Effect of training status on fuel selection during submaximal exercise with glucose ingestion

HbA1c and Liver Fat After 16 Weeks of Fasted versus Fed Exercise Training in Adults With Type 2 Diabetes

PURPOSE

Exercise-nutrient timing is of interest for people with type 2 diabetes (T2D) as a potential method to optimize glycemic control. However, the optimal nutritional environment for exercise is not well understood over the long term. The Fasted Exercise for Type 2 Diabetes (FED) Trial compared 16 wk of fasted versus postprandial morning exercise on glycated hemoglobin (HbA1c) and liver proton density fat fraction (PDFF).

METHODS

Twenty adults with T2D were recruited and randomized to complete exercise after an overnight fast versus after their morning meal. Participants walked three mornings per week, progressing to 180 min·wk -1 over 16 wk.

RESULTS

Groups were balanced with five males and five females each. Sixteen participants completed the trial (8 in each group, 50% female). Age, HbA1c, and PDFF were 59.8 ± 9.0 yr, 7.2 ± 0.7%, and 9.3 ± 4.1%, respectively. On average, both groups completed 98% of their walking sessions but there was no change in HbA1c (-0.2%, P = 0.588). However, one participant from each group had changes in their glucose-lowering medication during the trial, and when excluded, the fasted training group had greater improvements in HbA1c compared with the postprandial group (-0.3% vs 0.0%, P = 0.033). There was no difference in changes in liver PDFF between groups (-1.6% vs 0.3%, P = 0.221) but visceral fat and intramuscular fat decreased to a greater extent after fasted exercise.

CONCLUSIONS

Although our study had a small sample size, it suggests that exercise after an overnight fast can have high adherence and represents an option for people with T2D to improve longer-term indicators of glycemia and ectopic fat depots.

Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has emerged as a prevalent health concern, encompassing a wide spectrum of liver-related disorders. Insulin resistance, a key pathophysiological feature of MASLD, can be effectively ameliorated through dietary interventions. The Mediterranean diet, rich in whole grains, fruits, vegetables, legumes, and healthy fats, has shown promising results in improving insulin sensitivity. Several components of the Mediterranean diet, such as monounsaturated fats and polyphenols, exert anti-inflammatory and antioxidant effects, thereby reducing hepatic steatosis and inflammation. Furthermore, this dietary pattern has been associated with a higher likelihood of achieving MASLD remission. In addition to dietary modifications, physical exercise, particularly resistance exercise, plays a crucial role in enhancing metabolic flexibility. Resistance exercise training promotes the utilization of fatty acids as an energy source. It enhances muscle glucose uptake and glycogen storage, thus reducing the burden on the liver to uptake excess blood glucose. Furthermore, resistance exercise stimulates muscle protein synthesis, contributing to an improved muscle-to-fat ratio and overall metabolic health. When implemented synergistically, the Mediterranean diet and resistance exercise can elicit complementary effects in combating MASLD. Combined interventions have demonstrated additive benefits, including greater improvements in insulin resistance, increased metabolic flexibility, and enhanced potential for MASLD remission. This underscores the importance of adopting a multifaceted approach encompassing dietary modifications and regular physical exercise to effectively manage MASLD. This narrative review explores the biological mechanisms of diet and physical exercise in addressing MASLD by targeting insulin resistance and decreased metabolic flexibility.

Chronic exercise improves hepatic acylcarnitine handling

Exercise mediates tissue metabolic function through direct and indirect adaptations to acylcarnitine (AC) metabolism, but the exact mechanisms are unclear. We found that circulating medium-chain acylcarnitines (AC) (C12-C16) are lower in active/endurance trained human subjects compared to sedentary controls, and this is correlated with elevated cardiorespiratory fitness and reduced adiposity. In mice, exercise reduced serum AC and increased liver AC, and this was accompanied by a marked increase in expression of genes involved in hepatic AC metabolism and mitochondrial β-oxidation. Primary hepatocytes from high-fat fed, exercise trained mice had increased basal respiration compared to hepatocytes from high-fat fed sedentary mice, which may be attributed to increased Ca2+ cycling and lipid uptake into mitochondria. The addition of specific medium- and long-chain AC to sedentary hepatocytes increased mitochondrial respiration, mirroring the exercise phenotype. These data indicate that AC redistribution is an exercise-induced mechanism to improve hepatic function and metabolism.

Insulin resistance and metabolic flexibility as drivers of liver and cardiac disease in T2DM

Metabolic flexibility refers to the ability of tissues to adapt their use of energy sources according to substrate availability and energy demands. This review aims to disentangle the emerging mechanisms through which altered metabolic flexibility and insulin resistance promote NAFLD and heart disease progression. Insulin resistance and metabolic inflexibility are central drivers of hepatic and cardiac diseases in individuals with type 2 diabetes. Both play a critical role in the complex interaction between glucose and lipid metabolism. Disruption of metabolic flexibility results in hyperglycemia and abnormal lipid metabolism, leading to increased accumulation of fat in the liver, contributing to the development and progression of NAFLD. Similarly, insulin resistance affects cardiac glucose metabolism, leading to altered utilization of energy substrates and impaired cardiac function, and influence cardiac lipid metabolism, further exacerbating the progression of heart failure. Regular physical activity promotes metabolic flexibility by increasing energy expenditure and enabling efficient switching between different energy substrates. On the contrary, weight loss achieved through calorie restriction ameliorates insulin sensitivity without improving flexibility. Strategies that mimic the effects of physical exercise, such as pharmacological interventions or targeted lifestyle modifications, show promise in effectively treating both diabetes and NAFLD, finally reducing the risk of advanced liver disease.

Effects of exercise timing on metabolic health

The increasing prevalence of metabolic syndrome is associated with major health and socioeconomic consequences. Currently, physical exercise, together with dietary interventions, is the mainstay of the treatment of obesity and related metabolic complications. Although exercise training includes different modalities, with variable intensity, duration, volume, or frequency, which may have a distinct impact on several characteristics related to metabolic syndrome, the potential effects of exercise timing on metabolic health are yet to be fully elucidated. Remarkably, promising results with regard to this topic have been reported in the last few years. Similar to other time-based interventions, including nutritional therapy or drug administration, time-of-day-based exercise may become a useful approach for the management of metabolic disorders. In this article, we review the role of exercise timing in metabolic health and discuss the potential mechanisms that could drive the metabolic-related benefits of physical exercise performed in a time-dependent manner.

The effect of acute manipulation of carbohydrate availability on high intensity running performance, running economy, critical speed, and substrate metabolism in trained Male runners

Completing selected training sessions with reduced glycogen availability is associated with greater signalling and improved muscle oxidative capacity, although it may impact the overall quality of the session. We examined the effects of low carbohydrate availability on high intensity exercise performance, running economy, critical speed, and substrate metabolism. On two occasions, nine male runners (V̇O2peak 60.3 ± 3.3 mL.kg-1.min-1) completed a glycogen depletion protocol involving 90-min at 75%vV̇O2peak followed by 10 × 1-min at 110% vV̇O2peak. This was followed either by high (HIGH) or low (LOW) carbohydrate intake (>6 g.kg-1.day-1 and <50 g.day-1, respectively) until completion of a performance protocol on day 2 consisting of a series of time-trials (TT) (50m to 3000m) and physiological assessments. There were no differences between LOW and HIGH for any TT distance (mean TT performance times for LOW and HIGH were: 3000m TT 651.7 ± 52.8s and 646.4 ± 52.5s, 1500 m TT 304.0 ± 20.2s and 304.2 ± 22.1s, 400 m TT 67.64 ± 4.2s and 67.3 ± 3.8s, 50 m TT 7.27 ± 0.44s and 7.25 ± 0.45s, respectively, P > 0.05), though some athletes performed better in LOW (n = 5). While fat oxidation in LOW was significantly greater than HIGH (Δ0.32 ± 0.14 g.min-1; P < 0.001 at 14 km.h-1 and Δ0.34 ± 0.12 g.min-1 at 16 km.h-1; P < 0.01), running economy did not differ between trials (P > 0.05). Acute manipulation of carbohydrate availability showed immediate effects on substrate metabolism evidenced by greater fat oxidation without changes in RE. Acute low carbohydrate availability did not affect high intensity running performance across a range of distances.Highlights Acute manipulation of muscle glycogen availability using an exercise and dietary manipulation protocol did not affect subsequent high intensity running performance across a range of running distances.Reduced muscle glycogen resulted in a marked increase in fat oxidation in low glycogen condition but no changes in running economy or critical speed.Individual factors should be considered when prescribing high intensity sessions with restricted carbohydrate availability.

Exercise-induced changes to the fiber type-specific redox state in human skeletal muscle are associated with aerobic capacity

The benefits of exercise involve skeletal muscle redox state alterations of nicotinamide adenine dinucleotide (NAD) and flavin adenine dinucleotide (FAD). We determined the fiber-specific effects of acute exercise on the skeletal muscle redox state in healthy adults. Muscle biopsies were obtained from 19 participants (11 M, 8 F; 26 ± 4 yr) at baseline (fasted) and 30 min and 3 h after treadmill exercise at 80% maximal oxygen consumption (V̇o2max). Muscle samples were probed for autofluorescence of NADH (excitation at 340-360 nm) and oxidized flavoproteins (Fp; excitation at 440-470 nm) and subsequently, fiber typed to quantify the redox signatures of individual muscle fibers. Redox state was calculated as the oxidation-to-reduction redox ratio: Fp/(Fp + NADH). At baseline, pair-wise comparisons revealed that the redox ratio of myosin heavy chain (MHC) I fibers was 7.2% higher than MHC IIa (P = 0.023, 95% CI: 5.2, 9.2%) and the redox ratio of MHC IIa was 8.0% higher than MHC IIx (P = 0.035, 95% CI: 6.8, 9.2%). MHC I fibers also displayed greater NADH intensity than MHC IIx (P = 0.007) and greater Fp intensity than both MHC IIa (P = 0.019) and MHC IIx (P < 0.0001). Fp intensities increased in all fiber types (main effect, P = 0.039) but redox ratios did not change (main effect, P = 0.483) 30 min after exercise. The change in redox ratio was positively correlated with capillary density in MHC I (rho = 0.762, P = 0.037), MHC IIa fibers (rho = 0.881, P = 0.007), and modestly in MHC IIx fibers (rho = 0. 771, P = 0.103). These findings support the use of redox autofluorescence to interrogate skeletal muscle metabolism.NEW & NOTEWORTHY This study is the first to use autofluorescent imaging to describe differential redox states within human skeletal muscle fiber types with exercise. Our findings highlight an easy and efficacious technique for assessing skeletal muscle redox in humans.

Metabolic Adaptations and Substrate Oxidation are Unaffected by Exogenous Testosterone Administration during Energy Deficit in Men

INTRODUCTION/PURPOSE

The effects of testosterone on energy and substrate metabolism during energy deficit are unknown. The objective of this study was to determine the effects of weekly testosterone enanthate (TEST; 200 mg·wk -1 ) injections on energy expenditure, energy substrate oxidation, and related gene expression during 28 d of energy deficit compared with placebo (PLA).

METHODS

After a 14-d energy balance phase, healthy men were randomly assigned to TEST ( n = 24) or PLA ( n = 26) for a 28-d controlled diet- and exercise-induced energy deficit (55% below total energy needs by reducing energy intake and increasing physical activity). Whole-room indirect calorimetry and 24-h urine collections were used to measure energy expenditure and energy substrate oxidation during balance and deficit. Transcriptional regulation of energy and substrate metabolism was assessed using quantitative reverse transcription-polymerase chain reaction from rested/fasted muscle biopsy samples collected during balance and deficit.

RESULTS

Per protocol design, 24-h energy expenditure increased ( P < 0.05) and energy intake decreased ( P < 0.05) in TEST and PLA during deficit compared with balance. Carbohydrate oxidation decreased ( P < 0.05), whereas protein and fat oxidation increased ( P < 0.05) in TEST and PLA during deficit compared with balance. Change (∆; deficit minus balance) in 24-h energy expenditure was associated with ∆activity factor ( r = 0.595), but not ∆fat-free mass ( r = 0.147). Energy sensing (PRKAB1 and TP53), mitochondria (TFAM and COXIV), fatty acid metabolism (CD36/FAT, FABP, CPT1b, and ACOX1) and storage (FASN), and amino acid metabolism (BCAT2 and BCKHDA) genes were increased ( P < 0.05) during deficit compared with balance, independent of treatment.

CONCLUSIONS

These data demonstrate that increased physical activity and not exogenous testosterone administration is the primary determinate of whole-body and skeletal muscle metabolic adaptations during diet- and exercise-induced energy deficit.

Lymphocyte and dendritic cell response to a period of intensified training in young healthy humans and rodents: A systematic review and meta-analysis

Background: Intensified training coupled with sufficient recovery is required to improve athletic performance. A stress-recovery imbalance can lead to negative states of overtraining. Hormonal alterations associated with intensified training, such as blunted cortisol, may impair the immune response. Cortisol promotes the maturation and migration of dendritic cells which subsequently stimulate the T cell response. However, there are currently no clear reliable biomarkers to highlight the overtraining syndrome. This systematic review and meta-analysis examined the effect of intensified training on immune cells. Outcomes from this could provide insight into whether these markers may be used as an indicator of negative states of overtraining. Methods: SPORTDiscus, PUBMED, Academic Search Complete, Scopus and Web of Science were searched until June 2022. Included articles reported on immune biomarkers relating to lymphocytes, dendritic cells, and cytokines before and after a period of intensified training, in humans and rodents, at rest and in response to exercise. Results: 164 full texts were screened for eligibility. Across 57 eligible studies, 16 immune biomarkers were assessed. 7 were assessed at rest and in response to a bout of exercise, and 9 assessed at rest only. Included lymphocyte markers were CD3⁺, CD4⁺ and CD8⁺ T cell count, NK cell count, NK Cytolytic activity, lymphocyte proliferation and CD4/CD8 ratio. Dendritic cell markers examined were CD80, CD86, and MHC II expression. Cytokines included IL-1β, IL-2, IL-10, TNF-α and IFN-γ. A period of intensified training significantly decreased resting total lymphocyte (d= -0.57, 95% CI -0.30) and CD8⁺ T cell counts (d= -0.37, 95% CI -0.04), and unstimulated plasma IL-1β levels (d= -0.63, 95% CI -0.17). Resting dendritic cell CD86 expression significantly increased (d = 2.18, 95% CI 4.07). All other biomarkers remained unchanged. Conclusion: Although some biomarkers alter after a period of intensified training, definitive immune biomarkers are limited. Specifically, due to low study numbers, further investigation into the dendritic cell response in human models is required.

Effects of Hyperbaric Oxygen Therapy on Mitochondrial Respiration and Physical Performance in Middle-Aged Athletes: A Blinded, Randomized Controlled Trial

Introduction

Hyperbaric oxygen therapy (HBOT) has been used to increase endurance performance but has yet to be evaluated in placebo-controlled clinical trials. The current study aimed to evaluate the effect of an intermittent HBOT protocol on maximal physical performance and mitochondrial function in middle-aged master athletes.

Methods

A double-blind, randomized, placebo-controlled study on 37 healthy middle-aged (40–50) master athletes was performed between 2018 and 2020. The subjects were exposed to 40 repeated sessions of either HBOT [two absolute atmospheres (ATA), breathing 100% oxygen for 1 h] or SHAM (1.02ATA, breathing air for 1 h).

Results

Out of 37 athletes, 16 HBOT and 15 SHAM allocated athletes were included in the final analysis. Following HBOT, there was a significant increase in the maximal oxygen consumption (VO2Max) (p = 0.010, effect size(es) = 0.989) and in the oxygen consumption measured at the anaerobic threshold (VO2AT)(es = 0.837) compared to the SHAM group. Following HBOT, there were significant increases in both maximal oxygen phosphorylation capacity (es = 1.085, p = 0.04), maximal uncoupled capacity (es = 0.956, p = 0.02) and mitochondrial mass marker MTG (p = 0.0002) compared to the SHAM sessions.

Conclusion

HBOT enhances physical performance in healthy middle-age master athletes, including VO2max, power and VO2AT. The mechanisms may be related to significant improvements in mitochondrial respiration and increased mitochondrial mass.

Trial Registration ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT03524989 (May 15, 2018).

Ergogenic property of Morinda citrifolia L. leaf extract affects energy metabolism in obese Sprague Dawley rats

Ergogenic property is the ability to enhance capacity for physical activities through efficient production of energy and is potentially beneficial in weight management for the obese. In this study, ergogenic property of Morinda citrifolia leaf's extract (MCL) was evaluated using AMP-activated protein kinase (AMPK) activity and high fat diet-induced obese rats. Findings from the study showed that MCL demonstrated ergogenic activity via enhancement of AMPK activity using L6 skeletal muscle cell line. Interestingly, the result also revealed that rats treated with the intermediate dosage of MCL experienced the lowest % weight gain. The rats fed the highest dose of 200 mg/kg BW MCL demonstrated the longest swimming time of approximately three times that of green tea and caffeine-fed rats. The highest dose fed rats were also found to have lower glucose and lactate levels, suggesting that energy metabolism was more effective in these rats. In addition, lactate dehydrogenase and creatinine kinase activities, the muscle injury indicators, were found to be the lowest in rats fed the highest MCL dose. The same effect was not seen in rats fed either caffeine or green tea, indicating that MCL treatment is may be protective of the rats' muscles. It was also shown that MCL consisted of various flavonoids with epicatechin, catechin, and quercetin that may be responsible for the effects measured. In conclusion, improvements were seen in rats fed MCL in terms of weight management, endurance capacity, energy metabolism, and muscle injury parameters. PRACTICAL APPLICATIONS: Results of the study revealed that Morinda citrifolia leaf has great potential to be used as functional ingredient in the development of designer food/drink as ergogenic aid for both obese and non-obese individuals. Morinda citrifolia leaf could help in the weight management of obese people and enhance endurance capacity and energy metabolism in active individuals.

Relationship between physical activity time and intramuscular adipose tissue content of the thigh muscle groups of younger and older men

We investigated the effect of physical activity on muscle tissue size and intramuscular adipose tissue (IntraMAT) content in the thigh muscle groups of younger and older men. Twenty younger and 20 older men participated in this study. The muscle tissue cross-sectional area (CSA) and the IntraMAT content in the quadriceps femoris (QF), hamstrings (HM), hip adductors (AD), and mid-thigh total were measured using magnetic resonance imaging. The physical activity time was measured using a triaxial accelerometer, and four levels of physical activity were determined depending on the metabolic equivalent of task (METs), including sedentary (≤ 1.5 METs), light intensity (≤ 2.9 METs), moderate intensity (3.0–5.9 METs), and vigorous intensity (≥ 6.0 METs). No significant correlation was observed between the physical activity parameters and muscle tissue CSA in both groups. The IntraMAT content of the three muscle groups (QF, AD, and HM) and the total thigh was inversely correlated with the time of moderate-intensity physical activity (r_s =  − 0.625 to − 0.489, P < 0.05, for all comparisons) in the young group, but not in the older group. These results indicate that IntraMAT accumulation was associated with the amount of moderate-physical activity in younger men.

The Influence of Epigenetic Modifications on Metabolic Changes in White Adipose Tissue and Liver and Their Potential Impact in Exercise

Background: Epigenetic marks are responsive to a wide variety of environmental stimuli and serve as important mediators for gene transcription. A number of chromatin modifying enzymes orchestrate epigenetic responses to environmental stimuli, with a growing body of research examining how changes in metabolic substrates or co-factors alter epigenetic modifications.

Scope of Review: Here, we provide a systematic review of existing evidence of metabolism-related epigenetic changes in white adipose tissue (WAT) and the liver and generate secondary hypotheses on how exercise may impact metabolism-related epigenetic marks in these tissues.

Major Conclusions: Epigenetic changes contribute to the complex transcriptional responses associated with WAT lipolysis, hepatic de novo lipogenesis, and hepatic gluconeogenesis. While these metabolic responses may hypothetically be altered with acute and chronic exercise, direct testing is needed.

Regulation of Energy Substrate Metabolism in Endurance Exercise

The human body requires energy to function. Adenosine triphosphate (ATP) is the cellular currency for energy-requiring processes including mechanical work (i.e., exercise). ATP used by the cells is ultimately derived from the catabolism of energy substrate molecules—carbohydrates, fat, and protein. In prolonged moderate to high-intensity exercise, there is a delicate interplay between carbohydrate and fat metabolism, and this bioenergetic process is tightly regulated by numerous physiological, nutritional, and environmental factors such as exercise intensity and duration, body mass and feeding state. Carbohydrate metabolism is of critical importance during prolonged endurance-type exercise, reflecting the physiological need to regulate glucose homeostasis, assuring optimal glycogen storage, proper muscle fuelling, and delaying the onset of fatigue. Fat metabolism represents a sustainable source of energy to meet energy demands and preserve the ‘limited’ carbohydrate stores. Coordinated neural, hormonal and circulatory events occur during prolonged endurance-type exercise, facilitating the delivery of fatty acids from adipose tissue to the working muscle for oxidation. However, with increasing exercise intensity, fat oxidation declines and is unable to supply ATP at the rate of the exercise demand. Protein is considered a subsidiary source of energy supporting carbohydrates and fat metabolism, contributing to approximately 10% of total ATP turnover during prolonged endurance-type exercise. In this review we present an overview of substrate metabolism during prolonged endurance-type exercise and the regulatory mechanisms involved in ATP turnover to meet the energetic demands of exercise.

Carbohydrate supplementation during a simulated 10-km open water swimming race: effects on physiological, perceptual parameters and performance

The aim of the present study was to test the effect of carbohydrate ingestion, simulating a 10-km open water race competition on energy cost (Csw), perceived exertion (RPE), heart rate (HR), stroke rate (SR) and performance. We hypothesized that carbohydrate ingestion would reduce Csw and RPE in elite open water swimmers (OW-swimmers) and improve performance. Eight elite OW-swimmers swam for 3 × 30 min with 20-s of interval necessary to collect data in the swimming flume at a pre-set pace corresponding to their 10-km race pace, followed by a time to exhaustion test (TTE) at 100% of the peak oxygen uptake (V̇O_2peak). During the set, OW-swimmers ingested 45-g of carbohydrates (CHO) in 550-mL of water (8% solution) during each of the two intervals or a placebo solution (PLA). HR, RPE, V̇O₂ and SR were measured. Shapiro-Wilk test was used to verify the normal distribution of data. Two-way repeated measures ANOVA and t-test was performed (p < 0.05). A significant difference emerged in TTE between the trials (169.00 ± 91.06 s in CHO; 102.31 ± 57.47 s in PLA). HR, RPE and SR increased during the TTE but did not differ between trials. Csw did not show a significant main effect between the two conditions and in time course in both conditions. CHO ingestion significantly increased TTE at 100% of V̇O_2peak after 90-min of swimming at 10-km race pace. These findings indicate that CHO intake during a 10-km open water swimming competition should have a beneficial impact on performance in the final part of the race.

Effect of moderate-intensity seated exercise on the management of metabolic outcomes in hypertensive individuals with or without exercise habits

Background

We aimed to evaluate the effect of moderate-intensity seated exercise on metabolic outcomes in hypertensive individuals with or without exercise habits.

Methods

Forty-two hypertensive individuals volunteered for this study and were classified into 3 groups by their habits and place for moderate-intensity exercise prior to this study: NONE (<2 days/week or no exercise; n = 13), HOME (≥30 min/day and ≥2 days/week at home; n = 15), and GYM (≥30 min/day and ≥2 days/week at a hospital gym; n = 14). They performed their daily activities as usual and seated exercise (stepping and stepping with trunk rotation; a range of 11–13 on the Borg rating of perceived exertion scale) for at least 15 min/day and at least 3 days/week for 12 weeks.

Results

Thirty-five participants (age: 67.7 ± 5.9 years) completed the study, and there was no difference among the 3 groups regarding weekly exercise. The homeostasis model assessment of insulin resistance (HOMA-IR) value in the NONE group was significantly higher than that in the GYM group at baseline (p < 0.05), but it decreased significantly after 12 weeks (from 2.2 ± 0.8 to 1.7 ± 0.7, p < 0.05). Changes in HOMA-IR in the NONE group after 12 weeks was greater than that in the HOME and GYM groups (both p < 0.01). The HOME and GYM groups showed no significant changes in any of the variables.

Conclusion

Moderate-intensity seated exercise may be an effective strategy to improve insulin resistance in hypertensive individuals without exercise habits.

High-Fat Ketogenic Diets and Physical Performance: A Systematic Review

Use of high-fat, ketogenic diets (KDs) to support physical performance has grown in popularity over recent years. While these diets enhance fat and reduce carbohydrate oxidation during exercise, the impact of a KD on physical performance remains controversial. The objective of this work was to assess the effect of KDs on physical performance compared with mixed macronutrient diets [control (CON)]. A systematic review of the literature was conducted using PubMed and Cochrane Library databases. Randomized and nonrandomized studies were included if participants were healthy (free of chronic disease), nonobese [BMI (kg/m2) <30], trained or untrained men or women consuming KD (<50 g carbohydrate/d or serum or whole-blood β-hydroxybutyrate >0.5 mmol/L) compared with CON (fat, 12-38% of total energy intake) diets for ≥14 d, followed by a physical performance test. Seventeen studies (10 parallel, 7 crossover) with 29 performance (13 endurance, 16 power or strength) outcomes were identified. Of the 13 endurance-type performance outcomes, 3 (1 time trial, 2 time-to-exhaustion) reported lower and 10 (4 time trials, 6 time-to-exhaustion) reported no difference in performance between the KD compared with CON. Of the 16 power or strength performance outcomes, 3 (1 power, 2 strength) reported lower, 11 (4 power, 7 strength) no difference, and 2 (power) enhanced performance in the KD compared with the CON. Risk of bias identified some concern of bias primarily due to studies allowing participants to self-select diet intervention groups and the inability to blind participants to the study intervention. Overall, the majority of null results across studies suggest that a KD does not have a positive or negative impact on physical performance compared with a CON diet. However, discordant results between studies may be due to multiple factors, such as the duration consuming study diets, training status, performance test, and sex differences, which will be discussed in this systematic review.

Metabolic rate in sedentary adults, following different exercise training interventions: The FIT-AGEING randomized controlled trial

BACKGROUND & AIMS

This study compares the influence of different exercise training programs on basal metabolic rate (BMR) and fat oxidation, in basal conditions (BFox) and during exercise (MFO), in sedentary, middle-aged adults.

METHODS

The study subjects of this 12 week-long, randomised controlled trial, were 71 middle-aged adults (age 53.5 ± 4.9 years; 52% women). Subjects were randomly assigned to one of the following groups: (1) no exercise, (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT group), and (4) high intensity interval training plus whole-body electromyostimulation (HIIT + EMS group). Subject BMR, BFox and MFO were determined by indirect calorimetry before and after the intervention.

RESULTS

The HIIT + EMS subjects showed significant increases in BFox following the intervention compared with the control group (all P = 0.043); no such differences were seen in the PAR and HIIT compared with the control group (all P ≥ 0.1). A significant increase in post-intervention MFO was noted for the HIIT and HIIT + EMS group compared to the non-exercise control group (P < 0.05); no such difference was seen in the PAR group compared to the control group (all P ≥ 0.05).

CONCLUSIONS

Twelve weeks of high intensity interval training plus whole-body electromyostimulation may increase the BFox and MFO of middle-aged sedentary adults. These findings have important clinical implications; a well-designed high-intensity interval training program plus whole-body electromyostimulation might be followed to help combat the appearance of chronic metabolic diseases characterized by metabolic inflexibility in middle-aged sedentary adults, though it will be necessary to determine how long the effects last.

Charge Characteristics of Agouti-Related Protein Implicate Potent Involvement of Heparan Sulfate Proteoglycans in Metabolic Function

The endogenous melanocortin peptide agouti-related protein (AgRP) plays a well-known role in foraging, but its contribution to metabolic regulation is less understood. Mature AgRP_(83-132) has distinct residues for melanocortin receptor binding and heparan sulfate interactions. Here, we show that AgRP increases ad libitum feeding and operant responding for food in mice, decreases oxygen consumption, and lowers body temperature and activity, indicating lower energy expenditure. AgRP increased the respiratory exchange ratio, indicating a reduction of fat oxidation and a shift toward carbohydrates as the primary fuel source. The duration and intensity of AgRP's effects depended on the density of its positively charged amino acids, suggesting that its orexigenic and metabolic effects depend on its affinity for heparan sulfate. These findings may have major clinical implications by unveiling the critical involvement of interactions between AgRP and heparan sulfate to the central regulation of energy expenditure, fat utilization, and possibly their contribution to metabolic disease.

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AgRP increases both ad libitum and operant food intake and reduces energy expenditure

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AgRP reduces fat utilization as a fuel source, which promotes body fat accumulation

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These actions of AgRP depend on the positive charges, outside its ICK motif, that bind heparan sulfate

Cardiorespiratory Fitness May Influence Metabolic Inflexibility During Exercise in Obese Persons

CONTEXT

We examined whether obese individuals have a reduced maximal fat oxidation (MFO) and the intensity that elicit MFO (Fatmax) compared with normal weight and overweight persons, taking into account their level of cardiorespiratory fitness.

METHODS

The study subjects were 138 sedentary adults (87 women) aged 30.1 ± 13.6 years. Based on their body mass index, subjects were categorized as being of normal weight (n = 66), overweight (n = 48), or obese (n = 24). MFO and Fatmax were determined for all subjects by indirect calorimetry, using a walking graded exercise test. MFO was expressed in absolute terms (g/min) and relative to whole-body lean mass (mg/kgleanmass/min). Cardiorespiratory fitness was assessed via a maximal treadmill test.

RESULTS

No differences in absolute MFO and Fatmax values were seen between the obese, normal weight, and overweight subjects (all P > 0.2), although after adjusting for cardiorespiratory fitness, the obese subjects returned significantly higher values than did their normal weight and overweight counterparts (all P < 0.03). However, when expressed with respect to lean mass, the MFO of the normal weight subjects was significantly greater than that of the overweight and obese subjects, independent of age, sex, or cardiorespiratory fitness.

CONCLUSIONS

Obese individuals have higher absolute MFO values when cardiorespiratory fitness is taken into account, but when expressed with respect to lean mass, normal weight individuals show a greater capacity to oxidize fat during exercise per unit of metabolically active tissue independent of age, sex, or cardiorespiratory fitness. These findings suggest that obese individuals may suffer from metabolic inflexibility during exercise.

Comparison of Mitochondrial Respiration in M. triceps brachii and M. vastus lateralis Between Elite Cross-Country Skiers and Physically Active Controls

Rationale

The main purposes of this study were to compare mitochondrial respiration in M. triceps brachii and M. vastus lateralis between elite cross-country (XC) skiers and physically active controls (CON), and to explore the associations between mitochondrial respiration in these muscles and peak oxygen uptake ( V ˙ O_2peak) in arm- and leg-dominant exercise modes.

Methods

Thirteen male elite XC skiers (age: 25 ± 4; peak oxygen uptake ( V ˙ O_2peak): 75.5 ± 4.2 mL⋅kg^-1⋅min^-1) and twelve CON (age: 26 ± 3; V ˙ O_2peak: 57.2 ± 6.4 mL⋅kg^-1⋅min^-1) had microbiopsies taken from M. vastus lateralis and M. triceps brachii, which were analyzed for various measures of mitochondrial respiration using high-resolution respirometry. Thereafter, all participants tested V ˙ O_2peak in both running (RUN) and upper body poling (UBP).

Results

XC skiers had generally higher mitochondrial respiration in M. triceps brachii compared to CON (P < 0.001), whereas no significant group-differences in mitochondrial respiration in M. vastus lateralis were revealed. XC skiers had higher mitochondrial respiration in M. triceps brachii compared to M. vastus lateralis (P = 0.005-0.058), whereas in CON, most mitochondrial respiration measures were higher in M. vastus lateralis than in M. triceps brachii (P < 0.01). When all athletes were pooled, there was a strong positive correlation between V ˙ O_2peak in UBP and mitochondrial respiration in M. triceps brachii on several measures (P < 0.01), whereas no correlation was found for RUN.

Conclusion

The higher mitochondrial respiration found in M. triceps brachii compared to M. vastus lateralis among our elite XC skiers demonstrates the potential for the arm muscles to adapt to aerobic endurance training. The opposite pattern found in CON, clearly showed lower mitochondrial respiration in M. triceps brachii compared to XC skiers, whereas respiration in M. vastus lateralis did not differ between groups. The strong positive correlation between mitochondrial respiration in M. triceps brachii and V ˙ O_2peak in UBP indicate that arm muscles' respiratory function may be a limiting factor for V ˙ O_2peak in arm-dominant exercise modes.

Carbohydrate Supplementation Does Not Improve 10 km Swimming Intermittent Training

The aim of the present study was to test the effectiveness of carbohydrate (CHO) feeding supplemented every 2.5-km, as in official races, on the performance, rating of perceived exertion (RPE), and glycaemia during a 10-km intermittent training workout in elite open-water swimmers. A randomized crossover design was used. Participants completed two 10-km intermittent training sessions (20 × 500-m). The relative velocity was expressed in percentage of a single 500-m. Glycaemia was monitored by continuous glucose monitoring. Participants had to ingest either 1 L of tap water (WAT; 0.50 L·h⁻¹) or 120 g of CHO in the form of 8% solution (60 g·h⁻¹). The 15-point RPE scale was used during the trials. A two-way ANOVA for repeated measures was performed (p < 0.05). The relative velocity of each 500-m was not significantly different between the two trials. No significant differences emerged in the relative velocity of the last 500-m between trials. Average RPE was not statistically different between the two trials (11 ± 3 in WAT and 12 ± 3 in CHO). In the last 500-m, glycaemia was significantly higher in the CHO trial (5.92 ± 0.47 mmol·L⁻¹ in CHO; 5.61 ± 0.61 mmol·L⁻¹ in WAT). CHO ingestion did not improve performance or affect RPE during a 10-km intermittent training in elite open-water swimmers.

Dietary sugars, exercise and hepatic carbohydrate metabolism

The present paper reviews the physiological responses of human liver carbohydrate metabolism to physical activity and ingestion of dietary sugars. The liver represents a central link in human carbohydrate metabolism and a mechanistic crux point for the effects of dietary sugars on athletic performance and metabolic health. As a corollary, knowledge regarding physiological responses to sugar ingestion has potential application to either improve endurance performance in athletes, or target metabolic diseases in people who are overweight, obese and/or sedentary. For example, exercise increases whole-body glycogen utilisation, and the breakdown of liver glycogen to maintain blood glucose concentrations becomes increasingly important as exercise intensity increases. Accordingly, prolonged exercise at moderate-to-high exercise intensity results in depletion of liver glycogen stores unless carbohydrate is ingested during exercise. The exercise-induced glycogen deficit can increase insulin sensitivity and blood glucose control, and may result in less hepatic lipid synthesis. Therefore, the induction and maintenance of a glycogen deficit with exercise could be a specific target to improve metabolic health and could be achieved by carbohydrate (sugar) restriction before, during and/or after exercise. Conversely, for athletes, maintaining and restoring these glycogen stores is a priority when competing in events requiring repeated exertion with limited recovery. With this in mind, evidence consistently demonstrates that fructose-containing sugars accelerate post-exercise liver glycogen repletion and could reduce recovery time by as much as half that seen with ingestion of glucose (polymers)-only. Therefore, athletes aiming for rapid recovery in multi-stage events should consider ingesting fructose-containing sugars to accelerate recovery.

Contextualising Maximal Fat Oxidation During Exercise: Determinants and Normative Values

Using a short-duration step protocol and continuous indirect calorimetry, whole-body rates of fat and carbohydrate oxidation can be estimated across a range of exercise workloads, along with the individual maximal rate of fat oxidation (MFO) and the exercise intensity at which MFO occurs (Fatmax). These variables appear to have implications both in sport and health contexts. After discussion of the key determinants of MFO and Fatmax that must be considered during laboratory measurement, the present review sought to synthesize existing data in order to contextualize individually measured fat oxidation values. Data collected in homogenous cohorts on cycle ergometers after an overnight fast was synthesized to produce normative values in given subject populations. These normative values might be used to contextualize individual measurements and define research cohorts according their capacity for fat oxidation during exercise. Pertinent directions for future research were identified.

Ingestion of carbohydrate or carbohydrate plus protein does not enhance performance during endurance exercise: a randomized crossover placebo-controlled clinical trial

A beverage containing protein (PRO) and carbohydrate (CHO) may have an ergogenic effect on endurance performance. However, evidence regarding its efficacy on similar conditions to athletes' race day is still lacking. The objective of this study was to compare the effects of 3 different nutritional supplementation strategies on performance and muscle recovery in a duathlon protocol. Thirteen male athletes (29.7 ± 7.7 years) participated in 3 simulated Olympic-distance duathlon trials (SDTs) under 3 different, randomly assigned supplementation regimens: CHO drink (75 g CHO), isocaloric CHO plus PRO drink (60.5 g CHO and 14.5 g PRO), and placebo drink (PLA). Supplements were offered during the cycling bout. Blood samples were collected before, immediately after, and 24 h after each SDT for creatine kinase (CK) analysis. Isometric peak torque (PT) was measured before and 24 h after each SDT. The primary outcome measure was the time to complete the 5-km running section (t_5km) at a self-selected pace. There was no difference in t_5km between CHO (1270.3 ± 130.5 s), CHO+PRO (1267.2 ± 138.9 s), and PLA (1275.4 ± 120 s); p = 0.87, effect size (ES) ≤ 0.1. Pre-post changes for PT and CK were not significant for any of the 3 conditions (PT: p = 0.24, ES ≤ 0.4; CK: p = 0.32, ES = 0.3-1.04). For endurance sports lasting up to 2 h, with a pre-exercise meal containing CHO at 1.5 g·kg^-1, supplementation with CHO or CHO+PRO does not offer additional benefits for performance and muscle recovery when compared with PLA.

Systems-level computational modeling demonstrates fuel selection switching in high capacity running and low capacity running rats

High capacity and low capacity running rats, HCR and LCR respectively, have been bred to represent two extremes of running endurance and have recently demonstrated disparities in fuel usage during transient aerobic exercise. HCR rats can maintain fatty acid (FA) utilization throughout the course of transient aerobic exercise whereas LCR rats rely predominantly on glucose utilization. We hypothesized that the difference between HCR and LCR fuel utilization could be explained by a difference in mitochondrial density. To test this hypothesis and to investigate mechanisms of fuel selection, we used a constraint-based kinetic analysis of whole-body metabolism to analyze transient exercise data from these rats. Our model analysis used a thermodynamically constrained kinetic framework that accounts for glycolysis, the TCA cycle, and mitochondrial FA transport and oxidation. The model can effectively match the observed relative rates of oxidation of glucose versus FA, as a function of ATP demand. In searching for the minimal differences required to explain metabolic function in HCR versus LCR rats, it was determined that the whole-body metabolic phenotype of LCR, compared to the HCR, could be explained by a ~50% reduction in total mitochondrial activity with an additional 5-fold reduction in mitochondrial FA transport activity. Finally, we postulate that over sustained periods of exercise that LCR can partly overcome the initial deficit in FA catabolic activity by upregulating FA transport and/or oxidation processes.

Our bodies consume carbohydrates, fats, and amino acids as fuels, utilizing various catabolic pathways to transfer the energy required for normal physiological functions. The way these pathways function can have an important impact on overall health. While most catabolic pathways are known, we are still striving to understand how these pathways interact, are controlled, and change during exercise and in disease. Here, we have used computer modeling as a tool to understand fuel utilization differences during exercise for two animal models. High capacity running rats (HCR) were used as a healthy, fit cohort, and low capacity running rats (LCR) were used as a sedentary and disease-prone cohort. Our computer model results show that the HCRs are superior at fat utilization compared to LCRs because of their increased ability to transport and catabolize fatty acids. We postulate that these differences depend on exercise intensity and duration, such that longer acclimation periods may minimize fuel utilization differences between these rats.

Could Age, Sex and Physical Fitness Affect Blood Glucose Responses to Exercise in Type 1 Diabetes?

Closed-loop systems for patients with type 1 diabetes are progressing rapidly. Despite these advances, current systems may struggle in dealing with the acute stress of exercise. Algorithms to predict exercise-induced blood glucose changes in current systems are mostly derived from data involving relatively young, fit males. Little is known about the magnitude of confounding variables such as sex, age, and fitness level-underlying, uncontrollable factors that might influence blood glucose control during exercise. Sex-related differences in hormonal responses to physical exercise exist in studies involving individuals without diabetes, and result in altered fuel metabolism during exercise. Increasing age is associated with attenuated catecholamine responses and lower carbohydrate oxidation during activity. Furthermore, higher fitness levels can alter hormonal and fuel selection responses to exercise. Compounding the limited research on these factors in the metabolic response to exercise in type 1 diabetes is a limited understanding of how these variables affect blood glucose levels during different types, timing and intensities of activity in individuals with type 1 diabetes (T1D). Thus, there is currently insufficient information to model a closed-loop system that can predict them accurately and consistently prevent hypoglycemia. Further, studies involving both sexes, along with a range of ages and fitness levels, are needed to create a closed-loop system that will be more precise in regulating blood glucose during exercise in a wide variety of individuals with T1D.

Metabolic Flexibility in Health and Disease

Metabolic flexibility is the ability to respond or adapt to conditional changes in metabolic demand. This broad concept has been propagated to explain insulin resistance and mechanisms governing fuel selection between glucose and fatty acids, highlighting the metabolic inflexibility of obesity and type 2 diabetes. In parallel, contemporary exercise physiology research has helped to identify potential mechanisms underlying altered fuel metabolism in obesity and diabetes. Advances in "omics" technologies have further stimulated additional basic and clinical-translational research to further interrogate mechanisms for improved metabolic flexibility in skeletal muscle and adipose tissue with the goal of preventing and treating metabolic disease.

Glucose Plus Fructose Ingestion for Post-Exercise Recovery-Greater than the Sum of Its Parts?

Carbohydrate availability in the form of muscle and liver glycogen is an important determinant of performance during prolonged bouts of moderate- to high-intensity exercise. Therefore, when effective endurance performance is an objective on multiple occasions within a 24-h period, the restoration of endogenous glycogen stores is the principal factor determining recovery. This review considers the role of glucose-fructose co-ingestion on liver and muscle glycogen repletion following prolonged exercise. Glucose and fructose are primarily absorbed by different intestinal transport proteins; by combining the ingestion of glucose with fructose, both transport pathways are utilised, which increases the total capacity for carbohydrate absorption. Moreover, the addition of glucose to fructose ingestion facilitates intestinal fructose absorption via a currently unidentified mechanism. The co-ingestion of glucose and fructose therefore provides faster rates of carbohydrate absorption than the sum of glucose and fructose absorption rates alone. Similar metabolic effects can be achieved via the ingestion of sucrose (a disaccharide of glucose and fructose) because intestinal absorption is unlikely to be limited by sucrose hydrolysis. Carbohydrate ingestion at a rate of ≥1.2 g carbohydrate per kg body mass per hour appears to maximise post-exercise muscle glycogen repletion rates. Providing these carbohydrates in the form of glucose-fructose (sucrose) mixtures does not further enhance muscle glycogen repletion rates over glucose (polymer) ingestion alone. In contrast, liver glycogen repletion rates are approximately doubled with ingestion of glucose-fructose (sucrose) mixtures over isocaloric ingestion of glucose (polymers) alone. Furthermore, glucose plus fructose (sucrose) ingestion alleviates gastrointestinal distress when the ingestion rate approaches or exceeds the capacity for intestinal glucose absorption (~1.2 g/min). Accordingly, when rapid recovery of endogenous glycogen stores is a priority, ingesting glucose-fructose mixtures (or sucrose) at a rate of ≥1.2 g·kg body mass-1·h-1 can enhance glycogen repletion rates whilst also minimising gastrointestinal distress.

Liver glycogen metabolism during and after prolonged endurance-type exercise

Carbohydrate and fat are the main substrates utilized during prolonged endurance-type exercise. The relative contribution of each is determined primarily by the intensity and duration of exercise, along with individual training and nutritional status. During moderate- to high-intensity exercise, carbohydrate represents the main substrate source. Because endogenous carbohydrate stores (primarily in liver and muscle) are relatively small, endurance-type exercise performance/capacity is often limited by endogenous carbohydrate availability. Much exercise metabolism research to date has focused on muscle glycogen utilization, with little attention paid to the contribution of liver glycogen. (13)C magnetic resonance spectroscopy permits direct, noninvasive measurements of liver glycogen content and has increased understanding of the relevance of liver glycogen during exercise. In contrast to muscle, endurance-trained athletes do not exhibit elevated basal liver glycogen concentrations. However, there is evidence that liver glycogenolysis may be lower in endurance-trained athletes compared with untrained controls during moderate- to high-intensity exercise. Therefore, liver glycogen sparing in an endurance-trained state may account partly for training-induced performance/capacity adaptations during prolonged (>90 min) exercise. Ingestion of carbohydrate at a relatively high rate (>1.5 g/min) can prevent liver glycogen depletion during moderate-intensity exercise independent of the type of carbohydrate (e.g., glucose vs. sucrose) ingested. To minimize gastrointestinal discomfort, it is recommended to ingest specific combinations or types of carbohydrates (glucose plus fructose and/or sucrose). By coingesting glucose with either galactose or fructose, postexercise liver glycogen repletion rates can be doubled. There are currently no guidelines for carbohydrate ingestion to maximize liver glycogen repletion.

Effects of various concentrations of carbohydrate mouth rinse on cycling performance in a fed state

The objective of this study was to identify the effects of mouth rinsing with a 6% and 16% carbohydrate solution (CHO) on time trial performance when compared to a 0% control (PLA) when in a fed state. Twelve recreationally active males underwent three trials by which they had to complete a set workload (600 ± 65 W) in a fed state. Throughout each trial, participants rinsed their mouths with a 25 ml bolus of a 0% PLA, 6% or 16% CHO (maltodextrin) for every 12.5% of work completed. Rating of perceived exertion (RPE) and heart rate were recorded every 12.5% of total work. Performance times and power output improved significantly when using the 6% and 16% CHO versus the PLA trial (6% versus PLA, p = .002 and 16% versus PLA, p = .001). When comparing the performance times of the 6% to 16% CHO, no significance was observed (p = .244). There was no significant difference between heart rate levels or RPE values across the three trials. In conclusion, mouth rinsing with a 6% or 16% CHO solution has a positive effect on a cycling time trial performance undertaken in a fed state.

(13)C-Breath testing in animals: theory, applications, and future directions

The carbon isotope values in the exhaled breath of an animal mirror the carbon isotope values of the metabolic fuels being oxidized. The measurement of stable carbon isotopes in carbon dioxide is called (13)C-breath testing and offers a minimally invasive method to study substrate oxidation in vivo. (13)C-breath testing has been broadly used to study human exercise, nutrition, and pathologies since the 1970s. Owing to reduced use of radioactive isotopes and the increased convenience and affordability of (13)C-analyzers, the past decade has witnessed a sharp increase in the use of breath testing throughout comparative physiology--especially to answer questions about how and when animals oxidize particular nutrients. Here, we review the practical aspects of (13)C-breath testing and identify the strengths and weaknesses of different methodological approaches including the use of natural abundance versus artificially-enriched (13)C tracers. We critically compare the information that can be obtained using different experimental protocols such as diet-switching versus fuel-switching. We also discuss several factors that should be considered when designing breath testing experiments including extrinsic versus intrinsic (13)C-labelling and different approaches to model nutrient oxidation. We use case studies to highlight the myriad applications of (13)C-breath testing in basic and clinical human studies as well as comparative studies of fuel use, energetics, and carbon turnover in multiple vertebrate and invertebrate groups. Lastly, we call for increased and rigorous use of (13)C-breath testing to explore a variety of new research areas and potentially answer long standing questions related to thermobiology, locomotion, and nutrition.

Day to day variability in fat oxidation and the effect after only 1 day of change in diet composition

Indirect calorimetry is a common and noninvasive method to estimate rate of fat oxidation (FatOx) during exercise, and test-retest reliability should be considered when interpreting results. Diet also has an impact on FatOx. The aim of the present study was to investigate day to day variations in FatOx during moderate exercise given the same diet and 2 different isoenergetic diets. Nine healthy, moderately-trained females participated in the study. They performed 1 maximal oxygen uptake test and 4 FatOx tests. Habitual diets were recorded and repeated to assess day to day variability in FatOx. FatOx was also measured after 1 day of fat-rich (26.8% carbohydrates (CHO), 23.2% protein, 47.1% fat) and 1 day of CHO-rich diet (62.6% CHO, 20.1% protein, 12.4% fat). The reliability test revealed no differences in FatOx, respiratory exchange ratio (RER), oxygen uptake, carbon dioxide production, heart rate, blood lactate concentration, or blood glucose between the 2 habitual diet days. FatOx decreased after the CHO-rich diet compared with the habitual day 2 (from 0.42 ± 0.15 to 0.29 ± 0.13 g·min(-1), p < 0.05). No difference was found in FatOx between fat-rich diet and the 2 habitual diet days. FatOx was 31% lower (from 0.42 ± 0.14 to 0.29 ± 0.13 g·min(-1), p < 0.01) after the CHO-rich diet compared with the fat-rich diet. Using RER data to measure FatOx is a reliable method as long as the diet is strictly controlled. However, even a 1-day change in macronutrient composition will likely affect the FatOx results.

A step towards personalized sports nutrition: carbohydrate intake during exercise

There have been significant changes in the understanding of the role of carbohydrates during endurance exercise in recent years, which allows for more specific and more personalized advice with regard to carbohydrate ingestion during exercise. The new proposed guidelines take into account the duration (and intensity) of exercise and advice is not restricted to the amount of carbohydrate; it also gives direction with respect to the type of carbohydrate. Studies have shown that during exercise lasting approximately 1 h in duration, a mouth rinse or small amounts of carbohydrate can result in a performance benefit. A single carbohydrate source can be oxidized at rates up to approximately 60 g/h and this is the recommendation for exercise that is more prolonged (2-3 h). For ultra-endurance events, the recommendation is higher at approximately 90 g/h. Carbohydrate ingested at such high ingestion rates must be a multiple transportable carbohydrates to allow high oxidation rates and prevent the accumulation of carbohydrate in the intestine. The source of the carbohydrate may be a liquid, semisolid, or solid, and the recommendations may need to be adjusted downward when the absolute exercise intensity is low and thus carbohydrate oxidation rates are also low. Carbohydrate intake advice is independent of body weight as well as training status. Therefore, although these guidelines apply to most athletes, they are highly dependent on the type and duration of activity. These new guidelines may replace the generic existing guidelines for carbohydrate intake during endurance exercise.

Mitochondria express enhanced quality as well as quantity in association with aerobic fitness across recreationally active individuals up to elite athletes

Changes in skeletal muscle respiratory capacity parallel that of aerobic fitness. It is unknown whether mitochondrial content, alone, can fully account for these differences in skeletal muscle respiratory capacity. The aim of the present study was to examine quantitative and qualitative mitochondrial characteristics across four different groups (n = 6 each), separated by cardiorespiratory fitness. High-resolution respirometry was performed on muscle samples to compare respiratory capacity and efficiency in active, well-trained, highly trained, and elite individuals. Maximal exercise capacity (ml O(2)·min(-1)·kg(-1)) differed across all groups, with mean ± SD values of 51 ± 4, 64 ± 5, 71 ± 2, and 77 ± 3, respectively. Mitochondrial content assessed by citrate synthase activity was higher in elite trained compared with active and well-trained (29 ± 7 vs. 16 ± 4 and 19 ± 4 nmol·min(-1)·mg wet wt(-1), respectively). When normalizing respiration to mitochondrial content, the respiratory capacities during maximal fatty acid oxidation (P = 0.003), maximal state 3 respiration (P = 0.021), and total electron transport system capacity (P = 0.008) improved with respect to maximal exercise capacity. The coupling efficiency of β-oxidation, however, expressed no difference across groups. These data demonstrate the quantitative and qualitative differences that exist in skeletal muscle mitochondrial respiratory capacity and efficiency across individuals that differ in aerobic capacity. Mitochondrial-specific respiration capacities during β-oxidation, maximal oxidative phosphorylation, and electron transport system capacity all correspondingly improve with aerobic capacity, independent of mitochondrial content in human skeletal muscle.

Impact of postprandial glycaemia on health and prevention of disease

Postprandial glucose, together with related hyperinsulinemia and lipidaemia, has been implicated in the development of chronic metabolic diseases like obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this review, available evidence is discussed on postprandial glucose in relation to body weight control, the development of oxidative stress, T2DM, and CVD and in maintaining optimal exercise and cognitive performance. There is mechanistic evidence linking postprandial glycaemia or glycaemic variability to the development of these conditions or in the impairment in cognitive and exercise performance. Nevertheless, postprandial glycaemia is interrelated with many other (risk) factors as well as to fasting glucose. In many studies, meal-related glycaemic response is not sufficiently characterized, or the methodology with respect to the description of food or meal composition, or the duration of the measurement of postprandial glycaemia is limited. It is evident that more randomized controlled dietary intervention trials using effective low vs. high glucose response diets are necessary in order to draw more definite conclusions on the role of postprandial glycaemia in relation to health and disease. Also of importance is the evaluation of the potential role of the time course of postprandial glycaemia.

Physical activity and exercise in the regulation of human adipose tissue physiology

Physical activity and exercise are key components of energy expenditure and therefore of energy balance. Changes in energy balance alter fat mass. It is therefore reasonable to ask: What are the links between physical activity and adipose tissue function? There are many complexities. Physical activity is a multifaceted behavior of which exercise is just one component. Physical activity influences adipose tissue both acutely and in the longer term. A single bout of exercise stimulates adipose tissue blood flow and fat mobilization, resulting in delivery of fatty acids to skeletal muscles at a rate well-matched to metabolic requirements, except perhaps in vigorous intensity exercise. The stimuli include adrenergic and other circulating factors. There is a period following an exercise bout when fatty acids are directed away from adipose tissue to other tissues such as skeletal muscle, reducing dietary fat storage in adipose. With chronic exercise (training), there are changes in adipose tissue physiology, particularly an enhanced fat mobilization during acute exercise. It is difficult, however, to distinguish chronic "structural" changes from those associated with the last exercise bout. In addition, it is difficult to distinguish between the effects of training per se and negative energy balance. Epidemiological observations support the idea that physically active people have relatively low fat mass, and intervention studies tend to show that exercise training reduces fat mass. A much-discussed effect of exercise versus calorie restriction in preferentially reducing visceral fat is not borne out by meta-analyses. We conclude that, in addition to the regulation of fat mass, physical activity may contribute to metabolic health through beneficial dynamic changes within adipose tissue in response to each activity bout.

Impact of protein coingestion on muscle protein synthesis during continuous endurance type exercise

This study investigates the impact of protein coingestion with carbohydrate on muscle protein synthesis during endurance type exercise. Twelve healthy male cyclists were studied during 2 h of fasted rest followed by 2 h of continuous cycling at 55% W(max). During exercise, subjects received either 1.0 g·kg(-1)·h(-1) carbohydrate (CHO) or 0.8 g·kg(-1)·h(-1) carbohydrate with 0.2 g·kg(-1)·h(-1) protein hydrolysate (CHO+PRO). Continuous intravenous infusions with l-[ring-(13)C(6)]phenylalanine and l-[ring-(2)H(2)]tyrosine were applied, and blood and muscle biopsies were collected to assess whole body protein turnover and muscle protein synthesis rates at rest and during exercise conditions. Protein coingestion stimulated whole body protein synthesis and oxidation rates during exercise by 22 ± 3 and 70 ± 17%, respectively (P < 0.01). Whole body protein breakdown rates did not differ between experiments. As a consequence, whole body net protein balance was slightly negative in CHO and positive in the CHO+PRO treatment (-4.9 ± 0.3 vs. 8.0 ± 0.3 μmol Phe·kg(-1)·h(-1), respectively, P < 0.01). Mixed muscle protein fractional synthetic rates (FSR) were higher during exercise compared with resting conditions (0.058 ± 0.006 vs. 0.035 ± 0.006%/h in CHO and 0.070 ± 0.011 vs. 0.038 ± 0.005%/h in the CHO+PRO treatment, respectively, P < 0.05). FSR during exercise did not differ between experiments (P = 0.46). We conclude that muscle protein synthesis is stimulated during continuous endurance type exercise activities when carbohydrate with or without protein is ingested. Protein coingestion does not further increase muscle protein synthesis rates during continuous endurance type exercise.

Impaired microvascular perfusion: a consequence of vascular dysfunction and a potential cause of insulin resistance in muscle

Insulin has an exercise-like action to increase microvascular perfusion of skeletal muscle and thereby enhance delivery of hormone and nutrient to the myocytes. With insulin resistance, insulin's action to increase microvascular perfusion is markedly impaired. This review examines the present status of these observations and techniques available to measure such changes as well as the possible underpinning mechanisms. Low physiological doses of insulin and light exercise have been shown to increase microvascular perfusion without increasing bulk blood flow. In these circumstances, blood flow is proposed to be redirected from the nonnutritive route to the nutritive route with flow becoming dominant in the nonnutritive route when insulin resistance has developed. Increased vasomotion controlled by vascular smooth muscle may be part of the explanation by which insulin mediates an increase in microvascular perfusion, as seen from the effects of insulin on both muscle and skin microvascular blood flow. In addition, vascular dysfunction appears to be an early development in the onset of insulin resistance, with the consequence that impaired glucose delivery, more so than insulin delivery, accounts for the diminished glucose uptake by insulin-resistant muscle. Regular exercise may prevent and ameliorate insulin resistance by increasing "vascular fitness" and thereby recovering insulin-mediated capillary recruitment.

Protein coingestion stimulates muscle protein synthesis during resistance-type exercise

In contrast to the effect of nutritional intervention on postexercise muscle protein synthesis, little is known about the potential to modulate protein synthesis during exercise. This study investigates the effect of protein coingestion with carbohydrate on muscle protein synthesis during resistance-type exercise. Ten healthy males were studied in the evening after they consumed a standardized diet throughout the day. Subjects participated in two experiments in which they ingested either carbohydrate or carbohydrate with protein during a 2-h resistance exercise session. Subjects received a bolus of test drink before and every 15 min during exercise, providing 0.15 g x kg(-1) x h(-1) carbohydrate with (CHO + PRO) or without (CHO) 0.15 g x kg(-1) x h(-1) protein hydrolysate. Continuous intravenous infusions with l-[ring-(13)C(6)]phenylalanine and l-[ring-(2)H(2)]tyrosine were applied, and blood and muscle biopsies were collected to assess whole body and muscle protein synthesis rates during exercise. Protein coingestion lowered whole body protein breakdown rates by 8.4 +/- 3.6% (P = 0.066), compared with the ingestion of carbohydrate only, and augmented protein oxidation and synthesis rates by 77 +/- 17 and 33 +/- 3%, respectively (P < 0.01). As a consequence, whole body net protein balance was negative in CHO, whereas a positive net balance was achieved after the CHO + PRO treatment (-4.4 +/- 0.3 vs. 16.3 +/- 0.4 micromol phenylalanine x kg(-1) x h(-1), respectively; P < 0.01). In accordance, mixed muscle protein fractional synthetic rate was 49 +/- 22% higher after protein coingestion (0.088 +/- 0.012 and 0.060 +/- 0.004%/h in CHO + PRO vs. CHO treatment, respectively; P < 0.05). We conclude that, even in a fed state, protein coingestion stimulates whole body and muscle protein synthesis rates during resistance-type exercise.

Substrate source use in older, trained males after decades of endurance training

PURPOSE

The purpose of this study was to compare substrate source use in older, long-term exercising, endurance-trained males with sedentary controls.

METHODS

[U-C]palmitate and [6,6-H2]glucose tracers were applied to assess plasma free fatty acid (FFA) and glucose oxidation rates, and to estimate muscle- and/or lipoprotein-derived triacylglycerol (TG) and muscle glycogen use. Subjects were 10 long-term exercising, endurance-trained males and 10 sedentary controls (age 57 +/- 1 and 60 +/- 2 yr, respectively). Muscle biopsy samples were collected before and after exercise to assess muscle fiber type-specific intramyocellular lipid and glycogen content.

RESULTS

During exercise, plasma palmitate Ra, Rd, and Rox were significantly greater in the trained subjects compared with the controls (Ra: 0.36 +/- 0.02 and 0.25 +/- 0.02; Rd: 0.36 +/- 0.03 and 0.24 +/- 0.02; Rox: 0.31 +/- 0.02 and 0.20 +/- 0.02 mmol.min, respectively, P < 0.01). This resulted in greater plasma FFA and total fat oxidation rates in the trained versus sedentary subjects (P < 0.001). Muscle- and/or lipoprotein-derived TG use contributed 10 +/- 2 and 11 +/- 3% in the trained and control groups, respectively (NS). No significant net changes in muscle fiber lipid content were observed.

CONCLUSIONS

Older, endurance-trained males oxidize more fat during moderate-intensity exercise than do sedentary controls. This greater total fat oxidation rate is attributed to a higher plasma FFA release, uptake, and oxidation rate. In contrast, intramyocellular triacylglycerol does not seem to represent a major substrate source during 1 h of moderate-intensity exercise in older trained or sedentary men.