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Ashcroft SP, Stocks B, Egan B, Zierath JR. Exercise induces tissue-specific adaptations to enhance cardiometabolic health. Cell Metab 2024; 36:278-300. [PMID: 38183980 DOI: 10.1016/j.cmet.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
The risk associated with multiple cancers, cardiovascular disease, diabetes, and all-cause mortality is decreased in individuals who meet the current recommendations for physical activity. Therefore, regular exercise remains a cornerstone in the prevention and treatment of non-communicable diseases. An acute bout of exercise results in the coordinated interaction between multiple tissues to meet the increased energy demand of exercise. Over time, the associated metabolic stress of each individual exercise bout provides the basis for long-term adaptations across tissues, including the cardiovascular system, skeletal muscle, adipose tissue, liver, pancreas, gut, and brain. Therefore, regular exercise is associated with a plethora of benefits throughout the whole body, including improved cardiorespiratory fitness, physical function, and glycemic control. Overall, we summarize the exercise-induced adaptations that occur within multiple tissues and how they converge to ultimately improve cardiometabolic health.
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Affiliation(s)
- Stephen P Ashcroft
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ben Stocks
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Juleen R Zierath
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Integrative Physiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Integrative Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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2
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Silva FM, Duarte-Mendes P, Teixeira AM, Soares CM, Ferreira JP. The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: a systematic review and meta-analysis. Sci Rep 2024; 14:1936. [PMID: 38253590 PMCID: PMC10803738 DOI: 10.1038/s41598-024-51832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
This systematic review and meta-analysis aimed to determine the magnitude of the effect of combined exercise training on glucose metabolism markers, adipokines, and inflammatory cytokines in non-diabetic sedentary adults. PubMed, Web of Science, Scopus, Cochrane Library electronic databases and reference lists of included studies were explored for randomized controlled trials (RCTs) that included physically inactive adults and provided combined training interventions (aerobic plus resistance exercise). Effects on fasting glucose and insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), HbA1c, adiponectin, leptin, IL-6, TNF-α, and C-reactive protein (CRP) in exercise vs control groups were analyzed using random effects meta-analysis. The Cochrane Risk of Bias Tool for Randomized Trials 2.0 (RoB 2) was used to assess the risk of bias. A total of 24 RCTs were included in the quantitative analysis. Combined exercise training significantly decrease fasting glucose (standardized mean difference, SMD: - 0.474, 95% CI [- 0.829, - 0.120], p = 0.009, 35 study arms), fasting insulin (SMD: - 1.024, 95% CI [- 1.502, - 0.545], p < 0.001, 27 study arms), HOMA-IR (SMD: - 0.946, 95% CI [- 1.450, - 0.442], p < 0.001, 23 study arms), TNF-α (SMD: - 0.972, 95% CI [- 1.361, - 0.582], p < 0.001, 10 study arms), and CRP (SMD: - 0.507, 95% CI [- 0.818, - 0.196], p = 0.001, 14 study arms). No significant effects were observed for HbA1c, adiponectin, leptin, and IL-6 levels. Random effects meta-regression models by age, sex, and intervention length were not able to explain any of the variation in the effect size of HOMA-IR. Findings from this systematic review and meta-analysis suggest that combined exercise training improves some glucose metabolism markers and inflammatory parameters in sedentary adults without diabetes.
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Affiliation(s)
- Fernanda M Silva
- University of Coimbra, Faculty of Sport Sciences and Physical Education, FCDEF, Coimbra, Portugal.
- Research Unit for Sport and Physical Activity (CIDAF, Uid/Dtp/04213/2020), University of Coimbra, Coimbra, Portugal.
| | - Pedro Duarte-Mendes
- Department of Sports and Well-Being, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport, Health and Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
- Sport Physical activity and health Research & INnovation CenTer, SPRINT, Santarém, Portugal
| | - Ana M Teixeira
- University of Coimbra, Faculty of Sport Sciences and Physical Education, FCDEF, Coimbra, Portugal
- Research Unit for Sport and Physical Activity (CIDAF, Uid/Dtp/04213/2020), University of Coimbra, Coimbra, Portugal
| | - Carlos M Soares
- University of Coimbra, Faculty of Sport Sciences and Physical Education, FCDEF, Coimbra, Portugal
- Research Unit for Sport and Physical Activity (CIDAF, Uid/Dtp/04213/2020), University of Coimbra, Coimbra, Portugal
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - José P Ferreira
- University of Coimbra, Faculty of Sport Sciences and Physical Education, FCDEF, Coimbra, Portugal
- Research Unit for Sport and Physical Activity (CIDAF, Uid/Dtp/04213/2020), University of Coimbra, Coimbra, Portugal
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3
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Ding Y, Xu X. Dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress in overweight/obese populations. J Sci Med Sport 2023; 26:616-621. [PMID: 37775411 DOI: 10.1016/j.jsams.2023.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES This study aimed to analyze the dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress in overweight/obese populations and provide exercise recommendations to regulate inflammation and oxidative stress and reduce the risk of developing obesity-related diseases. DESIGN Second analysis of a cross-sectional study. METHODS A total number of 4978 overweight/obese adults were included from the 2015-2018 National Health and Nutrition Examination Survey. Multivariable regressions were conducted to investigate the dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress. Subgroup analyses based on the doses and intensities of physical activity and in different participants were performed to provide exercise recommendations. RESULTS The results demonstrated that leisure-time physical activity was negatively associated with inflammatory biomarkers in both overweight and obese populations, and positively associated with antioxidant markers in obese populations. Overweight/obese populations performing leisure-time physical activity at 660-760 min/week (dose calculated as moderate leisure-time physical activity, equals 330-380 min/week vigorous leisure-time physical activity) demonstrated the lowest levels of inflammatory markers. Vigorous leisure-time physical activity was superior to moderate one for overweight/obese populations, especially for inflammation regulation. In addition, the regulatory effect of leisure-time physical activity on inflammation was more significant in overweight/obese populations with hypertension or stroke. CONCLUSIONS The results suggest that overweight/obese populations can take vigorous-intensity leisure-time physical activity at 330-380 min/week (for example, 60 min/day, 6 days/week, metabolic equivalent = 8) to get the maximum health benefits in terms of inflammation and oxidative stress regulation.
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Affiliation(s)
- Yijian Ding
- Department of Physical Education, Nanjing University of Science & Technology, PR China
| | - Xi Xu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, PR China.
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Di Murro E, Di Giuseppe G, Soldovieri L, Moffa S, Improta I, Capece U, Nista EC, Cinti F, Ciccarelli G, Brunetti M, Gasbarrini A, Pontecorvi A, Giaccari A, Mezza T. Physical Activity and Type 2 Diabetes: In Search of a Personalized Approach to Improving β-Cell Function. Nutrients 2023; 15:4202. [PMID: 37836486 PMCID: PMC10574038 DOI: 10.3390/nu15194202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the most widespread diseases worldwide. Lifestyle interventions, including diet and physical activity (PA), are fundamental non-pharmacological components of T2DM therapy. Exercise interventions are strongly recommended for people with or at risk of developing or already with overt diabetes, but adherence to PA guidelines in this population is still challenging. Furthermore, the heterogeneity of T2DM patients, driven by differing residual β-cell functionality, as well as the possibility of practicing different types and intensities of PA, has led to the need to develop tailored exercise and training plans. Investigations on blood glucose variation in response to exercise could help to clarify why individuals do not respond in the same way to PA, and to guide the prescription of personalized treatments. The aim of this review is to offer an updated overview of the current evidence on the effects of different regimens and modalities of PA regarding glucose sensing and β-cell secretory dynamics in individuals with prediabetes or T2DM, with a special focus on β-cell function.
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Affiliation(s)
- Emanuela Di Murro
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Gianfranco Di Giuseppe
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Laura Soldovieri
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Simona Moffa
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Ilaria Improta
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Umberto Capece
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Enrico Celestino Nista
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
- Pancreas Unit, CEMAD Centro Malattie dell’Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Cinti
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Gea Ciccarelli
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Michela Brunetti
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
- Pancreas Unit, CEMAD Centro Malattie dell’Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Andrea Giaccari
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.D.M.); (G.D.G.); (L.S.); (S.M.); (I.I.); (U.C.); (F.C.); (G.C.); (M.B.); (A.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
| | - Teresa Mezza
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.C.N.); (A.G.)
- Pancreas Unit, CEMAD Centro Malattie dell’Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Malin SK, Frick H, Wisseman WS, Edwards ES, Edwards DA, Emerson SR, Kurti SP. β-Cell function during a high-fat meal in young versus old adults: role of exercise. Am J Physiol Regul Integr Comp Physiol 2023; 325:R164-R171. [PMID: 37306399 PMCID: PMC10393366 DOI: 10.1152/ajpregu.00047.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
The acute effect of exercise on β-cell function during a high-fat meal (HFM) in young adults (YA) versus old adults (OA) is unclear. In this randomized crossover trial, YA (n = 5 M/7 F, 23.3 ± 3.9 yr) and OA (n = 8 M/4 F, 67.7 ± 6.0 yr) underwent a 180-min HFM (12 kcal/kg body wt; 57% fat, 37% CHO) after a rest or exercise [∼65% heart rate peak (HRpeak)] condition ∼12 h earlier. After an overnight fast, plasma lipids, glucose, insulin, and free fatty acid (FFA) were determined to estimate peripheral, or skeletal muscle, insulin sensitivity (Matsuda index) as well as hepatic [homeostatic model assessment of insulin resistance (HOMA-IR)] and adipose insulin resistance (adipose-IR). β-Cell function was derived from C-peptide and defined as early-phase (0-30 min) and total-phase (0-180 min) disposition index [DI, glucose-stimulated insulin secretion (GSIS) adjusted for insulin sensitivity/resistance]. Hepatic insulin extraction (HIE), body composition [dual-energy X-ray absorptiometry (DXA)], and peak oxygen consumption (V̇o2peak) were also assessed. OA had higher total cholesterol (TC), LDL, HIE, and DI across organs as well as lower adipose-IR (all, P < 0.05) and V̇o2peak (P = 0.056) despite similar body composition and glucose tolerance. Exercise lowered early-phase TC and LDL in OA versus YA (P < 0.05). However, C-peptide area under the curve (AUC), total phase GSIS, and adipose-IR were reduced postexercise in YA versus OA (P < 0.05). Skeletal muscle DI increased in YA and OA after exercise (P < 0.05), whereas adipose DI tended to decline in OA (P = 0.06 and P = 0.08). Exercise-induced skeletal muscle insulin sensitivity (r = -0.44, P = 0.02) and total-phase DI (r = -0.65, P = 0.005) correlated with reduced glucose AUC180min. Together, exercise improved skeletal muscle insulin sensitivity/DI in relation to glucose tolerance in YA and OA, but only raised adipose-IR and reduced adipose-DI in OA.NEW & NOTEWORTHY High-fat diets may induce β-cell dysfunction. This study compared how young and older adults responded to a high-fat meal with regard to β-cell function and whether exercise comparably impacted glucose regulation. Older adults secreted more insulin during the high-fat meal than younger adults. Although exercise increased β-cell function adjusted for skeletal muscle insulin sensitivity in relation to glucose tolerance, it raised adipose insulin resistance and reduced pancreatic β-cell function relative to adipose tissue in older adults. Additional work is needed to discern nutrient-exercise interactions across age to mitigate chronic disease risk.
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Affiliation(s)
- Steven K Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, United States
| | - Hannah Frick
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
- Department of Kinesiology, Morrison Bruce Center, James Madison University, Harrisonburg, Virginia, United States
| | - William S Wisseman
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
| | - Elizabeth S Edwards
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
- Department of Kinesiology, Morrison Bruce Center, James Madison University, Harrisonburg, Virginia, United States
| | - David A Edwards
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, United States
| | - Sam R Emerson
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Stephanie P Kurti
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, Virginia, United States
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Syeda UA, Battillo D, Visaria A, Malin SK. The importance of exercise for glycemic control in type 2 diabetes. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100031. [PMID: 39035065 PMCID: PMC11256236 DOI: 10.1016/j.ajmo.2023.100031] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 07/23/2024]
Abstract
Exercise is a first-line therapy recommended for patients with type 2 diabetes (T2D). Although moderate to vigorous exercise (e.g. 150 min/wk) is often advised alongside diet and/or behavior modification, exercise is an independent treatment that can prevent, delay or reverse T2D. Habitual exercise, consisting of aerobic, resistance or their combination, fosters improved short- and long-term glycemic control. Recent work also shows high-intensity interval training is successful at lowering blood glucose, as is breaking up sedentary behavior with short-bouts of light to vigorous movement (e.g. up to 3min). Interestingly, performing afternoon compared with morning as well as post-meal versus pre-meal exercise may yield slightly better glycemic benefit. Despite these efficacious benefits of exercise for T2D care, optimal exercise recommendations remain unclear when considering, dietary, medication, and/or other behaviors.
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Affiliation(s)
- U.S. Afsheen Syeda
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Daniel Battillo
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | - Aayush Visaria
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
| | - Steven K. Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, United States
- Institute of Translational Medicine and Science, Rutgers University, New Brunswick, NJ, United States
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7
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Legaard GE, Lyngbæk MPP, Almdal TP, Karstoft K, Bennetsen SL, Feineis CS, Nielsen NS, Durrer CG, Liebetrau B, Nystrup U, Østergaard M, Thomsen K, Trinh B, Solomon TPJ, Van Hall G, Brønd JC, Holst JJ, Hartmann B, Christensen R, Pedersen BK, Ried-Larsen M. Effects of different doses of exercise and diet-induced weight loss on beta-cell function in type 2 diabetes (DOSE-EX): a randomized clinical trial. Nat Metab 2023; 5:880-895. [PMID: 37127822 PMCID: PMC10229430 DOI: 10.1038/s42255-023-00799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
Diet-induced weight loss is associated with improved beta-cell function in people with type 2 diabetes (T2D) with remaining secretory capacity. It is unknown if adding exercise to diet-induced weight loss improves beta-cell function and if exercise volume is important for improving beta-cell function in this context. Here, we carried out a four-armed randomized trial with a total of 82 persons (35% females, mean age (s.d.) of 58.2 years (9.8)) with newly diagnosed T2D (<7 years). Participants were randomly allocated to standard care (n = 20), calorie restriction (25% energy reduction; n = 21), calorie restriction and exercise three times per week (n = 20), or calorie restriction and exercise six times per week (n = 21) for 16 weeks. The primary outcome was beta-cell function as indicated by the late-phase disposition index (insulin secretion multiplied by insulin sensitivity) at steady-state hyperglycemia during a hyperglycemic clamp. Secondary outcomes included glucose-stimulated insulin secretion and sensitivity as well as the disposition, insulin sensitivity, and secretion indices derived from a liquid mixed meal tolerance test. We show that the late-phase disposition index during the clamp increases more in all three intervention groups than in standard care (diet control group, 58%; 95% confidence interval (CI), 16 to 116; moderate exercise dose group, 105%; 95% CI, 49 to 182; high exercise dose group, 137%; 95% CI, 73 to 225) and follows a linear dose-response relationship (P > 0.001 for trend). We report three serious adverse events (two in the control group and one in the diet control group), as well as adverse events in two participants in the diet control group, and five participants each in the moderate and high exercise dose groups. Overall, adding an exercise intervention to diet-induced weight loss improves glucose-stimulated beta-cell function in people with newly diagnosed T2D in an exercise dose-dependent manner (NCT03769883).
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Affiliation(s)
- Grit E Legaard
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Mark P P Lyngbæk
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of Endocrinology PE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Camilla S Feineis
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Nina S Nielsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Cody G Durrer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Ulrikke Nystrup
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Martin Østergaard
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Katja Thomsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Beckey Trinh
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Gerrit Van Hall
- Biomedical Sciences, Faculty of Health & Medical Science, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Clinical Biochemistry, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences and the Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and the Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente K Pedersen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark.
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Kirwan JP, Heintz EC, Rebello CJ, Axelrod CL. Exercise in the Prevention and Treatment of Type 2 Diabetes. Compr Physiol 2023; 13:4559-4585. [PMID: 36815623 DOI: 10.1002/cphy.c220009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Type 2 diabetes is a systemic, multifactorial disease that is a leading cause of morbidity and mortality globally. Despite a rise in the number of available medications and treatments available for management, exercise remains a first-line prevention and intervention strategy due to established safety, efficacy, and tolerability in the general population. Herein we review the predisposing risk factors for, prevention, pathophysiology, and treatment of type 2 diabetes. We emphasize key cellular and molecular adaptive processes that provide insight into our evolving understanding of how, when, and what types of exercise may improve glycemic control. © 2023 American Physiological Society. Compr Physiol 13:1-27, 2023.
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Affiliation(s)
- John P Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Elizabeth C Heintz
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Candida J Rebello
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Christopher L Axelrod
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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9
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Handy RM, Holloway GP. Insights into the development of insulin resistance: Unraveling the interaction of physical inactivity, lipid metabolism and mitochondrial biology. Front Physiol 2023; 14:1151389. [PMID: 37153211 PMCID: PMC10157178 DOI: 10.3389/fphys.2023.1151389] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Abstract
While impairments in peripheral tissue insulin signalling have a well-characterized role in the development of insulin resistance and type 2 diabetes (T2D), the specific mechanisms that contribute to these impairments remain debatable. Nonetheless, a prominent hypothesis implicates the presence of a high-lipid environment, resulting in both reactive lipid accumulation and increased mitochondrial reactive oxygen species (ROS) production in the induction of peripheral tissue insulin resistance. While the etiology of insulin resistance in a high lipid environment is rapid and well documented, physical inactivity promotes insulin resistance in the absence of redox stress/lipid-mediated mechanisms, suggesting alternative mechanisms-of-action. One possible mechanism is a reduction in protein synthesis and the resultant decrease in key metabolic proteins, including canonical insulin signaling and mitochondrial proteins. While reductions in mitochondrial content associated with physical inactivity are not required for the induction of insulin resistance, this could predispose individuals to the detrimental effects of a high-lipid environment. Conversely, exercise-training induced mitochondrial biogenesis has been implicated in the protective effects of exercise. Given mitochondrial biology may represent a point of convergence linking impaired insulin sensitivity in both scenarios of chronic overfeeding and physical inactivity, this review aims to describe the interaction between mitochondrial biology, physical (in)activity and lipid metabolism within the context of insulin signalling.
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Goedecke JH, Mendham AE. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia 2022; 65:1967-1980. [PMID: 36166072 PMCID: PMC9630207 DOI: 10.1007/s00125-022-05795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Abstract
Sub-Saharan Africa (SSA) is the region with the highest projected rates of increase in type 2 diabetes (129% by 2045), which will exacerbate the already high prevalence of type 2 diabetes complications and comorbidities in SSA. In addition, SSA is grappling with poverty-related health problems and infectious diseases and is also undergoing the most rapid rates of urbanisation globally. These socioenvironmental and lifestyle factors may interact with genetic factors to alter the pathophysiological sequence leading to type 2 diabetes in sub-Saharan African populations. Indeed, current evidence from SSA and the diaspora suggests that the pathophysiology of type 2 diabetes in Black Africans is different from that in their European counterparts. Studies from the diaspora suggest that insulin clearance is the primary defect underlying the development of type 2 diabetes. We propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. Nonetheless, the current understanding of the pathogenesis of type 2 diabetes and the clinical guidelines for preventing and managing the disease are largely based on studies including participants of predominately White European ancestry. In this review, we summarise the existing knowledge base and data from the only non-pharmacological intervention that explores the pathophysiology of type 2 diabetes in SSA. We also highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences.
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Affiliation(s)
- Julia H Goedecke
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Collins KA, Ross LM, Slentz CA, Huffman KM, Kraus WE. Differential Effects of Amount, Intensity, and Mode of Exercise Training on Insulin Sensitivity and Glucose Homeostasis: A Narrative Review. SPORTS MEDICINE - OPEN 2022; 8:90. [PMID: 35834023 PMCID: PMC9283590 DOI: 10.1186/s40798-022-00480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
As type 2 diabetes remains a leading cause of morbidity and mortality, identifying the most appropriate preventive treatment early in the development of disease is an important public health matter. In general, lifestyle interventions incorporating exercise and weight loss via caloric restriction improve cardiometabolic risk by impacting several key markers of insulin sensitivity and glucose homeostasis. However, variations in the effects of specific types of exercise interventions on these markers have led to conflicting results surrounding the optimal amount, intensity, and mode of exercise for optimal effects. Moreover, the addition of weight loss via caloric restriction to exercise interventions appears to differentially impact changes in body composition, metabolism, and insulin sensitivity compared to exercise alone. Determining the optimal amount, intensity, and mode of exercise having the most beneficial impact on glycemic status is both: (1) clinically important to provide guidelines for appropriate exercise prescription; and (2) physiologically important to understand the pathways by which exercise—with and without weight loss—impacts glycemic status to enhance precision lifestyle medicine. Thus, the purposes of this narrative review are to: (1) summarize findings from the three Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials regarding the differential effects of exercise amount, intensity, and mode on insulin action and glucose homeostasis markers; and (2) compare the STRRIDE findings to other published dose–response exercise trials in order to piece together the various physiologic pathways by which specific exercise interventions—with or without weight loss—impact glycemic status.
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Balducci S, Haxhi J, Vitale M, Mattia L, Bollanti L, Conti F, Cardelli P, Sacchetti M, Orlando G, Zanuso S, Nicolucci A, Pugliese G. Sustained decreases in sedentary time and increases in physical activity are associated with preservation of estimated β-cell function in individuals with type 2 diabetes. Diabetes Res Clin Pract 2022; 193:110140. [PMID: 36328211 DOI: 10.1016/j.diabres.2022.110140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
AIMS In the Italian Diabetes and Exercise Study_2, a counselling intervention produced modest but sustained increments in moderate-to vigorous-intensity physical activity (MVPA), with reallocation of sedentary-time (SED-time) to light-intensity physical activity (LPA). This post hoc analysis evaluated the impact of intervention on estimated β-cell function and insulin sensitivity. METHODS Patients with type 2 diabetes were randomized to one-month counselling once-a-year or standard care for 3 years. The HOmeostatic Model Assessment-2 (HOMA-2) method was used for estimating indices of β-cell function (HOMA-B%), insulin sensitivity (HOMA-S%), and insulin resistance (HOMA-IR); the disposition index (DI) was estimated as HOMA-β%/HOMA-IR; MVPA, LPA, and SED-time were objectively measured by accelerometer. RESULTS HOMA-B% and DI decreased in control group, whereas HOMA-B% remained stable and DI increased in intervention group. Between-group differences were significant for almost all insulin secretion and sensitivity indices. Changes in HOMA-B% and DI correlated with SED-time, MVPA and LPA. Changes in HOMA-B%, DI, and all indices were independently predicted by changes in SED-time (or LPA), MVPA, and BMI (or waist circumference), respectively. CONCLUSIONS In individuals with type 2 diabetes, increasing MVPA, even without achieving the recommended target, is effective in maintaining estimated β-cell function if sufficient amounts of SED-time are reallocated to LPA.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lorenza Mattia
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, University of Rome 'Foro Italico', Rome, Italy
| | - Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Silvano Zanuso
- Centre for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy; Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.
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Zhang S, Wei Y, Wang C. Impacts of an Exercise Intervention on the Health of Pancreatic Beta-Cells: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127229. [PMID: 35742478 PMCID: PMC9223540 DOI: 10.3390/ijerph19127229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
There is an increasing consensus that exercise is a medicine and that regular exercise can effectively improve and prevent metabolic diseases such as diabetes. Islet cells are the endocrine of the pancreas and vital to the development of diabetes. Decades of developmental research in exercise intervention and the health of islet cells confirmed that exercise exerts beneficial effects on the function, proliferation, and survival rate of islet cells. However, the precise exercise reference scheme is still elusive. To accomplish this goal, we searched and analyzed relevant articles, and concluded the precise exercise prescription treatments for various species such as humans, rats, and mice. Each exercise protocol is shown in the tables below. These exercise protocols form a rich pipeline of therapeutic development for exercise on the health of islet cells.
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Affiliation(s)
- Shuang Zhang
- Department of Sports Science, University of Harbin Sport, Harbin 150008, China; (S.Z.); (Y.W.)
- Department of Kinesiology, University of Shanghai Sport, Shanghai 200238, China
| | - Yaru Wei
- Department of Sports Science, University of Harbin Sport, Harbin 150008, China; (S.Z.); (Y.W.)
| | - Chunxiao Wang
- Department of Sports Science, University of Harbin Sport, Harbin 150008, China; (S.Z.); (Y.W.)
- Correspondence:
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Li M, Zheng Q, Miller JD, Zuo P, Yuan X, Feng J, Liu C, Bao S, Lou Q. Aerobic training reduces pancreatic fat content and improves β-cell function: A randomized controlled trial using IDEAL-IQ magnetic resonance imaging. Diabetes Metab Res Rev 2022; 38:e3516. [PMID: 34963031 DOI: 10.1002/dmrr.3516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Abstract
AIMS To explore the effects of six months of moderate-intensity aerobic exercise on pancreatic fat content and its impact on β-cell function. MATERIALS AND METHODS A total of 106 patients with type 2 diabetes mellitus were randomized to either a moderate-intensity aerobic training group (three times a week, including 5 min warm-up, 50 min aerobic dancing, and 5 min relaxation, n = 53) or control group (n = 53) with 6-month intervention. The primary endpoint was change in pancreatic fat content. An intention-to-treat analysis was conducted. RESULTS Eighty-six patients completed the study with 43 patients in the aerobic training group. The average age, HbA1c, and pancreatic fat content for all participants (106 patients) were 66.39 ± 5.59 years, 7.05 ± 1.24%, and 10.35 ± 9.20%, respectively. Nearly half (49.06%) of patients were males. Subjects in the aerobic training group saw a significant reduction in pancreatic fat content when compared to controls (p = 0.001). In logistic regression models containing age, diabetes duration, change in BMI, smoking/drinking status, changes in lipid indices, and other abdominal fat content, only reduction in pancreatic fat content (p < 0.05) was an independent protective factor for β-cell function and HbA1c. CONCLUSIONS Six months of moderate-intensity aerobic training significantly reduced the pancreatic fat content. The reduction of pancreatic fat content was an independent protective factor for β-cell function and HbA1c.
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Affiliation(s)
- Min Li
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qidong Zheng
- Department of Internal Medicine, Yuhuan Second People's Hospital, Yuhuan, China
| | - Joshua D Miller
- Division of Endocrinology and Metabolism, Department of Medicine, Renaissance School of Medicine at Stony Brook University, New York, USA
| | - Panpan Zuo
- School of Nursing, Taizhou Polytehnic College, Taizhou, China
| | - Xiaodan Yuan
- Department of Healthy Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jitao Feng
- Department of Radiology, Nanjing Pukou Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shan Bao
- Department of Gynaecology and Obstetrics, Hainan General Hospital, Haikou, China
| | - Qingqing Lou
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise? Nutrients 2022; 14:nu14081605. [PMID: 35458167 PMCID: PMC9027421 DOI: 10.3390/nu14081605] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
Recent literature shows that exercise is not simply a way to generate a calorie deficit as an add-on to restrictive diets but exerts powerful additional biological effects via its impact on mitochondrial function, the release of chemical messengers induced by muscular activity, and its ability to reverse epigenetic alterations. This review aims to summarize the current literature dealing with the hypothesis that some of these effects of exercise unexplained by an energy deficit are related to the balance of substrates used as fuel by the exercising muscle. This balance of substrates can be measured with reliable techniques, which provide information about metabolic disturbances associated with sedentarity and obesity, as well as adaptations of fuel metabolism in trained individuals. The exercise intensity that elicits maximal oxidation of lipids, termed LIPOXmax, FATOXmax, or FATmax, provides a marker of the mitochondrial ability to oxidize fatty acids and predicts how much fat will be oxidized over 45–60 min of low- to moderate-intensity training performed at the corresponding intensity. LIPOXmax is a reproducible parameter that can be modified by many physiological and lifestyle influences (exercise, diet, gender, age, hormones such as catecholamines, and the growth hormone-Insulin-like growth factor I axis). Individuals told to select an exercise intensity to maintain for 45 min or more spontaneously select a level close to this intensity. There is increasing evidence that training targeted at this level is efficient for reducing fat mass, sparing muscle mass, increasing the ability to oxidize lipids during exercise, lowering blood pressure and low-grade inflammation, improving insulin secretion and insulin sensitivity, reducing blood glucose and HbA1c in type 2 diabetes, and decreasing the circulating cholesterol level. Training protocols based on this concept are easy to implement and accept in very sedentary patients and have shown an unexpected efficacy over the long term. They also represent a useful add-on to bariatric surgery in order to maintain and improve its weight-lowering effect. Additional studies are required to confirm and more precisely analyze the determinants of LIPOXmax and the long-term effects of training at this level on body composition, metabolism, and health.
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Exercise targeted on maximal lipid oxidation has long-term weight-reducing effects but improves insulin secretion and lipid oxidation before reducing fat mass. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Eleftheriades M, Chatzakis C, Papachatzopoulou E, Papadopoulos V, Lambrinoudaki I, Dinas K, Chrousos G, Sotiriadis A. Prediction of insulin treatment in women with gestational diabetes mellitus. Nutr Diabetes 2021; 11:30. [PMID: 34601490 PMCID: PMC8487424 DOI: 10.1038/s41387-021-00173-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The identification of pregnant women with Gestational Diabetes Mellitus (GDM) who will require insulin therapy, may modify their management to closer monitoring and probable early interventions. The aim of the study was to develop a predictive model for the necessity of insulin treatment in women with GDM. MATERIALS AND METHODS This was a prospective cohort study. Data from 775 women diagnosed with GDM per the IADPSG criteria were analyzed using logistic regression and a machine learning algorithm, the Classification and Regression Trees (CART). Potential predictors routinely recorded at follow-up visits were tested and used for the development of the model. The resultant model was externally validated using the data from two different perinatology clinics. RESULTS Preconceptional maternal BMI and morning fasting blood glucose levels at baseline and at 1 h during an Oral Glucose Tolerance Test (OGTT) were independent significant predictors for the treatment modality of GDM. Baseline blood glucose greater than 98 mg/dl and preconceptional maternal Body Mass Index (BMI) between 26 and 31 kg/height2 increased substantially the probability of insulin therapy (odds ratio [OR] 4.04, 95% confidence interval [CI] CI 2.65-6.17 and 2.21, 95%CI 1.42-3.43, respectively). The area under the curve (AUC) for the internal and external validation of the predictive model was 0.74 and 0.77, respectively. CONCLUSIONS A simple model based on maternal characteristics and the values of an OGTT can predict the need for insulin treatment with accuracy. Overweight women with an abnormal baseline blood glucose at OGTT are at high likelihood for insulin treatment. KEY MESSAGE Fifteen to 30% of women with Gestational Diabetes Mellitus (GDM) require insulin therapy. Overweight women with baseline blood glucose greater than 98 mg/dl at OGTT are at increased risk for insulin treatment and close monitoring and increased physical exercise are required.
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Affiliation(s)
- Makarios Eleftheriades
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece.
| | - Christos Chatzakis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Eftychia Papachatzopoulou
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Vassilis Papadopoulos
- University of Patras Medical School, Department of Obstetrics and Gynecology, Patras, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Langlois A, Forterre A, Pinget M, Bouzakri K. Impact of moderate exercise on fatty acid oxidation in pancreatic β-cells and skeletal muscle. J Endocrinol Invest 2021; 44:1815-1825. [PMID: 33844166 PMCID: PMC8357749 DOI: 10.1007/s40618-021-01551-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
Fatty acids (FA) play a crucial role in glycaemia regulation in healthy and metabolic disorders conditions through various mechanisms. FA oxidation is one of the processes involved in lipid metabolism and can be modulated by exercise. Nowadays, physical activity is known to be an effective strategy for the prevention and treatment of Type 2 Diabetes. Moreover, its intensity, its duration, the sex-gender, the prandial state, exerkines… are as many parameters that can influence glycaemic control. However, the widely debated question is to determine the best type of exercise for patients with metabolic disorders. In this review, we will discuss the impact of exercise intensity, especially moderate activity, on glycaemic control by focussing on FA oxidation in pancreatic β-cells and skeletal muscle. Finally, thanks to all the recent data, we will determine whether moderate physical activity is a good therapeutic strategy and if FA oxidation represents a target of interest to treat diabetic, obese and insulin-resistant patients.
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Affiliation(s)
- A Langlois
- Centre Européen D'étude du Diabète, Unité Mixte de Recherche de L'Université de Strasbourg « Diabète et Thérapeutique », Strasbourg, France
| | - A Forterre
- Centre Européen D'étude du Diabète, Unité Mixte de Recherche de L'Université de Strasbourg « Diabète et Thérapeutique », Strasbourg, France
| | - M Pinget
- Centre Européen D'étude du Diabète, Unité Mixte de Recherche de L'Université de Strasbourg « Diabète et Thérapeutique », Strasbourg, France
| | - K Bouzakri
- Centre Européen D'étude du Diabète, Unité Mixte de Recherche de L'Université de Strasbourg « Diabète et Thérapeutique », Strasbourg, France.
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Lyngbaek MPP, Legaard GE, Bennetsen SL, Feineis CS, Rasmussen V, Moegelberg N, Brinkløv CF, Nielsen AB, Kofoed KS, Lauridsen CA, Ewertsen C, Poulsen HE, Christensen R, Van Hall G, Karstoft K, Solomon TPJ, Ellingsgaard H, Almdal TP, Pedersen BK, Ried-Larsen M. The effects of different doses of exercise on pancreatic β-cell function in patients with newly diagnosed type 2 diabetes: study protocol for and rationale behind the "DOSE-EX" multi-arm parallel-group randomised clinical trial. Trials 2021; 22:244. [PMID: 33794975 PMCID: PMC8017660 DOI: 10.1186/s13063-021-05207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lifestyle intervention, i.e. diet and physical activity, forms the basis for care of type 2 diabetes (T2D). The current physical activity recommendation for T2D is aerobic training for 150 min/week of moderate to vigorous intensity, supplemented with resistance training 2-3 days/week, with no more than two consecutive days without physical activity. The rationale for the recommendations is based on studies showing a reduction in glycated haemoglobin (HbA1c). This reduction is supposed to be caused by increased insulin sensitivity in muscle and adipose tissue, whereas knowledge about effects on abnormalities in the liver and pancreas are scarce, with the majority of evidence stemming from in vitro and animal studies. The aim of this study is to investigate the role of the volume of exercise training as an adjunct to dietary therapy in order to improve the pancreatic β-cell function in T2D patients less than 7 years from diagnosis. The objective of this protocol for the DOSE-EX trial is to describe the scientific rationale in detail and to provide explicit information about study procedures and planned analyses. METHODS/DESIGN In a parallel-group, 4-arm assessor-blinded randomised clinical trial, 80 patients with T2D will be randomly allocated (1:1:1:1, stratified by sex) to 16 weeks in either of the following groups: (1) no intervention (CON), (2) dietary intervention (DCON), (3) dietary intervention and supervised moderate volume exercise (MED), or (4) dietary intervention and supervised high volume exercise (HED). Enrolment was initiated December 15th, 2018, and will continue until N = 80 or December 1st, 2021. Primary outcome is pancreatic beta-cell function assessed as change in late-phase disposition index (DI) from baseline to follow-up assessed by hyperglycaemic clamp. Secondary outcomes include measures of cardiometabolic risk factors and the effect on subsequent complications related to T2D. The study was approved by The Scientific Ethical Committee at the Capital Region of Denmark (H-18038298). TRIAL REGISTRATION The Effects of Different Doses of Exercise on Pancreatic β-cell Function in Patients With Newly Diagnosed Type 2 Diabetes (DOSE-EX), NCT03769883, registered 10 December 2018 https://clinicaltrials.gov/ct2/show/NCT03769883 ). Any modification to the protocol, study design, and changes in written participant information will be approved by The Scientific Ethical Committee at the Capital Region of Denmark before effectuation. DISCUSSION The data from this study will add knowledge to which volume of exercise training in combination with a dietary intervention is needed to improve β-cell function in T2D. Secondarily, our results will elucidate mechanisms of physical activity mitigating the development of micro- and macrovascular complications correlated with T2D.
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Affiliation(s)
- Mark P. P. Lyngbaek
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Grit E. Legaard
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sebastian L. Bennetsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Camilla S. Feineis
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Villads Rasmussen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nana Moegelberg
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Cecilie F. Brinkløv
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anette B. Nielsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Katja S. Kofoed
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Carsten A. Lauridsen
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Bachelor’s Degree Programme in Radiography, Copenhagen University College, Copenhagen, Denmark
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik E. Poulsen
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Gerrit Van Hall
- Biomedical Sciences, Faculty of Health & Medical Science, University of Copenhagen & Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Karstoft
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Helga Ellingsgaard
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas P. Almdal
- Department of Endocrinology PE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Bente K. Pedersen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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20
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Liu L, Ma X, Xu H, Ruan S, Yuan X. Comparing the effects of 12 months aerobic exercise and resistance training on glucose metabolism among prediabetes phenotype: A explorative randomized controlled trial. Prim Care Diabetes 2021; 15:340-346. [PMID: 33309489 DOI: 10.1016/j.pcd.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/05/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Abstract
AIMS The pathophysiology of each phenotype of prediabetes is unique that promotes different levels of diabetes and cardiovascular disease risks. Exercise guidelines for individuals with prediabetes including both aerobic and resistance training could improve metabolic control, but its effects on different prediabetes subtypes are unclear. The aim of this explorative randomized controlled trial was to evaluate the effects of aerobic training (AT) or resistance training (RT) on glucose metabolism and lipid profile by different prediabetes subtypes with. METHODS A randomized controlled trial in which 128 individuals with isolated impaired fasting glucose (i-IFG; n = 39), isolated impaired glucose tolerance (i-IGT; n = 29), combined glucose tolerance (CGI; n = 27) and isolated elevated HbA1c (n = 33) were randomly assigned to the control group, AT group and RT group, respectively. Supervised exercise training, including AT and RT were completed at moderate intensity for 60 min per day, three non-consecutive days per week for 12 months. The primary outcome was improvement in glucose metabolism. Secondary outcomes included measure of lipid profile and if these effects were moderated by the prediabetes phenotype. RESULTS Of the initial 128 participants, 118 finished the study, but all participants were included in the intention-to-treat analyses. The improvement in 2 h postprandial plasma glucose (2 hPG) between group difference (AT vs. RT) at 12 months was 0.87 (95% CI, -1.59 to-0.16; p < 0.05). Compared with RT group, AT significantly decreased the 2hPG in participants with i-IGT at 12 months (-1.66, 95% CI -3.04 to -0.28; p < 0.05). CONCLUSIONS AT program conferred benefits in improving 2 h PG and HbA1c compared with RT for prediabetes. These findings may moderate by prediabetes phenotype, and AT appeared more effective in i-IGT. A future trial with large sample size and long time follow up of prediabetes phenotype groups are needed.
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Affiliation(s)
- Lin Liu
- Yangzhou University, 136 Jiangyang Road, Yangzhou, 225009 PR China.
| | - Xiaojun Ma
- Shaoyang University, Meizijing Campus, Xueyuan Road, Daxiang District, Shaoyang City, 422000 PR China.
| | - Huiwen Xu
- Yangzhou University, 136 Jiangyang Road, Yangzhou, 225009 PR China; Nagano College of Nursing, Komagane, Nagano, 399-4117 Japan
| | - Sijie Ruan
- Central Hospital of Shaoyang, 36 Qianyuan Lane, Daxiang District, Shaoyang City, 422000 PR China
| | - Xiaodan Yuan
- Jiangsu Province Academy of Traditional Chinese Medicine, #100 Hongshan Road, Qixia District Nanjing, 210028 PR China.
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21
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Jelstad S, Ditta Valsdottir T, Johansen EI, Jensen JR. Eight sessions of endurance training decrease fasting glucose and improve glucose tolerance in middle-aged overweight males. Arch Physiol Biochem 2021; 127:12-19. [PMID: 30688111 DOI: 10.1080/13813455.2018.1563189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Exercise improves metabolic regulation and reduces the risk of developing type 2 diabetes and other metabolic diseases. The recommendations for exercise are rather general and the health benefits of controlled training studies are important to make better recommendations. In the present study, we report that eight endurance training sessions over 3 weeks reduced fasting glucose, and improved glucose tolerance and plasma lipids in sedentary middle-aged males (44-64 years) with overweight or obesity (BMI: 27-38). The decrease in fasting glucose was substantial (from 5.3 ± 0.3 to 4.8 ± 0.2 mM; p < .001). The training sessions consisted of 60-min indoor-cycling at ∼83% of peak heart rate divided in four blocks of 15 min cycling, with 2-min rest between blocks. Maximal oxygen uptake did not increase (38.8 ± 1.8 vs. 39.0 ± 1.6 ml kg-1 min-1). In conclusion, 3-weekly sessions of moderate-/high-intensity endurance training can be recommended for untrained males with overweight or obesity to improve glucose homeostasis.
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Affiliation(s)
- Stian Jelstad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thorhildur Ditta Valsdottir
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Medicine, Atlantis Medical University College, Oslo, Norway
| | - Egil I Johansen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Rgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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22
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Malin SK, Stewart NR. Metformin May Contribute to Inter-individual Variability for Glycemic Responses to Exercise. Front Endocrinol (Lausanne) 2020; 11:519. [PMID: 32849302 PMCID: PMC7431621 DOI: 10.3389/fendo.2020.00519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Metformin and exercise independently improve glycemic control. Metformin traditionally is considered to reduce hepatic glucose production, while exercise training is thought to stimulate skeletal muscle glucose disposal. Collectively, combining treatments would lead to the anticipation for additive glucose regulatory effects. Herein, we discuss recent literature suggesting that metformin may inhibit, enhance or have no effect on exercise mediated benefits toward glucose regulation, with particular emphasis on insulin sensitivity. Importantly, we address issues surrounding the impact of metformin on exercise induced glycemic benefit across multiple insulin sensitive tissues (e.g., skeletal muscle, liver, adipose, vasculature, and the brain) in effort to illuminate potential sources of inter-individual glycemic variation. Therefore, the review identifies gaps in knowledge that require attention in order to optimize medical approaches that improve care of people with elevated blood glucose levels and are at risk of cardiovascular disease.
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Affiliation(s)
- Steven K. Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, United States
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Nathan R. Stewart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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23
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Malin SK, Navaneethan SD, Fealy CE, Scelsi A, Huang H, Rocco M, Kirwan JP. Exercise plus caloric restriction lowers soluble RAGE in adults with chronic kidney disease. Obes Sci Pract 2020; 6:307-312. [PMID: 32523720 PMCID: PMC7278900 DOI: 10.1002/osp4.408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The incidence of chronic kidney disease (CKD) has increased in recent years. CKD is associated with obesity, type 2 diabetes, and cardiovascular disease, although the mechanism remains unclear. Elevated soluble form of the receptor for advanced glycation end products ( RAGE) is related to proinflammatory signaling pathways that may promote diabetic nephropathy and vascular dysfunction. Because lifestyle modification reduces systematic inflammation in adults with obesity and hyperglycaemia, the hypothesis that exercise plus caloric restriction would lower soluble RAGE in adults with CKD was tested in this study. METHODS Eight adults (n = 6 females; age: 56.3 ± 2.8 y; BMI: 43.7 ± 2.2 kg/m2; 2-h OGTT glucose: 215 ± 9.8 mg/dL; eGFR: 49.6 ± 3.3 mL/min/1.73 m2) were enrolled in a 12-week pilot lifestyle intervention (supervised aerobic exercise [5 d/wk, up to 60 min/d at approximately 65%-85% HRmax] plus low-fat dietary counseling). Body composition (DXA), aerobic fitness (VO2max), insulin sensitivity (120 min 75 g OGTT; Matsuda Index), plasma levels of soluble RAGE and fetuin-A were measured before and after the intervention. RESULTS Exercise reduced body weight, fasting glucose, and fetuin-A as well as increased VO2max, glucose tolerance, and insulin sensitivity (all P < .05). Lifestyle intervention decreased plasma soluble RAGE (pre: 1018.1 ± 163 vs post: 810.6 ± 119.6 ng/mL; P = .02), and the decrease was associated with a lower 2-hour blood glucose (r = 0.76, P = .03) and with increased insulin sensitivity (r = -0.90, P < .01). CONCLUSIONS Exercise and caloric restriction are effective at lowering soluble RAGE in relation to glucose regulation in patients with CKD.
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Affiliation(s)
- Steven K. Malin
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVAUSA
- Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVAUSA
- Robert M. Berne Cardiovascular Research CenterUniversity of VirginiaCharlottesvilleVAUSA
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of MedicineBaylor College of MedicineHoustonTXUSA
| | - Ciaran E. Fealy
- Department of Pathobiology, Lerner Research InstituteCleveland ClinicClevelandOHUSA
| | - Amanda Scelsi
- Department of Pathobiology, Lerner Research InstituteCleveland ClinicClevelandOHUSA
| | - Hazel Huang
- Department of Pathobiology, Lerner Research InstituteCleveland ClinicClevelandOHUSA
| | - Michael Rocco
- Heart and Vascular InstituteCleveland ClinicClevelandOHUSA
| | - John P. Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLAUSA
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24
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Ding C, Chooi YUC, Chan Z, Lo J, Choo J, Ding BTK, Leow MKS, Magkos F. Dose-Dependent Effects of Exercise and Diet on Insulin Sensitivity and Secretion. Med Sci Sports Exerc 2020; 51:2109-2116. [PMID: 31033904 DOI: 10.1249/mss.0000000000002020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE A single bout of aerobic exercise increases insulin sensitivity the next day. The effects of exercise on insulin secretion, the role of exercise-induced energy deficit, and possible dose-response relationships are not well understood. This study aimed to evaluate insulin sensitivity and insulin secretion after progressively greater negative energy balance induced by exercise or diet. METHODS Acute energy deficits (20% or 40% of weight maintenance needs) were induced by a single day of aerobic exercise (cycling at moderate intensity, n = 13) or dietary restriction (n = 19) in healthy men and women (age, 26 ± 2 yr; body mass index, 21.8 ± 0.5 kg·m). Intravenous glucose tolerance tests in conjunction with minimal modeling were performed the next morning, and blood samples were collected for 3 h to measure glucose and insulin concentrations. RESULTS Insulin sensitivity increased linearly after exercise-induced energy deficits (P = 0.007) but did not change after equivalent diet-induced energy deficits (P = 0.673). Acute insulin response decreased after both exercise (P < 0.001) and dietary restriction (P = 0.005). The disposition index and glucose effectiveness were not affected by exercise (P = 0.138 and 0.808, respectively), but both decreased after 40% dietary restriction (P = 0.048 and 0.002, respectively). CONCLUSIONS These results indicate that insulin sensitivity and insulin secretion are related to exercise energy expenditure, albeit in a different fashion (insulin sensitivity increases linearly, whereas insulin secretion drops to a nadir with a low exercise dose and does not decrease further). These changes cannot be replicated by equivalent energy deficits induced by dietary restriction, suggesting that exercise and diet have different effects on the mechanisms regulating glucose homeostasis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03264001.
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Affiliation(s)
- Cherlyn Ding
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - Y U Chung Chooi
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - Zhiling Chan
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - Jezebel Lo
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - John Choo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - Benjamin Tze Keong Ding
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE
| | - Melvin K-S Leow
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE.,Department of Endocrinology, Tan Tock Seng Hospital, SINGAPORE.,Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, SINGAPORE.,Lee Kong Chian School of Medicine, Nanyang Technological University, SINGAPORE
| | - Faidon Magkos
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) and National University Health System, SINGAPORE.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), SINGAPORE.,Section for Obesity Research, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, DENMARK
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25
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Curran M, Drayson MT, Andrews RC, Zoppi C, Barlow JP, Solomon TPJ, Narendran P. The benefits of physical exercise for the health of the pancreatic β-cell: a review of the evidence. Exp Physiol 2020; 105:579-589. [PMID: 32012372 DOI: 10.1113/ep088220] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses the evidence of the benefits of exercise training for β-cell health through improvements in function, proliferation and survival which may have implications in the treatment of diabetes. What advances does it highlight? This review highlights how exercise may modulate β-cell health in the context of diabetes and highlights the need for further exploration of whether β-cell preserving effects of exercise translates to T1D. ABSTRACT Physical exercise is a core therapy for type 1 and type 2 diabetes. Whilst the benefits of exercise for different physiological systems are recognised, the effect of exercise specifically on the pancreatic β-cell is not well described. Here we review the effects of physical exercise on β-cell health. We show that exercise improves β-cell mass and function. The improved function manifests primarily through the increased insulin content of the β-cell and its increased ability to secrete insulin in response to a glucose stimulus. We review the evidence relating to glucose sensing, insulin signalling, β-cell proliferation and β-cell apoptosis in humans and animal models with acute exercise and following exercise training programmes. Some of the mechanisms through which these benefits manifest are discussed.
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Affiliation(s)
- Michelle Curran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Functional and Mechanistic Safety, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Claudio Zoppi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Jonathan P Barlow
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Thomas P J Solomon
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
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26
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Vechetti IJ, Valentino T, Mobley CB, McCarthy JJ. The role of extracellular vesicles in skeletal muscle and systematic adaptation to exercise. J Physiol 2020; 599:845-861. [PMID: 31944292 DOI: 10.1113/jp278929] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
Regular exercise has a central role in human health by reducing the risk of type 2 diabetes, obesity, stroke and cancer. How exercise is able to promote such systemic benefits has remained somewhat of a mystery but has been thought to be in part mediated by the release of myokines, skeletal muscle-specific cytokines, in response to exercise. Recent studies have revealed skeletal muscle can also release extracellular vesicles (EVs) into circulation following a bout of exercise. EVs are small membrane-bound vesicles capable of delivering biomolecules to recipient cells and subsequently altering their metabolism. The notion that EVs may have a role in both skeletal muscle and systemic adaptation to exercise has generated a great deal of excitement within a number of different fields including exercise physiology, neuroscience and metabolism. The purpose of this review is to provide an introduction to EV biology and what is currently known about skeletal muscle EVs and their potential role in the response of muscle and other tissues to exercise.
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Affiliation(s)
- Ivan J Vechetti
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - Taylor Valentino
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - C Brooks Mobley
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - John J McCarthy
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
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27
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Yuan X, Dai X, Liu L, Hsue C, Miller JD, Fang Z, Li J, Feng J, Huang Y, Liu C, Shen J, Chen T, Liu Y, Mordes J, Lou Q. Comparing the effects of 6 months aerobic exercise and resistance training on metabolic control and β-cell function in Chinese patients with prediabetes: A multicenter randomized controlled trial. J Diabetes 2020; 12:25-37. [PMID: 31141300 DOI: 10.1111/1753-0407.12955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/15/2019] [Accepted: 05/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is clear that aerobic training (AT) can delay pancreatic exhaustion and slow the progression from prediabetes to type 2 diabetes (T2D), but there is little information regarding the effects of resistance training (RT) in people with prediabetes. This study compared the effectiveness of RT and AT in improving metabolic control and protecting β-cell function in people with prediabetes. METHODS Chinese subjects (n = 248) with prediabetes were randomized to three groups: AT (n = 83), RT (n = 82) and control (n = 83). Subjects in the RT group performed 13 different resistance exercises per session using an elastic string. Those in the AT group performed aerobic exercises at 60%-70% of maximum heart rate. In both cases, exercises were performed three times per week for a period of 6 months. The primary outcome was improvement in metabolic control. Longitudinal changes between groups were tested using repeated-measures analysis of variance. RESULTS Of the initial 248 participants, 217 finished the study, but all participants were included in the intention-to-treat analyses. There were no significant differences in demographic characteristics among the RT, AT, and control groups (P > 0.05). Changes in HbA1c were not significantly greater in RT than AT cohort (P = 0.059), but the decrease in HbA1c in both exercise groups was higher than in the control group (P < 0.05). CONCLUSIONS In subjects with prediabetes, RT appears to improve metabolic control and preserve β-cell function comparable to AT.
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Affiliation(s)
- Xiaodan Yuan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xia Dai
- The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Lin Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Nursing, Yangzhou University, Yangzhou, China
| | - Cunyi Hsue
- Department of Nature Science, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Zhaohui Fang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Anhui, China
| | - Jianing Li
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jitao Feng
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Huang
- Danyang People's Hospital of Jiangsu Province, Danyang, China
| | - Chao Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianping Shen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tao Chen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yanjun Liu
- Lanzhou Ruijing Diabetes Hospital, Lanzhou, China
| | - John Mordes
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Qingqing Lou
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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28
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Chobanyan-Jürgens K, Scheibe RJ, Potthast AB, Hein M, Smith A, Freund R, Tegtbur U, Das AM, Engeli S, Jordan J, Haufe S. Influences of Hypoxia Exercise on Whole-Body Insulin Sensitivity and Oxidative Metabolism in Older Individuals. J Clin Endocrinol Metab 2019; 104:5238-5248. [PMID: 30942862 DOI: 10.1210/jc.2019-00411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Aging is a primary risk factor for most chronic diseases, including type 2 diabetes. Both exercise and hypoxia regulate pathways that ameliorate age-associated metabolic muscle dysfunction. OBJECTIVE We hypothesized that the combination of hypoxia and exercise would be more effective in improving glucose metabolism than normoxia exercise. DESIGN AND PARTICIPANTS We randomized 29 older sedentary individuals (62 ± 6 years; 14 women, 15 men) to bicycle exercise under normobaric hypoxia (fraction of inspired oxygen = 15%) or normoxia (fraction of inspired oxygen = 21%). INTERVENTION Participants trained thrice weekly for 30 to 40 minutes over 8 weeks at a heart rate corresponding to 60% to 70% of peak oxygen update. MAIN OUTCOME MEASURES Insulin sensitivity measured by hyperinsulinemic-euglycemic glucose clamp and muscle protein expression before and after hyperinsulinemic-euglycemic glucose clamp. RESULTS Heart rate and perceived exertion during training were similar between groups, with lower oxygen saturation when exercising under hypoxia (88.7 ± 1.5 vs 96.2 ± 1.2%, P < 0.01). Glucose infusion rate after 8 weeks increased in both the hypoxia (5.7 ± 1.1 to 6.7 ± 1.3 mg/min/kg; P < 0.01) and the normoxia group (6.2 ± 2.1 to 6.8 ± 2.1 mg/min/kg; P = 0.04), with a mean difference between groups of -0.44 mg/min/kg; 95% CI, -1.22 to 0.34; (P = 0.25). Markers of mitochondrial content and oxidative capacity in skeletal muscle were similar after training in both groups. Changes in Akt phosphorylation and glucose transporter 4 under fasting and insulin-stimulated conditions were not different between groups over time. CONCLUSIONS Eight weeks of hypoxia endurance training led to similar changes in insulin sensitivity and markers of oxidative metabolism compared with normoxia training. Normobaric hypoxia exercise did not enhance metabolic effects in sedentary older women and men beyond exercise alone.
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Affiliation(s)
- Kristine Chobanyan-Jürgens
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Renate J Scheibe
- Institute of Cell Biochemistry, Hannover Medical School, Hannover, Germany
| | - Arne B Potthast
- Department of Pediatrics, Pediatric Metabolic Medicine, Hannover Medical School, Hannover, Germany
| | - Markus Hein
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Andrea Smith
- Institute of Biometry, Hannover Medical School, Hannover, Germany
| | - Robert Freund
- Institute of Cell Biochemistry, Hannover Medical School, Hannover, Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Anibh M Das
- Department of Pediatrics, Pediatric Metabolic Medicine, Hannover Medical School, Hannover, Germany
| | - Stefan Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Jens Jordan
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Sven Haufe
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
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29
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Gilbertson NM, Eichner NZM, Heiston EM, Gaitán JM, Francois ME, Mehaffey JH, Hassinger TE, Hallowell PT, Weltman A, Malin SK. A low-calorie diet with or without interval exercise training improves adiposopathy in obese women. Appl Physiol Nutr Metab 2019; 44:1057-1064. [PMID: 30785773 DOI: 10.1139/apnm-2018-0717] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this study was to test if a low-calorie diet plus interval exercise (LCD+INT) improves adiposopathy, an endocrine dysfunction, when compared with an energy-deficit-matched LCD in obese women. Subjects (age: 48.2 ± 2.4 years, body mass index: 37.8 ± 1.3 kg/m2) were randomized to a 13-day LCD (n = 12; mixed meals of ∼1200 kcal/day) or LCD+INT (n = 12; 12 sessions of 60 min/day alternating 3 min at 50% and 90% peak heart rate). Exercise was estimated to expend 350 kcal per oxygen uptake-heart rate regression analysis and individuals were refed calories expended to match energy availability between groups. Absolute (post - pre caloric intake) and relative (total daily and exercise energy expenditure relative to calorie intake) energy deficits were calculated. Fitness (peak oxygen uptake) and body composition (BodPod; Cosmed USA Inc.) were measured and a 120-min, 75g oral glucose tolerance test was performed at pre- and post-intervention to assess adiposopathy (i.e., ratio of high molecular weight-adiponectin to leptin) and estimate insulin sensitivity. LCD and LCD+INT had similar absolute (P = 0.55) and relative (P = 0.76) energy deficits. LCD and LCD+INT had similar reductions in fat mass (both P < 0.001), despite LCD inducing greater weight loss (P = 0.02) than LCD+INT. Both treatments improved adiposopathy (P = 0.003) and peripheral insulin sensitivity (P = 0.02). Absolute energy deficit correlated to improved adiposopathy (r = -0.41, P = 0.05), and absolute and relative energy deficits were associated with increased insulin sensitivity (r = -0.47, P = 0.02; and r = -0.40, P = 0.05, respectively), independent of body composition changes and increased peak oxygen uptake. Taken together, LCD, with or without INT, improves adiposopathy in relation to insulin sensitivity in obese women, suggesting that a short-term energy deficit is key for reducing risk of type 2 diabetes.
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Affiliation(s)
- Nicole M Gilbertson
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
| | - Natalie Z M Eichner
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
| | - Emily M Heiston
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
| | - Julian M Gaitán
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
| | - Monique E Francois
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, VA 22902, USA
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia, Charlottesville, VA 22902, USA
| | - Peter T Hallowell
- Department of Surgery, University of Virginia, Charlottesville, VA 22902, USA
| | - Arthur Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA 22902, USA
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22902, USA
- Division of Endocrinology & Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA 22902, USA
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA 22902, USA
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Gilbertson NM, Miller SL, Eichner NZ, Malin SK. Endothelial function following interval exercise plus low-calorie diet treatment in obese females. Physiol Rep 2019; 7:e14239. [PMID: 31552710 PMCID: PMC6759506 DOI: 10.14814/phy2.14239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/30/2019] [Indexed: 12/30/2022] Open
Abstract
We determined if interval exercise plus a low-calorie diet (LCD + INT) increases endothelial function more than an energy-matched LCD. Obese women (47.2 ± 2.6y, 37.5 ± 1.3kg/m2 ) were randomized to 13 days of a LCD (n = 12; mixed meals of ~ 1200kcal/d) or LCD + INT (n = 13; 12 supervised 60-min INT bouts of 3 min at 90% and 50% HRpeak ). LCD + INT subjects received 350kcal postexercise to equate energy availability with LCD. Fitness (VO2 peak) and body composition (BodPod) were determined and a 120 min, 75 g oral glucose tolerance test was performed to examine fasting and postprandial flow-mediated dilation (FMD, endothelial function), respiratory exchange ratio (RER) via indirect calorimetry as well as glucose and insulin incremental area under the curve (iAUC120min ). LCD + INT increased VO2 peak (P = 0.02) compared with LCD, and both treatments decreased fat mass (P < 0.001) and insulin iAUC120min (P = 0.03). There was no overall treatment effect on fasting or iAUC120min FMD. However, in participants who increased fasting endothelial function after each treatment (Δ > 50%; LCD n = 5, LCD + INT n = 7), LCD + INT increased fasted (P = 0.005) and decreased iAUC120min (P = 0.003) FMD compared with LCD. Enhanced fitness correlated with increased fasting FMD (r = 0.43, P = 0.03) and diminished FMD iAUC120min (r = -0.44, P = 0.03). Decreased FMD iAUC120min correlated with reduced glucose iAUC120min (r = 0.64, P = 0.001) as well as increased 60-min RER (r = -0.42, P = 0.04). Low baseline fasting and iAUC120min FMD was also linked to enhanced fasting and iAUC120min FMD post-treatment (r = -0.71, P < 0.001; r = -0.89, P < 0.001, respectively). In conclusion, increasing fitness via INT may increase the effect of LCD on lowering cardiovascular disease risk in obese women.
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Affiliation(s)
| | | | | | - Steven K. Malin
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginia
- Division of Endocrinology & MetabolismDepartment of MedicineUniversity of VirginiaCharlottesvilleVirginia
- Robert M. Berne Cardiovascular Research CenterUniversity of VirginiaCharlottesvilleVirginia
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Dai X, Zhai L, Chen Q, Miller JD, Lu L, Hsue C, Liu L, Yuan X, Wei W, Ma X, Fang Z, Zhao W, Liu Y, Huang F, Lou Q. Two-year-supervised resistance training prevented diabetes incidence in people with prediabetes: A randomised control trial. Diabetes Metab Res Rev 2019; 35:e3143. [PMID: 30768758 DOI: 10.1002/dmrr.3143] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/30/2018] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
AIM The purpose of this study is to explore the long-term effects of aerobic training (AT), resistance training (RT), and combined training (AT + RT) on the prevention of T2D incidence in patients with prediabetes. MATERIALS AND METHODS In this randomised controlled trial, people with prediabetes (fasting glucose ≥5.6 and <7.0 mmol/L and/or 2-h glucose ≥7.8 and <11.1 mmol/L on the 75-g oral glucose tolerance test and/or haemoglobin A1c ≥5.7% and <6.4%) were randomly assigned to the control group, AT group, RT group, or AT + RT group. Supervised exercise programmes, including AT, RT, and AT + RT, were completed for 60 minutes per day, three non-consecutive days per week for 24 months. The primary outcome was the incidence of T2D; secondary outcomes were blood glucose and lipid levels, including total cholesterol (TC) and standard 2-hour oral glucose tolerance (2hPG). RESULTS A total of 137 (80%) subjects with a mean age of 59 years (45 men, 92 women) entered the final analysis. After 24 months of intervention, the incidences of T2D adjusted by sex and age were significantly decreased by 74% (95% CI, 38-89), 65% (95% CI, 21-85), and 72% (95% CI, 36-87) in the AT + RT, RT, and AT groups compared with the control group (HR: AT + RT 0.26 [95% CI, 0.11-0.62], RT 0.35 [95% CI, 0.15-0.79], and AT 0.28 [95% CI, 0.13-0.64]). The cumulative T2D incidences were significantly lower in the AT + RT, RT, and AT groups than in the control group (21%, 26%, and 22% vs 69%). The blood glucose and lipid profiles improved more in the AT, RT, and AT + RT groups than in the control group. CONCLUSION RT and RT plus AT were as effective as isolated AT in preventing progression to T2D.
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Affiliation(s)
- Xia Dai
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Zhai
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingyun Chen
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Joshua D Miller
- Department of Medicine Health Science Tower, Stony Brook University Hospital, Stony Brook, New York
| | - Lirong Lu
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Cunyi Hsue
- University of Massachusetts Amherst, Amherst, Massachusetts
| | - Lin Liu
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated with Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaodan Yuan
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated with Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Wei
- Department of Geriatric Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaojun Ma
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhaohui Fang
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Wenpiao Zhao
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuhua Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Feng Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingqing Lou
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated with Nanjing University of Chinese Medicine, Nanjing, China
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O'Donoghue G, Kennedy A, Andersen GS, Carr B, Cleary S, Durkan E, Davis H, Færch K, Fitzpatrick P, Kenny H, McCaffrey N, Monedero J, Murphy E, Noone J, Suvitaival T, Thybo T, Wheeler M, Vistisen D, Nolan JJ, O'Gorman DJ. Phenotypic Responses to a Lifestyle Intervention Do Not Account for Inter-Individual Variability in Glucose Tolerance for Individuals at High Risk of Type 2 Diabetes. Front Physiol 2019; 10:317. [PMID: 30971951 PMCID: PMC6443958 DOI: 10.3389/fphys.2019.00317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background: Lifestyle interventions have been shown to delay or prevent the onset of type 2 diabetes among high risk adults. A better understanding of the variability in physiological responses would support the matching of individuals with the best type of intervention in future prevention programmes, in order to optimize risk reduction. The purpose of this study was to determine if phenotypic characteristics at baseline or following a 12 weeks lifestyle intervention could explain the inter-individual variability in change in glucose tolerance in individuals with high risk for type 2 diabetes. Methods: In total, 285 subjects with normal glucose tolerance (NGT, FINDRISC score > 12), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were recruited for a 12 weeks lifestyle intervention. Glucose tolerance, insulin sensitivity, anthropometric characteristics and aerobic fitness were measured. Variability of responses was examined by grouping participants by baseline glycemic status, by cluster analysis based on the change in glucose tolerance and by Principal Component Analysis (PCA). Results: In agreement with other studies, the mean response to the 12 weeks intervention was positive for the majority of parameters. Overall, 89% improved BMI, 80% waist circumference, and 81% body fat while only 64% improved fasting plasma glucose and 60% 2 h glucose. The impact of the intervention by glycaemic group did not show any phenotypic differences in response between NGT, IFG, and IGT. A hierarchical cluster analysis of change in glucose tolerance identified four sub-groups of "responders" (high and moderate) and "non-responders" (no response or deteriorated) but there were few differences in baseline clincal and physiological parameters or in response to the intervention to explain the overall variance. A further PCA analysis of 19 clinical and physiological univariables could explain less than half (48%) of total variability. Conclusion: We found that phenotypic characteristics from standard clinical and physiological parameters were not sufficient to account for the inter-individual variability in glucose tolerance following a 12 weeks lifestyle intervention in inidivuals at high risk for type 2 diabetes. Further work is required to identify biomarkers that complement phenotypic traits and better predict the response to glucose tolerance.
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Affiliation(s)
- Grainne O'Donoghue
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Aileen Kennedy
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | | | - Stephen Cleary
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Eoin Durkan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Heidi Davis
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - Paula Fitzpatrick
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Helena Kenny
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Noel McCaffrey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Javier Monedero
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Enda Murphy
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - John Noone
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - Tanja Thybo
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Wheeler
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | | | - John J Nolan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Trinity College Dublin, Dublin, Ireland
| | - Donal J O'Gorman
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.,National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
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Malin SK, Kullman EL, Scelsi AR, Godin JP, Ross AB, Kirwan JP. A Whole-Grain Diet Increases Glucose-Stimulated Insulin Secretion Independent of Gut Hormones in Adults at Risk for Type 2 Diabetes. Mol Nutr Food Res 2019; 63:e1800967. [PMID: 30763457 DOI: 10.1002/mnfr.201800967] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/29/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The effect of whole-grain (WG) versus refined-grain (RG) diets on glucose-stimulated insulin secretion (GSIS) and β-cell function is unclear. METHODS In a double-blind crossover randomized controlled trial, 13 prediabetic adults (37.2 ± 1.8 y, BMI: 33.6 ± 1.4 kg m-2 , 2 h glucose: 146.9 ± 11.6 mg dL-1 ) are provided isocaloric-matched WG and RG diets for 8-weeks each, with an 8-10 week washout between diets. Glucose, insulin, and C-peptide are studied over 240 min following a 75 g OGTT. Incretins (GLP-1 and GIP), PYY, and total ghrelin are assessed at 0, 30, and 60 min. Mixed-meal diets for carbohydrate (54%), fat (28%), and protein (18%) contain either WG (50 g/1000 kcal) or equivalent RG. RESULTS Both diets induce fat loss (≈2 kg). While neither diet impacts early phase GSIS, the WG diet increases total GSIS (iAUC of C-peptide0-240 /Glc0-240 , p = 0.02) and β-cell function (disposition index; GSIS × insulin sensitivity, p = 0.02). GIP and PYY are unaltered by either diet, but GLP-1 is higher at 30 min following RG versus WG (p = 0.04). Ghrelin levels are higher at 60 min of the OGTT following both interventions (p = 0.01). CONCLUSION A WG-rich diet increases β-cell function independent of gut hormones in adults with prediabetes.
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Affiliation(s)
- Steven K Malin
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.,Department of Kinesiology, University of Virginia, Charlottesville, VA, 22904, USA
| | - Emily L Kullman
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.,Department of Health and Human Performance, Cleveland State University, Cleveland, OH, 44115, USA
| | - Amanda R Scelsi
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jean-Philippe Godin
- Institute of Food Safety and Analytical Sciences, Nestlé Research Center, 1015, Lausanne, Switzerland
| | - Alastair B Ross
- Department of Biology and Biological Engineering, Chalmers University of Technology, Chalmersplatsen 4, 412 96, Gothenburg, Sweden
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.,Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
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Heiston EM, Eichner NZM, Gilbertson NM, Gaitán JM, Kranz S, Weltman A, Malin SK. Two weeks of exercise training intensity on appetite regulation in obese adults with prediabetes. J Appl Physiol (1985) 2019; 126:746-754. [PMID: 30629474 PMCID: PMC6459386 DOI: 10.1152/japplphysiol.00655.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/20/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
No short-term exercise data exist testing whether training intensity modifies hormonal and perceived appetite in obese adults with prediabetes. Therefore, we compared the effects of short-term moderate-continuous (CONT) vs. high-intensity interval (INT) training on appetite regulation. Twenty-eight obese adults [age: 61.3 ± 1.5 yr; body mass index (BMI): 33.2 ± 1.1 kg/m2] with prediabetes were randomized to work-matched CONT ( n = 14) or INT ( n = 14) training for 2 wk. Plasma acylated ghrelin (AG), des-acylated ghrelin (dAG), active glucagon-like peptide-1 (GLP-1), and insulin were measured at 0, 30, and 60 min of a 75-g oral glucose tolerance test (OGTT) before and after training. Visual analog scales were administered at 0 and 120 min during the OGTT to examine perceived appetite. Three-day food logs were collected before and after testing to assess ad libitum diet. CONT and INT increased peak oxygen consumption ( P < 0.01) and decreased BMI ( P < 0.01). Although neither intervention altered fasting levels of AG ( P = 0.94), dAG ( P = 0.36), or insulin ( P = 0.67), CONT raised GLP-1 compared with INT ( P = 0.05). Exercise training did not affect postprandial suppression of AG ( P = 0.81) and dAG ( P = 0.67) or stimulation of GLP-1 ( P = 0.67) and insulin ( P = 0.32). Both interventions tended to decrease total energy and protein intake ( P = 0.09 and P = 0.05, respectively), despite no change in fasting hunger ( P = 0.88) and reduced perceived fullness at 120 min during the OGTT ( P = 0.05). We conclude that 2 wk of exercise training intensity does not modulate appetite-regulatory hormones in obese adults with prediabetes. Although perceived fullness to the OGTT was reduced after exercise, CONT and INT decreased energy intake, suggesting that exercise does not elicit compensatory appetite behavior to gain weight. NEW & NOTEWORTHY Adults with prediabetes are at risk for appetite dysregulation. Although exercise promotes weight management, it is unclear whether moderate-continuous or high-intensity interval training is more beneficial for appetite regulation. We show that 2 wk of exercise, independent of intensity, does not alter postprandial appetite hormones or hunger, despite slight reductions in food intake and weight. These data support exercise as an effective method to induce negative energy balance without compensatory weight gain.
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Affiliation(s)
- Emily M Heiston
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
| | - Natalie Z M Eichner
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
| | - Nicole M Gilbertson
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
| | - Julian M Gaitán
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
| | - Sibylle Kranz
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
| | - Arthur Weltman
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia , Charlottesville, Virginia
| | - Steven K Malin
- Department of Kinesiology, University of Virginia , Charlottesville, Virginia
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia , Charlottesville, Virginia
- Robert M. Berne Cardiovascular Research Center, University of Virginia , Charlottesville, Virginia
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Barlow J, Solomon TPJ. Conditioned media from contracting skeletal muscle potentiates insulin secretion and enhances mitochondrial energy metabolism of pancreatic beta-cells. Metabolism 2019; 91:1-9. [PMID: 30445139 DOI: 10.1016/j.metabol.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/16/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS In this study, we aimed to examine real-time effects of molecules released by contracting skeletal muscle on the insulin secretory function of β-cells using a novel perifusion platform. We hypothesised that media conditioned by contracting skeletal muscle will influence insulin secretion and mitochondrial energy metabolism in β-cells under normal and type-2 diabetic conditions. METHODS INS-1 832/3 pseudoislets were perifused with media from C2C12 myotubes treated with or without electrical pulse stimulation (EPS; 40 V, 1.0 Hz, 2 ms). Insulin secretory function of pseudoislets was measured before, during, and after EPS to simulate pre-, during-, and post-exercise like effects. Additional experiments were completed in INS-1 832/3 cells under "healthy" and "diabetic-like" conditions as well as human pancreatic islets isolated from nondiabetic and type 2 diabetic donors. RESULTS Insulin secretion increased significantly (P < 0.05) by pseudoislets when perifused with media from myotubes treated with but not without EPS. Conditioned media from EPS-treated myotubes also potentiated insulin secretion from INS-1 832/3 cell monolayers in the presence (P < 0.05) and absence of palmitate (P < 0.001) and in nondiabetic (P < 0.01) and type-2 diabetic (P = 0.06) isolated human islets. Pre-treatment of INS-1 832/3 cells to 24-hour high glucose ± palmitate dampened this effect. Moreover, conditioned media from myotubes treated with EPS significantly increased mitochondrial respiratory activity of INS-1 832/3 cells. CONCLUSION/INTERPRETATION Conditioned media from myotubes treated with EPS potentiates acute insulin release from normal cultured β-cells, nondiabetic islets and Type-2 diabetic islets and is associated with enhanced mitochondrial substrate oxidation.
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Affiliation(s)
- Jonathan Barlow
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK.
| | - Thomas P J Solomon
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK; Institute for Metabolism and Systems Research (IMSR), University of Birmingham, UK
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Eichner NZM, Gaitán JM, Gilbertson NM, Khurshid M, Weltman A, Malin SK. Postprandial augmentation index is reduced in adults with prediabetes following continuous and interval exercise training. Exp Physiol 2019; 104:264-271. [PMID: 30537411 DOI: 10.1113/ep087305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/10/2018] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? We compared high-intensity interval versus continuous training on fasting and postprandial arterial stiffness in people with prediabetes. What is the main finding and its importance? We show, for the first time, that exercise improves the augmentation index during the postprandial state, but not the fasted state, in adults with prediabetes. However, the fasted augmentation index improved in relationship to exercise dose, as assessed by kilocalories per session. Collectively, these findings suggest that short-term exercise can improve arterial compliance in adults with prediabetes. Therefore, lifestyle interventions designed to reduce arterial stiffness could have considerable clinical impact. ABSTRACT People with prediabetes have elevated risk for cardiovascular disease, in part, owing to arterial stiffness mediated by low insulin sensitivity. However, the effect the intensity and/or amount (i.e. kilocalories per session) of short-term exercise training on fasting and postprandial arterial stiffness is unknown. We tested the hypothesis that increased intensity and dose (i.e. amount) of exercise would be correlated with reduced fasting and postprandial arterial stiffness in obese adults with prediabetes. After randomization, 31 adults (age 61.4 ± 8.3 years, body mass index 32.1 ± 5.4 kg m-2 ) with prediabetes performed supervised continuous (CONT; n = 17; 70% of peak heart rate) or interval (INT; n = 14; 3 min at 50% of peak heart rate and 3 min at 90% of peak heart rate) cycling training for 60 min day-1 over 2 weeks. The amount of exercise was calculated using regression equations derived from oxygen uptake (V ̇ O 2 ) and heart rate. Arterial stiffness [augmentation index (AI) and cartoid-femoral pulse wave velocity], insulin and glucose were determined during a 180 min 75 g oral glucose tolerance test (OGTT) and analysed by the total area under the curve (tAUC) pre- versus post-training. The simple index of insulin sensitivity, (SIIS )OGTT, was calculated; aerobic fitness (peakV ̇ O 2 ) and body mass were also assessed. Short-term training had no effect on weight but did improve peakV ̇ O 2 (P = 0.003), glucose tAUC180min (P = 0.01) and insulin sensitivity (P = 0.002), independent of intensity. The CONT and INT exercise significantly reduced AI 2 h postprandial (P = 0.008) and tAUC180min (P = 0.03). Reductions in fasted AI were related to exercise dose (trend: r = -0.37, P = 0.055). Increased peakV ̇ O 2 was linked to reduced fasted (r = -0.47, P = 0.01) and tAUC180min AI (r = -0.39, P = 0.05). Decreased AI tAUC180min was correlated with increased insulin sensitivity (r = -0.50, P = 0.009). Short-term CONT and INT training reduced postprandial arterial stiffness comparably in adults with prediabetes.
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Affiliation(s)
| | - Julian M Gaitán
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | | | - Mahnoor Khurshid
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Arthur Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA
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Heiston EM, Malin SK. Impact of Exercise on Inflammatory Mediators of Metabolic and Vascular Insulin Resistance in Type 2 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1134:271-294. [PMID: 30919343 DOI: 10.1007/978-3-030-12668-1_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The development of obesity is cornerstone in the etiology of metabolic and vascular insulin resistance and consequently exacerbates glycemic control. Exercise is an efficacious first-line therapy for type 2 diabetes that improves insulin action through, in part, reducing hormone mediated inflammation. Together, improving the coordination of skeletal muscle metabolism with vascular delivery of glucose will be required for optimizing type 2 diabetes and cardiovascular disease treatment.
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Affiliation(s)
- Emily M Heiston
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA.
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA.
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Malin SK, Francois ME, Eichner NZM, Gilbertson NM, Heiston EM, Fabris C, Breton M. Impact of short-term exercise training intensity on β-cell function in older obese adults with prediabetes. J Appl Physiol (1985) 2018; 125:1979-1986. [PMID: 30307821 PMCID: PMC6842889 DOI: 10.1152/japplphysiol.00680.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 12/12/2022] Open
Abstract
The effect of work-matched exercise intensity on β-cell function is unknown in people with prediabetes before clinical weight loss. We determined if short-term moderate continuous (CONT) vs. high-intensity interval (INT) exercise increased β-cell function. Thirty-one subjects (age: 61.4 ± 2.5 yr; body mass index: 32.1 ± 1.0 kg/m2) with prediabetes [American Diabetes Association criteria, 75-g oral glucose tolerance test (OGTT)] were randomized to work-matched CONT (70% HRpeak) or INT (3 min 90% HRpeak and 3 min 50% HRpeak) exercise for 60 min/day over 2 wk. A 75-g 2-h OGTT was conducted after an overnight fast, and plasma glucose, insulin, C-peptide, and free fatty acids were determined for calculations of skeletal muscle [oral minimal model (OMM)], hepatic (homeostatic model of insulin resistance), and adipose (Adipose-IR) insulin sensitivity. β-Cell function was defined from glucose-stimulated insulin secretion (GSIS, deconvolution modeling) and the disposition index (DI). Glucagon-like polypeptide-1 [GLP-1(active)] and glucose-dependent insulinotropic polypeptide (GIP) were also measured during the OGTT, along with peak oxygen consumption and body composition. CONT and INT increased skeletal muscle- but not hepatic- or adipose-derived DI ( P < 0.05). Although both treatments tended to reduce fasting GLP-1(active) ( P = 0.08), early phase GLP-1(active) increased post-CONT and INT training ( P < 0.001). Interestingly, CONT exercise increased fasting GIP compared with decreases in INT ( P = 0.02). Early and total-phase skeletal muscle DI correlated with decreased total glucose area under the curve ( r = -0.52, P = 0.002 and r = -0.50, P = 0.003, respectively). Independent of intensity, short-term training increased pancreatic function adjusted to skeletal muscle in relation to improved glucose tolerance in adults with prediabetes. Exercise also uniquely affected GIP and GLP-1(active). Further work is needed to elucidate the dose-dependent mechanism(s) by which exercise impacts glycemia. NEW & NOTEWORTHY Exercise is cornerstone for reducing blood glucose, but whether high-intensity interval training is better than moderate continuous exercise is unclear in people with prediabetes before weight loss. We show that 2 wk of exercise training, independent of intensity, increased pancreatic function in relation to elevated glucagon-like polypeptide-1 secretion. Furthermore, β-cell function, but not insulin sensitivity, was also correlated with improved glucose tolerance. These data suggest that β-cell function is a strong predictor of glycemia regardless of exercise intensity.
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Affiliation(s)
- Steven K Malin
- Department of Kinesiology; University of Virginia , Charlottesville, Virginia
- Division of Endocrinology & Metabolism; University of Virginia , Charlottesville, Virginia
- Robert M. Berne Cardiovascular Research Center, University of Virginia , Charlottesville, Virginia
| | - Monique E Francois
- Department of Kinesiology; University of Virginia , Charlottesville, Virginia
| | - Natalie Z M Eichner
- Department of Kinesiology; University of Virginia , Charlottesville, Virginia
| | - Nicole M Gilbertson
- Department of Kinesiology; University of Virginia , Charlottesville, Virginia
| | - Emily M Heiston
- Department of Kinesiology; University of Virginia , Charlottesville, Virginia
| | - Chiara Fabris
- Center for Diabetes Technology, School of Medicine, University of Virginia , Charlottesville, Virginia
| | - Marc Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia , Charlottesville, Virginia
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Malin SK. Dosing Exercise: Is More Really Better for Obesity-Related Outcomes? Obesity (Silver Spring) 2018; 26:1672. [PMID: 30358154 PMCID: PMC6278925 DOI: 10.1002/oby.22330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Steven K. Malin
- Department of Kinesiology; University of Virginia, Charlottesville, VA
- Division of Endocrinology & Metabolism; University of Virginia, Charlottesville, VA
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA
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Heiskanen MA, Motiani KK, Mari A, Saunavaara V, Eskelinen JJ, Virtanen KA, Koivumäki M, Löyttyniemi E, Nuutila P, Kalliokoski KK, Hannukainen JC. Exercise training decreases pancreatic fat content and improves beta cell function regardless of baseline glucose tolerance: a randomised controlled trial. Diabetologia 2018; 61:1817-1828. [PMID: 29717337 PMCID: PMC6061150 DOI: 10.1007/s00125-018-4627-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/22/2018] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Pancreatic fat accumulation may contribute to the development of beta cell dysfunction. Exercise training improves whole-body insulin sensitivity, but its effects on pancreatic fat content and beta cell dysfunction are unclear. The aim of this parallel-group randomised controlled trial was to evaluate the effects of exercise training on pancreatic fat and beta cell function in healthy and prediabetic or type 2 diabetic participants and to test whether the responses were similar regardless of baseline glucose tolerance. METHODS Using newspaper announcements, a total of 97 sedentary 40-55-year-old individuals were assessed for eligibility. Prediabetes (impaired fasting glucose and/or impaired glucose tolerance) and type 2 diabetes were defined by ADA criteria. Of the screened candidates, 28 healthy men and 26 prediabetic or type 2 diabetic men and women met the inclusion criteria and were randomised into 2-week-long sprint interval or moderate-intensity continuous training programmes in a 1:1 allocation ratio using random permuted blocks. The primary outcome was pancreatic fat, which was measured by magnetic resonance spectroscopy. As secondary outcomes, beta cell function was studied using variables derived from OGTT, and whole-body insulin sensitivity and pancreatic fatty acid and glucose uptake were measured using positron emission tomography. The measurements were carried out at the Turku PET Centre, Finland. The analyses were based on an intention-to-treat principle. Given the nature of the intervention, blinding was not applicable. RESULTS At baseline, the group of prediabetic or type 2 diabetic men had a higher pancreatic fat content and impaired beta cell function compared with the healthy men, while glucose and fatty acid uptake into the pancreas was similar. Exercise training decreased pancreatic fat similarly in healthy (from 4.4% [3.0%, 6.1%] to 3.6% [2.4%, 5.2%] [mean, 95% CI]) and prediabetic or type 2 diabetic men (from 8.7% [6.0%, 11.9%] to 6.7% [4.4%, 9.6%]; p = 0.036 for time effect) without any changes in pancreatic substrate uptake (p ≥ 0.31 for time effect in both insulin-stimulated glucose and fasting state fatty acid uptake). In prediabetic or type 2 diabetic men and women, both exercise modes similarly improved variables describing beta cell function. CONCLUSIONS/INTERPRETATION Two weeks of exercise training improves beta cell function in prediabetic or type 2 diabetic individuals and decreases pancreatic fat regardless of baseline glucose tolerance. This study shows that short-term training efficiently reduces ectopic fat within the pancreas, and exercise training may therefore reduce the risk of type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT01344928 FUNDING: This study was funded by the Emil Aaltonen Foundation, the European Foundation for the Study of Diabetes, the Finnish Diabetes Foundation, the Orion Research Foundation, the Academy of Finland (grants 251399, 256470, 281440, and 283319), the Ministry of Education of the State of Finland, the Paavo Nurmi Foundation, the Novo Nordisk Foundation, the Finnish Cultural Foundation, the Hospital District of Southwest Finland, the Turku University Foundation, and the Finnish Medical Foundation.
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Affiliation(s)
- Marja A Heiskanen
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Kumail K Motiani
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Virva Saunavaara
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | | | | | - Mikko Koivumäki
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | | | - Pirjo Nuutila
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Kari K Kalliokoski
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Jarna C Hannukainen
- Turku PET Centre, University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
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Solomon TPJ. Sources of Inter-individual Variability in the Therapeutic Response of Blood Glucose Control to Exercise in Type 2 Diabetes: Going Beyond Exercise Dose. Front Physiol 2018; 9:896. [PMID: 30061841 PMCID: PMC6055062 DOI: 10.3389/fphys.2018.00896] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023] Open
Abstract
In the context of type 2 diabetes, inter-individual variability in the therapeutic response of blood glucose control to exercise exists to the extent that some individuals, occasionally referred to as “non-responders,” may not experience therapeutic benefit to their blood glucose control. This narrative review examines the evidence and, more importantly, identifies the sources of such inter-individual variability. In doing so, this review highlights that no randomized controlled trial of exercise has yet prospectively measured inter-individual variability in blood glucose control in individuals with prediabetes or type 2 diabetes. Of the identified sources of inter-individual variability, neither has a prospective randomized controlled trial yet quantified the impact of exercise dose, exercise frequency, exercise type, behavioral/environmental barriers, exercise-meal timing, or anti-hyperglycemic drugs on changes in blood glucose control, in individuals with prediabetes or type 2 diabetes. In addition, there is also an urgent need for prospective trials to identify molecular or physiological predictors of inter-individual variability in the changes in blood glucose control following exercise. Therefore, the narrative identifies critical science gaps that must be filled if exercise scientists are to succeed in optimizing health care policy recommendations for type 2 diabetes, so that the therapeutic benefit of exercise may be maximized for all individuals with, or at risk of, diabetes.
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Affiliation(s)
- Thomas P J Solomon
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
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Francois ME, Gilbertson NM, Eichner NZM, Heiston EM, Fabris C, Breton M, Mehaffey JH, Hassinger T, Hallowell PT, Malin SK. Combining Short-Term Interval Training with Caloric Restriction Improves ß-Cell Function in Obese Adults. Nutrients 2018; 10:nu10060717. [PMID: 29865281 PMCID: PMC6024769 DOI: 10.3390/nu10060717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023] Open
Abstract
Although low-calorie diets (LCD) improve glucose regulation, it is unclear if interval exercise (INT) is additive. We examined the impact of an LCD versus LCD + INT training on ß-cell function in relation to glucose tolerance in obese adults. Twenty-six adults (Age: 46 ± 12 year; BMI 38 ± 6 kg/m²) were randomized to 2-week of LCD (~1200 kcal/day) or energy-matched LCD + INT (60 min/day alternating 3 min at 90 and 50% HRpeak). A 2 h 75 g oral glucose tolerance test (OGTT) was performed. Insulin secretion rates (ISR) were determined by deconvolution modeling to assess glucose-stimulated insulin secretion ([GSIS: ISR/glucose total area under the curve (tAUC)]) and ß-cell function (Disposition Index [DI: GSIS/IR]) relative to skeletal muscle (Matsuda Index), hepatic (HOMA-IR) and adipose (Adipose-IRfasting) insulin resistance (IR). LCD + INT, but not LCD alone, reduced glucose and total-phase ISR tAUC (Interactions: p = 0.04 and p = 0.05, respectively). Both interventions improved skeletal muscle IR by 16% (p = 0.04) and skeletal muscle and hepatic DI (Time: p < 0.05). Improved skeletal muscle DI was associated with lower glucose tAUC (r = -0.57, p < 0.01). Thus, LCD + INT improved glucose tolerance more than LCD in obese adults, and these findings relate to ß-cell function. These data support LCD + INT for preserving pancreatic function for type 2 diabetes prevention.
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Affiliation(s)
- Monique E Francois
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.
| | - Nicole M Gilbertson
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.
| | - Natalie Z M Eichner
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.
| | - Emily M Heiston
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.
| | - Chiara Fabris
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
| | - Marc Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
| | - J Hunter Mehaffey
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
| | - Taryn Hassinger
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
| | - Peter T Hallowell
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22903, USA.
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, 22903, USA.
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Winding KM, Munch GW, Iepsen UW, Van Hall G, Pedersen BK, Mortensen SP. The effect on glycaemic control of low-volume high-intensity interval training versus endurance training in individuals with type 2 diabetes. Diabetes Obes Metab 2018; 20:1131-1139. [PMID: 29272072 DOI: 10.1111/dom.13198] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022]
Abstract
AIM To evaluate whether high-intensity interval training (HIIT) with a lower time commitment can be as effective as endurance training (END) on glycaemic control, physical fitness and body composition in individuals with type 2 diabetes. MATERIALS AND METHODS A total of 29 individuals with type 2 diabetes were allocated to control (CON; no training), END or HIIT groups. Training groups received 3 training sessions per week consisting of either 40 minutes of cycling at 50% of peak workload (END) or 10 1-minute intervals at 95% of peak workload interspersed with 1 minute of active recovery (HIIT). Glycaemic control (HbA1c, oral glucose tolerance test, 3-hour mixed meal tolerance test with double tracer technique and continuous glucose monitoring [CGM]), lipolysis, VO2 peak and body composition were evaluated before and after 11 weeks of intervention. RESULTS Exercise training increased VO2 peak more in the HIIT group (20% ± 20%) compared with the END group (8% ± 9%) despite lower total energy expenditure and time usage during the training sessions. HIIT decreased whole body and android fat mass compared with the CON group. In addition, visceral fat mass, HbA1c, fasting glucose, postprandial glucose, glycaemic variability and HOMA-IR decreased after HIIT. The reduced postprandial glucose in the HIIT group was driven primarily by a lower rate of exogenous glucose appearance. In the CON group, postprandial lipolysis was augmented over the 11-week control period. CONCLUSIONS Despite a ~45% lower training volume, HIIT resulted in similar or even better improvements in physical fitness, body composition and glycemic control compared to END. HIIT therefore appears to be an important time-efficient treatment for individuals with type 2 diabetes.
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Affiliation(s)
- Kamilla M Winding
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Gregers W Munch
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik W Iepsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit Van Hall
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet and Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bente K Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stefan P Mortensen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
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Eichner NZM, Gilbertson NM, Gaitan JM, Heiston EM, Musante L, LaSalvia S, Weltman A, Erdbrügger U, Malin SK. Low cardiorespiratory fitness is associated with higher extracellular vesicle counts in obese adults. Physiol Rep 2018; 6:e13701. [PMID: 29845758 PMCID: PMC5974724 DOI: 10.14814/phy2.13701] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022] Open
Abstract
Low cardiorespiratory fitness (CRF) is associated with cardiovascular disease (CVD) independent of obesity. Extracellular vesicles (EVs) are a novel target of CVD, however, it remains unknown if obese individuals with very poor fitness (VPF) have elevated EVs versus people with poor fitness (PF). Thus, we tested whether VPF was associated with greater EV subtypes in obese adults. Subjects with VPF (n = 13, VO2 peak: 15.4 ± 0.6 mL/kg/min, BMI: 34.1 ± 1.7 kg/m2 ) and PF (n = 13, VO2 peak: 25.9 ± 3.0 mL/kg/min, BMI: 32.1 ± 1.2 kg/m2 ) were compared in this cross-sectional study. After an overnight fast, AnnexinV (AV) +/- platelet (CD31+ /CD41+ ), leukocyte (CD45+ /CD41- ), and endothelial EVs (CD105+ , CD31+ /CD41- ) were analyzed from fresh platelet poor plasma via imaging flow cytometry. Body fat, blood pressure (BP), and glucose tolerance (OGTT) were also tested. Body weight, BP, and circulating glucose were similar between groups, although VPF subjects were older than PF (64.0 ± 2.1 vs. 49.8 ± 4.2 year; P < 0.05). People with VPF, compared with PF, had higher total AV- EVs (P = 0.04), AV- platelet EVs (CD31+ /CD41+ ; P = 0.006), and AV- endothelial EVs (CD31+ /CD41- ; P = 0.005) independent of age and body fat. Higher AV- platelet and endothelial EVs were associated with lower VO2 peak (r = -0.56, P = 0.006 and r = -0.55, P = 0.005, respectively). Endothelial-derived AV- /CD31+ /CD41- EVs were also related to pulse pressure (r = 0.45, P = 0.03), whereas AV- /CD105 was linked to postprandial glucose (r = 0.41, P = 0.04). VPF is associated with higher AnnexinV- total, endothelial, and platelet EVs in obese adults, suggesting that subtle differences in fitness may reduce type 2 diabetes and CVD risk through an EV-related mechanism.
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Affiliation(s)
| | | | - Julian M. Gaitan
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginia
| | - Emily M. Heiston
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginia
| | - Luca Musante
- Division of NephrologyUniversity of VirginiaCharlottesvilleVirginia
| | - Sabrina LaSalvia
- Division of NephrologyUniversity of VirginiaCharlottesvilleVirginia
| | - Arthur Weltman
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginia
- Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVirginia
| | - Uta Erdbrügger
- Division of NephrologyUniversity of VirginiaCharlottesvilleVirginia
| | - Steven K. Malin
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginia
- Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVirginia
- Robert M. Berne Cardiovascular Research CenterUniversity of VirginiaCharlottesvilleVirginia
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Bariatric Surgery Resistance: Using Preoperative Lifestyle Medicine and/or Pharmacology for Metabolic Responsiveness. Obes Surg 2018; 27:3281-3291. [PMID: 29058238 DOI: 10.1007/s11695-017-2966-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is an effective and durable treatment for individuals with obesity and its associated comorbidities. However, not all patients meet weight loss and/or cardiometabolic goals following bariatric surgery, suggesting that some people are bariatric surgery resistant. The reason for this resistance is unclear, but potential factors, such as adiposity-derived inflammation, insulin resistance, hyperglycemia, and aerobic fitness prior to surgery, have been related to blunted surgery responsiveness. Exercise, diet, and/or pharmacology are effective at reducing inflammation and improving insulin action as well as physical function. Herein, we present data that supports the novel hypothesis that intervening prior to surgery can enhance disease resolution in people who are resistant to bariatric surgery.
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Barlow JP, Solomon TP. Do skeletal muscle-secreted factors influence the function of pancreatic β-cells? Am J Physiol Endocrinol Metab 2018; 314:E297-E307. [PMID: 29208613 DOI: 10.1152/ajpendo.00353.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Skeletal muscle is an endocrine organ that secretes a variety of compounds including proteins (myokines), metabolites, microRNAs (miRNAs), and exosomes, many of which are regulated by exercise and play important roles in endocrine signaling. Interorgan communication via muscle-secreted factors therefore provides a novel area for investigation and implicates the importance of skeletal muscle in the pathophysiology of metabolic diseases such as type 2 diabetes (T2D). Given that underlying molecular mechanisms of T2D are subject of ongoing research, in light of new evidence it is probable that interorgan cross-talk between skeletal muscle and pancreatic β-cells plays an important part. To date, the number of studies published in this field provide the basis of this review. Specifically, we discuss current experimental evidence in support for a role of skeletal muscle to β-cell cross-talk, paying particular attention to muscle-secreted factors including myokines, metabolites, miRNAs, and factors contained within exosomes that influence the function and/or the survival of β-cells in health and disease. In reviewing this evidence, we provide an update on the list of known muscle-secreted factors that have potential to influence the function and/or survival of β-cells under normal and diabetic conditions. We also report limitations of current cross-talk methods and discuss future directions in this growing field.
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Affiliation(s)
- Jonathan P Barlow
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham , Birmingham, West Midlands , United Kingdom
| | - Thomas P Solomon
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham , Birmingham, West Midlands , United Kingdom
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Dauriz M, Bacchi E, Boselli L, Santi L, Negri C, Trombetta M, Bonadonna RC, Bonora E, Moghetti P. Association of free-living physical activity measures with metabolic phenotypes in type 2 diabetes at the time of diagnosis. The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS). Nutr Metab Cardiovasc Dis 2018; 28:343-351. [PMID: 29477578 DOI: 10.1016/j.numecd.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/07/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Lifestyle is considered a major determinant of risk of type 2 diabetes (T2D). We investigated whether daily physical activity (DPA) is associated with beta-cell function (BF) and/or insulin sensitivity (IS) in patients with T2D at the time of diagnosis. METHODS AND RESULTS In 41 subjects enrolled in the Verona Newly-Diagnosed Type 2 Diabetes Study we assessed: (1) IS, by euglycaemic insulin clamp; (2) BF, estimated by prolonged-OGTT minimal modeling and expressed as derivative and proportional control; (3) DPA and energy expenditure (EE), assessed over 48-h monitoring by a validated wearable armband system. Study participants (median [IQR]; age: 62 [53-67] years, BMI: 30.8 [26.5-34.3] Kg m-2, HbA1c: 6.7 [6.3-7.3]%; 49.7 [45.4-56.3] mmol/mol) were moderately active (footsteps/day: 7773 [5748-10,927]; DPA≥3MET: 70 [38-125] min/day), but none of them exercised above 6 metabolic equivalents (MET). EE, expressed as EETOT (total daily-EE) and EE≥3MET (EE due to DPA≥3MET) were 2398 [2226-2801] and 364 [238-617] Kcal/day, respectively. IS (M-clamp 630 [371-878] μmol/min/m2) was positively associated with DPA and EE, independent of age, sex and BMI (p < 0.05). Among the DPA and EE parameters assessed, DPA≥3MET and EETOT were independent predictors of IS in multivariable regression analyses, adjusted for age, sex, BMI (R2 = 16%, R2 = 19%, respectively; p < 0.01). None of model-derived components of BF was significantly associated with DPA or accompanying EE. CONCLUSIONS Our study highlighted moderate levels of DPA and total EE as potential determinants of IS, but not BF, in T2D at the time of diagnosis. Intervention studies are needed to conclusively elucidate the effect of DPA on these features. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER NCT01526720.
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Affiliation(s)
- M Dauriz
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy.
| | - E Bacchi
- Department of Medicine, University of Verona, Verona, Italy
| | - L Boselli
- Department of Medicine, University of Verona, Verona, Italy
| | - L Santi
- Department of Medicine, University of Verona, Verona, Italy
| | - C Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - M Trombetta
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - R C Bonadonna
- Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Parma School of Medicine, Parma, Italy; Azienda Ospedaliera Universitaria, Parma, Italy
| | - E Bonora
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - P Moghetti
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
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Rowan CP, Riddell MC, Gledhill N, Jamnik VK. Aerobic Exercise Training Modalities and Prediabetes Risk Reduction. Med Sci Sports Exerc 2017; 49:403-412. [PMID: 27776003 DOI: 10.1249/mss.0000000000001135] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Prediabetes is linked to several modifiable risk factors, in particular, physical activity participation. The optimal prescription for physical activity remains uncertain. This pilot study aimed to investigate the effectiveness of continuous moderate intensity (CON) versus high-intensity interval training (HIIT) in persons with prediabetes. Outcome measures included glycated hemoglobin (A1C), body composition, musculoskeletal and aerobic fitness. METHODS Participants (n = 35) were recruited and screened using a questionnaire plus capillary blood point-of-care A1C analysis. After baseline screening/exclusions, 21 participants were randomly assigned to either HIIT or CON training three times per week for 12 wk. All participants also undertook resistance training two times per week. A1C, an oral glucose tolerance test, select measures of physical and physiological fitness were assessed at baseline and follow-up. RESULTS There were no significant differences in improvements in select metabolic indicators to training between CON and HIT groups. Pooled participant data showed a mean reduction in A1C of 0.5% (95% confidence interval [CI] = 0.3%-0.7%), whereas β-cell function (%β) improved by 28.9% (95% CI = 16.5%-39.2%) and insulin sensitivity (%S) decreased by 34.8 (95% CI = 57.8%-11.8), as assessed by the Homeostatic Model Assessment. Significant reductions in waist circumference of 4.5 cm (P < 0.001) and a 20% (P < 0.001) improvement in aerobic fitness were also observed in both training groups. CONCLUSION The completion of a 12-wk exercise program involving both resistance training and either HIIT or CON training results in improved glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes.
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Affiliation(s)
- Chip P Rowan
- 1York University, School of Kinesiology and Health Science, Toronto, ON, CANADA; and 2LMC Diabetes and Endocrinology and Manna Research, Toronto, ON, CANADA
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Colleluori G, Napoli N, Phadnis U, Armamento-Villareal R, Villareal DT. Effect of Weight Loss, Exercise, or Both on Undercarboxylated Osteocalcin and Insulin Secretion in Frail, Obese Older Adults. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4807046. [PMID: 28951766 PMCID: PMC5603129 DOI: 10.1155/2017/4807046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/25/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obesity exacerbates age-related decline in glucometabolic control. Undercarboxylated osteocalcin (UcOC) regulates pancreatic insulin secretion. The long-term effect of lifestyle interventions on UcOC and insulin secretion has not been investigated. METHODS One hundred seven frail, obese older adults were randomized into the control (N = 27), diet (N = 26), exercise (N = 26), and diet-exercise (N = 28) groups for 1 year. Main outcomes included changes in UcOC and disposition index (DI). RESULTS UcOC increased in the diet group (36 ± 11.6%) but not in the other groups (P < 0.05 between groups). Although similar increases in DI occurred in the diet-exercise and diet groups at 6 months, DI increased more in the diet-exercise group (92.4 ± 11.4%) than in the diet group (61.9 ± 15.3%) at 12 months (P < 0.05). UcOC and body composition changes predicted DI variation in the diet group only (R2 = 0.712), while adipocytokines and physical function changes contributed to DI variation in both the diet (∆R2 = 0.140 and 0.107) and diet-exercise (∆R2 = 0.427 and 0.243) groups (P < 0.05 for all). CONCLUSIONS Diet, but not exercise or both, increases UcOC, whereas both diet and diet-exercise increase DI. UcOC accounts for DI variation only during active weight loss, while adipocytokines and physical function contribute to diet-exercise-induced DI variation, highlighting different mechanisms for lifestyle-induced improvements in insulin secretion. This trial was registered with ClinicalTrials.gov number NCT00146107.
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Affiliation(s)
- Georgia Colleluori
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- University Campus-Biomedico, 00128, Rome, Italy
| | | | - Uma Phadnis
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Dennis T. Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Rynders CA, Blanc S, DeJong N, Bessesen DH, Bergouignan A. Sedentary behaviour is a key determinant of metabolic inflexibility. J Physiol 2017; 596:1319-1330. [PMID: 28543022 DOI: 10.1113/jp273282] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/22/2017] [Indexed: 01/14/2023] Open
Abstract
Metabolic flexibility is defined as the ability to adapt substrate oxidation rates in response to changes in fuel availability. The inability to switch between the oxidation of lipid and carbohydrate appears to be an important feature of chronic disorders such as obesity and type 2 diabetes. Laboratory assessment of metabolic flexibility has traditionally involved measurement of the respiratory quotient (RQ) by indirect calorimetry during the fasted to fed transition (e.g. mixed meal challenge) or during a hyperinsulinaemic-euglycaemic clamp. Under these controlled experimental conditions, 'metabolic inflexibility' is characterized by lower fasting fat oxidation (higher fasting RQ) and/or an impaired ability to oxidize carbohydrate during feeding or insulin-stimulated conditions (lower postprandial or clamp RQ). This experimental paradigm has provided fundamental information regarding the role of substrate oxidation in the development of obesity and insulin resistance. However, the key determinants of metabolic flexibility among relevant clinical populations remain unclear. Herein, we propose that habitual physical activity levels are a primary determinant of metabolic flexibility. We present evidence demonstrating that high levels of physical activity predict metabolic flexibility, while physical inactivity and sedentary behaviours trigger a state of metabolic 'inflexibility', even among individuals who meet physical activity recommendations. Furthermore, we describe alternative experimental approaches to studying the concept of metabolic flexibility across a range of activity and inactivity. Finally, we address the promising use of strategies that aim to reduce sedentary behaviours as therapy to improve metabolic flexibility and reduce weight gain risk.
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Affiliation(s)
- Corey A Rynders
- Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Stephane Blanc
- Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, CNRS, Strasbourg, France.,UMR 7178 Centre National de la Recherche Scientifique (CNRS), Strasbourg, France
| | - Nathan DeJong
- Division of Endocrinology, Metabolism and Diabetes and Anschutz Health and Wellness Center, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes and Anschutz Health and Wellness Center, University of Colorado, School of Medicine, Aurora, CO, USA.,Denver Health Medical Center, Denver, CO, USA
| | - Audrey Bergouignan
- Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, CNRS, Strasbourg, France.,UMR 7178 Centre National de la Recherche Scientifique (CNRS), Strasbourg, France.,Division of Endocrinology, Metabolism and Diabetes and Anschutz Health and Wellness Center, University of Colorado, School of Medicine, Aurora, CO, USA
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