Metabolic response to moderate exercise in obese man during prolonged fasting

Effects of fasting on endurance exercise

Early studies agree that fasting is detrimental to overall physical performance and to endurance performance in humans; however, a study in rats reported an ergogenic effect where time to exhaustion was increased by a glycogen-sparing effect of elevated free fatty acids in blood resulting from a 24-hour fast. Later studies on humans have also found a detrimental effect of fasting on exercise endurance, with the exception of 1 study which found no difference. The discrepancy between humans and rats could not be explained by level of glycogen sparing, mode of exercise, duration of the fast, physiological differences or level of training. The intensity of exercise, and a potential placebo effect of fasting, are possible reasons for the conflicting results. Despite reduced endurance performance, fasted humans are able to exercise and maintain blood glucose homeostasis; the specific cause of an earlier onset of fatigue during a single bout of exercise in the fasted state remains unclear.

Fatty acid kinetic responses to exercise. Effects of obesity, body fat distribution, and energy-restricted diet

Upper body obesity (UB Ob) is associated with a reduced net free fatty acid (FFA) response to epinephrine compared with nonobese (Non Ob) and lower-body obese (LB Ob) women. Because catecholamines regulate some of the metabolic responses to exercise, we hypothesized that UB Ob would have a reduced net FFA response to exercise. Plasma FFA rate of appearance (Ra) ([1-14C]palmitate) and fatty acid oxidation (indirect calorimetry) were therefore measured during 2.5 h of stationary bicycle exercise (45% VO2 peak) in 13 UB Ob, 11 LB Ob, and 8 Non Ob premenopausal women. 10 UB Ob and 8 LB Ob women were retested after an approximately 8-kg weight loss.

RESULTS

During exercise Non Ob and LB Ob women had greater increments in FFA availability (51 +/- 7 and 53 +/- 8 mmol, respectively) than UB Ob women (27 +/- 4 mmol, P < 0.05). Total exercise FFA availability and fatty acid oxidation were not different between Non Ob, LB Ob, and UB Ob women, however. Following weight loss (approximately 8 kg), the FFA response to exercise increased (P < 0.01) and remained greater (P < 0.05) in LB Ob than in UB Ob women. In conclusion, the FFA response to exercise was reduced in UB Ob women before and after weight loss, but no effects on fatty acid oxidation were apparent.

Plasma glucose metabolism during exercise in humans

Plasma glucose is an important energy source in exercising humans, supplying between 20 and 50% of the total oxidative energy production and between 25 and 100% of the total carbohydrate oxidised during submaximal exercise. Plasma glucose utilisation increases with the intensity of exercise, due to an increase in glucose utilisation by each active muscle fibre, an increase in the number of active muscle fibres, or both. Plasma glucose utilisation also increases with the duration of exercise, thereby partially compensating for the progressive decrease in muscle glycogen concentration. When compared at the same absolute exercise intensity (i.e. the same VO2), reliance on plasma glucose is also greater during exercise performed with a small muscle mass, i.e. with the arms or just 1 leg. This may be due to differences in the relative exercise intensity (i.e. the %VO2peak), or due to differences between the arms and legs in their fitness for aerobic activity. The rate of plasma glucose utilisation is decreased when plasma free fatty acid or muscle glycogen concentrations are very high, effects which are probably mediated by increases in muscle glucose-6-phosphate concentration. However, glucose utilisation is also reduced during exercise following a low carbohydrate diet, despite the fact that muscle glycogen is also often lower. When exercise is performed at the same absolute intensity before and after endurance training, plasma glucose utilisation is lower in the trained state. During exercise performed at the same relative intensity, however, glucose utilisation may be lower, the same, or actually higher in trained than in untrained subjects, because of the greater absolute VO2 and demand for substrate in trained subjects during exercise at a given relative exercise intensity. Although both hyperglycaemia and hypoglycaemia may occur during exercise, plasma glucose concentration usually remains relatively constant. Factors which increase or decrease the reliance of peripheral tissues on plasma glucose during exercise are therefore generally accompanied by quantitatively similar increases or decreases in glucose production. These changes in total glucose production are mediated by changes in both hepatic glycogenolysis and hepatic gluconeogenesis. Glycogenolysis dominates under most conditions, and is greatest early in exercise, during high intensity exercise, or when dietary carbohydrate intake is high. The rate of gluconeogenesis is increased when exercise is prolonged, preceded by a restricted carbohydrate intake, or performed with the arms. Both glycogenolysis and gluconeogenesis appear to be decreased by endurance exercise training. These effects are due to changes in both the hormonal milieu and in the availability of hepatic glycogen and gluconeogenic precursors.(ABSTRACT TRUNCATED AT 400 WORDS)

Influence of a 24 h fast on high intensity cycle exercise performance in man

The influence of a 24 h fast on endurance performance and the metabolic response to maximal cycle exercise was investigated in 6 healthy men (mean +/- SD: age = 27 +/- 7 years; weight = 73 +/- 10 kg; VO2max = 46 +/- 10 ml.kg-1.min-1). Subjects performed in randomised order two exercise bouts to exhaustion separated by one week. Test rides were performed in fasted (F) and post-absorptive (normal-diet, ND) conditions on an electrically braked cycle ergometer at a workload equivalent to 100% of VO2max. Acid-base status and selected metabolites were measured on arterialised venous blood at rest prior to exercise and at intervals for 15 mins following exercise. Exercise time to exhaustion was shorter after F compared with ND (p less than 0.01). Pre-exercise blood bicarbonate (HCO3-) concentration, PCO2 and base excess (BE) were lower after F compared with ND (p less than 0.05). Prior to exercise, circulating concentrations of free fatty acids (FFA), beta-hydroxybutyrate (B-HB) and glycerol were higher after F compared with ND (p less than 0.01) but blood glucose and lactate concentration were not different. On the F treatment, after exercise, blood pH, HCO3-, and BE were all significantly higher (p less than 0.01) than on ND; blood lactate concentration was significantly lower for the whole of the post-exercise period after F compared with ND (p less than 0.01). Circulating levels of FFA and B-HB after exercise on the F treatment fell but levels of these substrates were not altered by exercise after ND.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic islet hormone response to oral glucose in morbidly obese patients

Pancreatic islet peptides, as well as other gastrointestinal hormones, have been implicated in both the pathogenesis of obesity and the etiology of associated metabolic derangements. This study evaluated the pancreatic islet and gastrointestinal (GI) hormone response to oral glucose in 20 morbidly obese (151% above ideal body weight) patients. Glucose intolerance, hyperinsulinism, and exaggerated gastric inhibitory polypeptide (GIP) release occurred following glucose ingestion. Significant release of PP occurred in 14 patients, while only six patients had release of somatostatin. No significant changes in plasma concentrations of glucagon occurred. Since GIP is insulinotropic in the presence of hyperglycemia, the hyperinsulinism of morbid obesity may be secondary to the abnormally high glucose-stimulated GIP levels in these patients. Failure of glucagon suppression in response to oral glucose many contribute to the hyperglycemia noted. Somatostatin and pancreatic polypeptide may be responsible for some of the metabolic derangements of morbid obesity.