Administration of the beta-adrenoceptor-blocking agent propranolol to splanchnicotomized-adrenalectomized rats lowered basal insulin secretion to the same level as seen in intact rats. In these beta-adrenoceptor-blocked rats somatostatin (0.1 mug/min) inhibited insulin release both in the presence and absence of alpha-adrenoceptor blockade.5. Rats subjected to chemical sympathectomy through pre-treatment with 6-hydroxydopamine together with adrenalectomy displayed plasma insulin concentrations slightly above the normal range, but the values were much lower than in splanchnicotomized-adrenalectomized rats. Infusion of phentolamine to the chemically sympathectomized rats did not further increase insulin secretion, and somatostatin (0.1 mug/min) depressed insulin release both in the absence and presence of alpha-adrenoceptor blockade.6. It is suggested that an inhibitory tone exerted by the splanchnic nerves modulates the basal insulin secretion in the rat. Somatostatin and the sympathoadrenal system show a complex interaction on the insulin cells in that the sensitivity to somatostatin in splanchnicotomized-adrenalectomized rats with intact beta-adrenoceptors is decreased in the presence of the alpha-adrenoceptor-blocker phentolamine. The exact mechanism behind this decreased sensitivity remains unclear.

Diabetes and exercise

This review describes (1) the metabolic and hormonal response to exercise in normal and diabetic man, and (2) the potential benefits of physical training in diabetes. Whereas in normal man plasma glucose varies little during exercise, the insulin-dependent diabetic subject may experience an increase in plasma glucose, a modest decrease or a marked decrease which can result in symptomatic hypoglycemia. Evidence is reviewed that the glycemic response depends on the ambient plasma concentration of insulin and that this may be influenced by an effect of exercise on the absorbtion of insulin from its site of injection. The response to exercise of noninsulin-dependent diabetic subjects and of diabetic subjects with autonomic neuropathy is also described. Physical training improves glucose tolerance in some noninsulin-dependent diabetic subjects and in insulin-dependent patients, it may diminish insulin requirements. It may also have a role in retarding the development of cardiovascular complications. Physical training is not totally innocuous, however, and in many patients with diabetes special precautions are required.

Epinephrine and norepinephrine are cleared through beta-adrenergic, but not alpha-adrenergic, mechanisms in man

Although catecholamines are rapidly removed from the extracellular fluid, the role of adrenergic mechanisms in the clearance of epinephrine and norepinephrine has not been defined. In five normal human subjects, mean (+/- SE) plasma epinephrine concentrations did not change during control infusions, rose from 21 +/- 6 pg/ml to 834 +/- 84 pg/ml during the infusion of epinephrine (50 ng/kg/min) over 180 min and to 853 +/- 112 pg/ml during the infusion of epinephrine plus phentolamine (500 micrograms/min after a 5.0 mg loading dose infused over 2 min), but to 2400 +/- 104 pg/ml during the infusion of epinephrine plus propranolol (80 micrograms/min after a 5.0 mg loading dose infused over 2 min), indicating that beta-adrenergic blockade sharply reduces the clearance of epinephrine in man. In separate studies in seven subjects, similar increments in plasma epinephrine occurred during the infusion of epinephrine alone and the clearance of epinephrine was comparably reduced during the infusion of epinephrine plus propranolol and during the infusion of epinephrine plus propranolol plus phentolamine, suggesting that the reduction of epinephrine clearance produced by beta-adrenergic blockade during epinephrine infusion is not mediated by an alpha-adrenergic reduction of blood flow to organs of epinephrine clearance. Endogenous plasma norepinephrine concentrations doubled during the infusion of phentolamine without propranolol but rose to nearly fourfold higher values during the infusion of phentolamine with propranolol indicating that beta-adrenergic blockade reduces the clearance of norepinephrine as well as that of epinephrine. These findings indicate that epinephrine and norepinephrine are cleared through beta-adrenergic, but not alpha-adrenergic, mechanisms in man.

The role of the adrenergic innervation to the pancreatic islets in the control of insulin release during exercise in man

The normal depression of plasma insulin concentration during exercise has been ascribed to adrenergic inhibition of insulin release and the role of humoral catecholamines in this hormonal adjustment has repeatedly been stressed. In the present study this contention has been investigated in 6 bilaterally adrenalectomized patients and in 6 sex- and age-matched controls who undertook exercise on an ergometer until they were exhausted. No differences were observed in any cardiovascular or metabolic adjustments between the two groups during strenous exercise. Mean plasma insulin concentration fell by about 50% in both groups. Phentolamine effectively abolished the fall in plasma insulin concentration during exercise in 2 adrenalectomized patients. The results suggest that the adrenergic nerves that supply the B-cells have a functional role in man during exercise.

Effect of oral labetalol on plasma catecholamines, renin and aldosterone in patients with severe arterial hypertension

Arterial blood pressure and plasma catecholamines, renin activity and aldosterone concentration in 12 patients with severe essential hypertension were studied before and after combined alpha- and beta-adrenergic receptor blockage induced by oral labetalol treatment for 2 months. Furosemide in a fixed dose was employed as a basic antihypertensive agent throughout the study. Blood pressure was adequately controlled in only 6 patients. Mean body weight increased by 1.8 kg and there was a rise in body weight which was inversely correlated with the fall in standing mean blood pressure. The mean plasma noradrenaline concentration decreased from 0.30 to 0.20 ng/ml, whereas plasma adrenaline did not change significantly. Plasma renin activity and aldosterone concentration varied greatly, but the mean values did not change significantly. Change in body weight was correlated inversely with changes in plasma noradrenaline and renin. The results suggest that labetalol, through its combined alpha- and beta-adrenergic receptor blocking action, induces a rise in body weight, probably due to sodium and fluid retention, which partly counterbalances the antihypertensive effect of labetalol, and partly modifies both renin and sympathetic nervous activity.

The effect of different diets and of insulin on the hormonal response to prolonged exercise

The importance of carbohydrate availability during exercise for metabolism and plasma hormone levels was studied. Seven healthy men ran on a treadmill at 70% of individual maximal oxygen uptake having eaten a diet low (F) or high (CH) in carbohydrate through 4 days. At exhaustion the subjects were encouraged to continue to run while glucose infusion increased plasma glucose to preexercise levels. Forearm venous blood, biopsies from vastus muscle and expiratory gas were analyzed. Time to exhaustion was longer in CH- (106 +/- 5 min (S.E.)) than in F-expts. (64 +/- 6). During exercise, overall carbohydrate combustion rate, muscular glycogen depletion and glucose and lactate concentrations, carbohydrate metabolites in plasma, and estimated rate of hepatic glucose production were higher, fat metabolites lower, and the decrease in plasma glucose slower in CH- than in F-expts. Plasma norepinephrine increased and insulin decreased similarly in CH- and F-expts., whereas the increase in glucagon, epinephrine, growth hormone and cortisol was enhanced in F-expts. Glucose infusion eliminated hypoglycemic symptoms but did not substantially increase performance time. During the infusion epinephrine decreased markedly and glucagon even to preexercise levels. Infusion of insulin (to 436% of preexercise concentration) in addition to glucose in F-expts. did not change the plasma levels of the other hormones more than infusion of glucose only but reduced fat metabolites in plasma. At exhaustion muscular glycogen depletion was slow, and the glucose gradient between plasma and sarcoplasma as well as the muscular glucose 6-phosphate concentration had decreased.

CONCLUSIONS

The preceding diet modifies the energy depots, the state of which (as regards size, receptors and enzymes) is of prime importance for metabolism during prolonged exercise. Plentiful carbohydrate stores favor both glucose oxidation and lactate production. During exercise norepinephrine increases and insulin decreases independent of plasma glucose changes whereas receptors sensitive to glucose privation but not to acute changes in insulin levels enhance the exercise-induced secretion of glucagon, epinephrine, growth hormone and cortisol. Abolition of cerebral hypoglycemia does not inevitably increase performance time, because elimination of the hypoglycemia may not abolish muscular energy lack.

Stimulation of heart rate by insulin: uninfluenced by beta-adrenergic receptor blockade in rabbits

Intravenous injection of insulin increased heart rate approximately 20% in six alloxan-diabetic rabbits. Blood glucose concentrations after insulin did not decrease below the fasting level of non-diabetic animals and none of the rabbits had signs of hypoglycermia. Intravenous injection of saline or insulin solvent had no effect on heart rate. The stimulatory effect of insulin on heart rate was not influenced by autonomic nervous blockade by propranolol or by propranolol plus atropine.