Adding fat calories to meals after exercise does not alter glucose tolerance

Carbohydrate-Energy Replacement Following High-Intensity Interval Exercise Blunts Next-Day Glycemic Control in Untrained Women

Background

Improved glycemic control has been reported for ∼24 h following low-volume high-intensity interval exercise (HIIE), but it is unclear if this is a direct effect of exercise or an indirect effect of the exercise-induced energy deficit. The purpose of this study was to investigate the effect of carbohydrate-energy replacement after low-volume HIIE on 24 h glycemic control in women.

Methods

Seven untrained women (age: 22 ± 2 yr; BMI: 22 ± 3 kg/m2; VO2peak: 33 ± 7 ml/kg/min) completed three 2-day trials in the mid-follicular phase of the menstrual cycle. Continuous glucose monitoring was used to measure blood glucose concentrations during, and for 24 h following three conditions: (1) HIIE followed by a high-carbohydrate energy replacement drink (EX-HC); (2) HIIE followed by a non-caloric taste-matched placebo drink (EX-NC); and (3) seated control with no drink (CTL). HIIE involved an evening session (1,700 h) of 10 × 1-min cycling efforts at ∼90% maximal heart rate with 1 min recovery. Diet was standardized and identical across all three 2-day trials, apart from the post-exercise carbohydrate drink in EX-HC, which was designed to replenish the exercise-induced energy expenditure. Postprandial glycemic responses to the following days breakfast, snack, lunch, and dinner, as well as 24 h indices of glycemic control, were analyzed.

Results

The day after HIIE, postprandial glycemia following breakfast and snack were reduced in EX-NC compared to EX-HC, as reflected by lower 3 h glucose mean (breakfast: 5.5 ± 0.5 vs. 6.7 ± 1, p = 0.01, Cohen’s d = 1.4; snack: 4.9 ± 0.3 vs. 5.7 ± 0.8 mmol/L, p = 0.02, d = 1.4) and/or area under the curve (AUC) (breakfast: 994 ± 86 vs. 1,208 ± 190 mmol/L x 3 h, p = 0.01, d = 1.5). Postprandial glycemic responses following lunch and dinner were not different across conditions (p > 0.05). The 24 h glucose mean (EX-NC: 5.2 ± 0.3 vs. EX-HC: 5.7 ± 0.7 mmol/L; p = 0.02, d = 1.1) and AUC (EX-NC: 7,448 ± 425 vs. EX-HC: 8,246 ± 957 mmol/L × 24 h; p = 0.02, d = 1.1) were reduced in EX-NC compared to EX-HC.

Conclusion

Post-exercise carbohydrate-energy replacement attenuates glycemic control the day following a single session of low-volume HIIE in women.

Exercise-nutrient interactions for improved postprandial glycemic control and insulin sensitivity

Type 2 diabetes (T2D) is a rapidly growing yet largely preventable chronic disease. Exaggerated increases in blood glucose concentration following meals is a primary contributor to many long-term complications of the disease that decrease quality of life and reduce lifespan. Adverse health consequences also manifest years prior to the development of T2D due to underlying insulin resistance and exaggerated postprandial concentrations of the glucose-lowering hormone insulin. Postprandial hyperglycemic and hyperinsulinemic excursions can be improved by exercise, which contributes to the well-established benefits of physical activity for the prevention and treatment of T2D. The aim of this review is to describe the postprandial dysmetabolism that occurs in individuals at risk for and with T2D, and highlight how acute and chronic exercise can lower postprandial glucose and insulin excursions. In addition to describing the effects of traditional moderate-intensity continuous exercise on glycemic control, we highlight other forms of activity including low-intensity walking, high-intensity interval exercise, and resistance training. In an effort to improve knowledge translation and implementation of exercise for maximal glycemic benefits, we also describe how timing of exercise around meals and post-exercise nutrition can modify acute and chronic effects of exercise on glycemic control and insulin sensitivity. Novelty: Exaggerated postprandial blood glucose and insulin excursions are associated with disease risk. Both a single session and repeated sessions of exercise improve postprandial glycemic control in individuals with and without T2D. The glycemic benefits of exercise can be enhanced by considering the timing and macronutrient composition of meals around exercise.

Interactive effects of acute exercise and carbohydrate-energy replacement on insulin sensitivity in healthy adults

This study investigated whether carbohydrate-energy replacement immediately after prolonged endurance exercise attenuates insulin sensitivity the following morning, and whether exercise improves insulin sensitivity the following morning independent of an exercise-induced carbohydrate deficit. Oral glucose tolerance and whole-body insulin sensitivity were compared the morning after 3 evening conditions, involving (1) treadmill exercise followed by a carbohydrate replacement drink (200 or 150 g maltodextrin for males and females, respectively; CHO-replace); (2) treadmill exercise followed by a non-caloric, taste-matched placebo (CHO-deficit); or (3) seated rest with no drink provided (Rest). Treadmill exercise involved 90 minutes at ∼80% age-predicted maximum heart rate. Seven males and 2 females (aged 23 ± 1 years; body mass index 24.0 ± 2.7 kg·m^-2) completed all conditions in a randomised order. Matsuda index improved by 22% (2.2 [0.3, 4.0] au, p = 0.03) and HOMA2-IR improved by 10% (-0.04 [-0.08, 0.00] au, p = 0.04) in CHO-deficit versus CHO-replace, without corresponding changes in postprandial glycaemia. Outcomes were similar between Rest and other conditions. These data suggest that improvements to insulin sensitivity in healthy populations following acute moderate/vigorous intensity endurance exercise may be dependent on the presence of a carbohydrate-energy deficit. Novelty: Restoration of carbohydrate balance following acute endurance exercise attenuated whole-body insulin sensitivity. Exercise per se failed to enhance whole-body insulin sensitivity. Maximising or prolonging the post-exercise carbohydrate deficit may enhance acute benefits to insulin sensitivity.

Dose-Dependent Effects of Exercise and Diet on Insulin Sensitivity and Secretion

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.

Accounting for the Nutritional Context to Correctly Interpret Results from Studies of Exercise and Sedentary Behavior

There is a wealth of research lauding the benefits of exercise to oppose cardiometabolic disease such as diabetes, CVD and hypertension. However, in the great majority of these studies, the nutritional context (energy balance, deficit, or surplus) has been ignored, despite its profound effect on responses to both exercise and inactivity. Even a minor energy deficit or surplus can strongly modulate the magnitude and duration of the metabolic responses to an intervention; therefore, failure to account for this important confounding variable obscures clear interpretation of the results from studies of exercise or inactivity. The aim of this review is to highlight key lessons from studies examining the interaction between exercise and sedentary behavior, energy status, and glucose and insulin regulation. In addition to identifying notable problems, we suggest a few potential solutions.

Effects of Aerobic Exercises on Serum Levels of Myonectin and Insulin Resistance in Obese and Overweight Women

Background and Aim: Obesity is associated with cardiovascular diseases, metabolic syndrome, and diabetes and insulin resistance. Myonectin is a myokine mostly secreted from skeletal muscles and inversely associated with obesity. The aim of the present study was to evaluate the effects of 8 weeks of aerobic exercises on serum levels of myonectin and insulin resistance in obese and overweight women.

Materials and Methods: Eighty obese women were assigned to exercise (34) and control groups (46). The exercise program comprised three weekly 45-minute sessions of aerobic exercise training for 8 weeks that included running with 50–70% of maximum heart rate (first 2 weeks – 50%; second week – 60%; third week – 65%; and the last 2 weeks by 70% of maximum heart rate). Twenty-four hours before and after the training session, fasting myonectin serum levels were measured. ANCOVA was used to assess differences between the groups.

Results: Serum levels of myonectin in the experimental group increased significantly (P=0.000); however, insulin resistance significantly decreased in the experimental group (P=0.000).

Conclusion: Therefore, considering the role of myonectin in increasing fatty acid uptake, exercise training can play an essential role in decreasing obesity-related diseases and metabolic syndrome; this effect is partly related to the roles of myonectin. Therefore, the use of this type of exercise is recommended to reduce the risk of diseases associated with obesity and metabolic syndrome.

Acute Effects of Exercise Intensity on Insulin Sensitivity under Energy Balance

Exercise is known to improve insulin sensitivity (SI); however, studies to date have been confounded by negative energy deficits after exercise.

PURPOSE

The primary objective of this study was to assess the effect of 8 to 16 wk of aerobic exercise training on the SI of untrained women under rigorously controlled energy-balanced conditions. The secondary objective was to determine if one acute bout of moderate-intensity continuous (MIC) or high-intensity interval (HII) exercise further affected SI.

METHODS

Insulin sensitivity was assessed in 28 untrained women at baseline, after 8 to 16 wk of training with no-exercise (NE) before assessment, 22 h after MIC (50% V˙O2peak), and 22 h after HII (84% V˙O2peak) using a hyperinsulinemic-euglycemic clamp. Participants were in a whole-room indirect calorimeter during each condition, and food intake was adjusted to ensure energy balance across 23 h before each clamp.

RESULTS

There were no significant differences in acute energy balance between each condition. Results indicated a significant main effect of time, such that SI was higher during the HII condition compared with both baseline and NE (P < 0.05). No significant differences in SI were observed after NE or MIC.

CONCLUSIONS

Widely reported improvements in SI in response to chronic exercise training may be mediated in part by shifts in energy balance. However, an acute bout of HII exercise may increase SI even in the context of energy balance.

Post-Exercise Carbohydrate-Energy Replacement Attenuates Insulin Sensitivity and Glucose Tolerance the Following Morning in Healthy Adults

The carbohydrate deficit induced by exercise is thought to play a key role in increased post-exercise insulin action. However, the effects of replacing carbohydrate utilized during exercise on postprandial glycaemia and insulin sensitivity are yet to be determined. This study therefore isolated the extent to which the insulin-sensitizing effects of exercise are dependent on the carbohydrate deficit induced by exercise, relative to other exercise-mediated mechanisms. Fourteen healthy adults performed a 90-min run at 70% V˙O2max starting at 1600–1700 h before ingesting either a non-caloric artificially-sweetened placebo solution (CHO-DEFICIT) or a 15% carbohydrate solution (CHO-REPLACE; 221.4 ± 59.3 g maltodextrin) to precisely replace the measured quantity of carbohydrate oxidized during exercise. The alternate treatment was then applied one week later in a randomized, placebo-controlled, and double-blinded crossover design. A standardized low-carbohydrate evening meal was consumed in both trials before overnight recovery ahead of a two-hour oral glucose tolerance test (OGTT) the following morning to assess glycemic and insulinemic responses to feeding. Compared to the CHO-DEFICIT condition, CHO-REPLACE increased the incremental area under the plasma glucose curve by a mean difference of 68 mmol·L⁻¹ (95% CI: 4 to 132 mmol·L⁻¹; p = 0.040) and decreased the Matsuda insulin sensitivity index by a mean difference of −2 au (95% CI: −1 to −3 au; p = 0.001). This is the first study to demonstrate that post-exercise feeding to replaceme the carbohydrate expended during exercise can attenuate glucose tolerance and insulin sensitivity the following morning. The mechanism through which exercise improves insulin sensitivity is therefore (at least in part) dependent on carbohydrate availability and so the day-to-day metabolic health benefits of exercise might be best attained by maintaining a carbohydrate deficit overnight.

Enhancing Exercise Responsiveness across Prediabetes Phenotypes by Targeting Insulin Sensitivity with Nutrition

Exercise is a cornerstone therapy for chronic diseases related to multiorgan insulin resistance. However, not all individuals show the anticipated improvement in insulin sensitivity following exercise and these individuals are considered exercise resistant. Caloric restriction is an approach to enhance the effect of exercise on increasing peripheral and hepatic insulin sensitivity, as replenishing expended calories blunts these benefits. Alternatively, restricting carbohydrate intake, independent of energy balance, following exercise provides an additive effect on peripheral insulin sensitivity when compared to refeeding carbohydrate. Although carbohydrate composition modulates insulin sensitivity, few have studied effects of low glycemic index or whole-grain diets following exercise across prediabetes phenotypes on insulin sensitivity. Herein, we propose the novel hypothesis that the combination of individualized nutrition therapy and exercise should be based on the clinical pathology of prediabetes to overcome exercise resistance and improve responsiveness in people at risk for type 2 diabetes and cardiovascular disease.

Effect of short-duration lipid supplementation on fat oxidation during exercise and cycling performance

The effect of intramyocellular lipids (IMCLs) on endurance performance with high skeletal muscle glycogen availability remains unclear. Previous work has shown that a lipid-supplemented high-carbohydrate (CHO) diet increases IMCLs while permitting normal glycogen loading. The aim of this study was to assess the effect of fat supplementation on fat oxidation (Fox) and endurance performance. Twenty-two trained male cyclists performed 2 simulated time trials (TT) in a randomized crossover design. Subjects cycled at ∼53% maximal voluntary external power for 2 h and then followed 1 of 2 diets for 2.5 days: a high-CHO low-fat (HC) diet, consisting of CHO 7.4 g·kg(-1)·day(-1) and fat 0.5 g·kg(-1)·day(-1); or a high-CHO fat-supplemented (HCF) diet, which was a replication of the HC diet with ∼240 g surplus fat (30% saturation) distributed over the last 4 meals of the diet period. On trial morning, fasting blood was sampled and Fox was measured during an incremental exercise; a ∼1-h TT followed. Breath volatile compounds (VOCs) were measured at 3 time points. Mental fatigue, measured as reaction time, was evaluated during the TT. Plasma free fatty acid concentration was 50% lower after the HCF diet (p < 0.0001), and breath acetone was reduced (p < 0.05) "at rest". Fox peaked (∼0.35 g·kg(-1)) at ∼42% peak oxygen consumption, and was not influenced by diet. Performance was not significantly different between the HCF and HC diets (3369 ± 46 s vs 3398 ± 48 s; p = 0.39), nor were reaction times to the attention task and VOCs (p = NS for both). In conclusion, the short-term intake of a lipid supplement in combination with a glycogen-loading diet designed to boost intramyocellular lipids while avoiding fat adaptation did not alter substrate oxidation during exercise or 1-hour cycling performance.

Nutrient timing revisited: is there a post-exercise anabolic window?

Nutrient timing is a popular nutritional strategy that involves the consumption of combinations of nutrients--primarily protein and carbohydrate--in and around an exercise session. Some have claimed that this approach can produce dramatic improvements in body composition. It has even been postulated that the timing of nutritional consumption may be more important than the absolute daily intake of nutrients. The post-exercise period is widely considered the most critical part of nutrient timing. Theoretically, consuming the proper ratio of nutrients during this time not only initiates the rebuilding of damaged muscle tissue and restoration of energy reserves, but it does so in a supercompensated fashion that enhances both body composition and exercise performance. Several researchers have made reference to an anabolic “window of opportunity” whereby a limited time exists after training to optimize training-related muscular adaptations. However, the importance - and even the existence - of a post-exercise ‘window’ can vary according to a number of factors. Not only is nutrient timing research open to question in terms of applicability, but recent evidence has directly challenged the classical view of the relevance of post-exercise nutritional intake with respect to anabolism. Therefore, the purpose of this paper will be twofold: 1) to review the existing literature on the effects of nutrient timing with respect to post-exercise muscular adaptations, and; 2) to draw relevant conclusions that allow practical, evidence-based nutritional recommendations to be made for maximizing the anabolic response to exercise.

Lowering physical activity impairs glycemic control in healthy volunteers

INTRODUCTION

Postprandial glucose (PPG) is an independent predictor of cardiovascular events and death, regardless of diabetes status. Whereas changes in physical activity produce changes in insulin sensitivity, it is not clear whether changes in daily physical activity directly affect PPG in healthy free-living persons.

METHODS

We used continuous glucose monitors to measure PPG and PPG excursions (ΔPPG, postmeal - premeal blood glucose) at 30-min increments after meals in healthy habitually active volunteers (n = 12, age = 29 ± 1 yr, body mass index = 23.6 ± 0.9 kg·m(-2), VO2max = 53.6 ± 3.0 mL·kg(-1)·min(-1)) during 3 d of habitual (≥10,000 steps per day) and reduced (<5000 steps per day) physical activity. Diets were standardized across monitoring periods, and fasting-state oral glucose tolerance tests (OGTT) were performed on the fourth day of each monitoring period.

RESULTS

During 3 d of reduced physical activity (12,956 ± 769 to 4319 ± 256 steps per day), PPG increased at 30 and 60 min after a meal (6.31 ± 0.19 to 6.68 ± 0.23 mmol·L(-1) and 5.75 ± 0.16 to 6.26 ± 0.28 mmol·L(-1), P < 0.05 relative to corresponding active time point), and ΔPPG increased by 42%, 97%, and 33% at 30, 60, and 90 min after a meal, respectively (P < 0.05). Insulin and C-peptide responses to the OGTT increased after 3 d of reduced activity (P < 0.05), and the glucose response to the OGTT did not change significantly.

CONCLUSIONS

Thus, despite evidence of compensatory increases in plasma insulin during an OGTT, ΔPPG assessed by continuous glucose monitoring systems increased markedly during 3 d of reduced physical activity in otherwise healthy free-living individuals. These data indicate that daily physical activity is an important mediator of glycemic control, even among healthy individuals, and reinforce the utility of physical activity in preventing pathologies associated with elevated PPG.

High fatty acid availability after exercise alters the regulation of muscle lipid metabolism

We previously reported that a single exercise session protects against fatty acid (FA)-induced insulin resistance, perhaps in part through augmented intramyocellular triacylglycerol (IMTG) synthesis. The aim of this study was to examine the effect of elevated FA availability after exercise on factors regulating IMTG metabolism. After exercise (90 minutes, 65% peak oxygen uptake), 7 healthy women (body mass index, 23 ± 1 kg/m(2)) were infused overnight (16 hours) with either a lipid and heparin solution (LIPID, 0.11 g fat per kilogram per hour) or saline (SALINE). We measured resting FA oxidation (indirect calorimetry) and obtained a skeletal muscle biopsy sample the next morning. The 4-fold increase in overnight plasma FA concentration during LIPID increased IMTG by approximately 30% during LIPID vs SALINE. This was accompanied by an approximately 25% greater membrane-associated abundance of the FA transporter FAT/CD36 (P < .01) and an approximately 8% increase in the activity of the IMTG synthesis enzyme glycerol-3-phosphate acyltransferase (GPAT, P < .01). In contrast, resting FA oxidation was not affected. We also found no difference in the protein abundance of GPAT1 and diacylglycerol acyltransferase-1, diacylglycerol acyltransferase activity, or the abundance of the lipid droplet coat proteins (perilipins 2, 3, 4, and 5) between treatments. Our findings suggest that augmented capacity for FA flux into muscle (ie, via membrane-associated FAT/CD36), perhaps together with a slight yet significant increase in activity of a key IMTG synthesis enzyme (GPAT), may enhance IMTG storage when FA availability is high after exercise. The importance of the absence of a change in perilipin protein abundance despite increased muscle lipid storage remains to be determined.

Acute high-fat feeding does not prevent the improvement in glucose tolerance after resistance exercise in lean individuals

Our first aim was to investigate whether the ingestion of a single high-fat meal impairs glucose tolerance. Our second aim was to investigate whether improvements in glucose tolerance that are seen after resistance exercise remain when exercise is performed after ingestion of a high-fat meal. Eight young males consumed either a high fat (HF) or an isocaloric control (CON) meal in the morning and underwent an oral glucose tolerance test (OGTT) 6 h later. On two other occasions, a single 1 h bout of resistance exercise was completed 2 h after consumption of each meal (HFE and CONE). There were no significant differences in plasma glucose and plasma insulin areas under the curve (AUC) or estimates of insulin sensitivity between the HF and CON trials (P > 0.05). The HFE and CONE trials elicited a ~20% lower plasma glucose AUC (P < 0.05) compared to their respective control trials. The HFE also elicited a ~25% lower plasma insulin AUC (P < 0.05) in comparison to the HF trial. The HFE trial also significantly improved estimates of insulin sensitivity in comparison to the HF condition (P < 0.05). In conclusion, this study demonstrates that consumption of a single HF meal does not impair glucose tolerance in the resting state in lean individuals and that an acute bout of resistance exercise remains effective in enhancing glucose tolerance following the ingestion of a single high-fat meal.

Paradoxical increase in TAG and DAG content parallel the insulin sensitizing effect of unilateral DGAT1 overexpression in rat skeletal muscle

BACKGROUND

The involvement of muscle triacylglycerol (TAG) storage in the onset of insulin resistance is questioned and the attention has shifted towards inhibition of insulin signalling by the lipid intermediate diacylglycerol (DAG). The enzyme 1,2-acylCoA:diacylglyceroltransferase-1 (DGAT1) esterifies a fatty acyl-CoA on DAG to form TAG. Therefore, the aim of the present study was to investigate if unilateral overexpression of DGAT1 in adult rat Tibialis anterior (TA) muscle will increase conversion of the lipid intermediate DAG into TAG, thereby improving muscle insulin sensitivity.

METHODOLOGY/PRINCIPAL FINDINGS

The DGAT1 gene construct was injected in the left TA muscle of male rats on chow or high-fat (45% kcal) diet for three weeks, followed by application of one 800 V/cm and four 80 V/cm pulses, using the contralateral leg as sham-electroporated control. Seven days after electroporation, muscle specific insulin sensitivity was assessed with a hyperinsulinemic euglycemic clamp using 2-deoxy-[3H]glucose. Here, we provide evidence that unilateral overexpression of DGAT1 in TA muscle of male rats is associated with an increased rather than decreased DAG content. Strikingly, this increase in DAG content was accompanied by improved muscle insulin sensitivity. Interestingly, markers of muscle lipolysis and mitochondrial function were also increased in DGAT1 overexpressing muscle.

CONCLUSIONS/SIGNIFICANCE

We conclude that unilateral DGAT1 overexpression can rescue insulin sensitivity, possibly by increasing DAG and TAG turnover in skeletal muscle. In case of a proper balance between the supply and oxidation of fatty acids in skeletal muscle, the lipid intermediate DAG may not exert harmful effects on insulin signalling.

The effect of exercise and nutrition on intramuscular fat metabolism and insulin sensitivity

Intramuscular triacylglycerol (IMTG) is both a dynamic fat-storage depot that can expand during periods of elevated lipid availability and a fatty acid source that can be utilized during periods of increased energy expenditure in active individuals. Although many studies have investigated the lifestyle determinants of IMTG content, the results are far from consistent, and studies attempting to unravel the mechanisms behind IMTG metabolism are in their infancy. The limited evidence available suggests that the enzymes responsible for skeletal muscle lipolysis and IMTG synthesis play an important role in determining the fate of fatty acids and therefore the concentration of lipid metabolites and insulin sensitivity of skeletal muscle. This review provides a summary of current knowledge on the effects of acute and chronic exercise as well as energy intake and macronutrient composition of the diet upon the metabolism of IMTG and the implications for metabolic health.

Enhanced insulin sensitivity after acute exercise is not associated with changes in high-molecular weight adiponectin concentration in plasma

BACKGROUND AND OBJECTIVE

The effect of exercise on the plasma concentration of high-molecular weight (HMW) adiponectin (i.e. the biologically active form of circulating adiponectin) and the possible role of HMW adiponectin in mediating the exercise-induced enhancement of insulin action are not known. The aim of this study was to evaluate the relationship between the post-exercise increase in insulin sensitivity and plasma HMW adiponectin concentration.

DESIGN AND METHODS

We measured total and HMW adiponectin concentrations in plasma using an ELISA kit, and insulin sensitivity using the updated homeostasis model assessment of insulin sensitivity (HOMA2-IS) score in the basal, overnight fasted state, once approximately 12 h after a single bout of moderate-intensity endurance exercise and once after an equivalent period of rest, in 27 healthy men and women (age: 29+/-1 years and body mass index: 24.7+/-0.8 kg/m(2)).

RESULTS

The HOMA2-IS score was 18+/-7% greater after exercise than after rest (229+/-20 and 196+/-17 respectively; P=0.006), whereas the concentrations of total adiponectin (7.8+/-0.5 and 7.7+/-0.5 mg/l respectively; P=0.597) and HMW adiponectin (3.0+/-0.3 and 3.0+/-0.3 mg/l respectively; P=0.625) were not different. The exercise-induced change in HOMA2-IS score was not related to changes in total and HMW adiponectin concentrations (P>0.3).

CONCLUSIONS

Changes in HMW adiponectin concentration are not involved in the acute exercise-induced enhancement of insulin action.

The effect of carbohydrate availability following exercise on whole-body insulin action

One bout of exercise enhances insulin-stimulated glucose uptake (insulin action), but the effect is blunted by consumption of carbohydrate-containing food after exercise. The independent roles of energy and carbohydrate in mediating post-exercise insulin action have not been systematically evaluated in humans. The purpose of this study was to determine if varying carbohydrate availability, with energy intake held constant, mediates post-exercise insulin action. Ten young (21 +/- 2 y, overweight (body fat 37% +/- 3%) men and women completed 3 conditions in random order: (i) no-exercise (BASE), (ii) exercise with energy balance but carbohydrate deficit (C-DEF), and (iii) exercise with energy and carbohydrate balance (C-BAL). In the exercise conditions, subjects expended 30% of total daily energy expenditure on a cycle ergometer at 70% VO2 peak. Following exercise, subjects consumed a meal that replaced expended energy (~3000 kJ) and was either balanced (intake = expenditure) or deficient (-100 g) in carbohydrate. Twelve hours later, insulin action was measured by continuous infusion of glucose with stable isotope tracer (CIG-SIT). Changes in insulin action were evaluated using a one-way ANOVA with repeated measures. During CIG-SIT, non-oxidative glucose disposal (i.e., glucose storage) was higher in C-DEF than in BASE (27.2 +/- 3.2 vs. 16.9 +/- 3.5 micromol.L-1.kg-1.min-1, p < 0.05). Conversely, glucose oxidation was lower in C-DEF (8.6 +/- 1.3 micromol.L-1.kg-1.min-1) compared with C-BAL (12.2 +/- 1.2 micromol.L-1.kg-1.min-1), and BASE (17.1 +/- 2.2 micromol.L-1.kg-1.min-1), p < 0.05). Fasting fat oxidation was higher in C-DEF than in BASE (109.8 +/- 10.5 vs. 80.7 +/- 9.6 mg.min-1, p < 0.05). In C-DEF, enhanced insulin action was correlated with the magnitude of the carbohydrate deficit (r = 0.82, p < 0.01). Following exercise, re-feeding expended energy, but not carbohydrate, increased fasting fat oxidation, and shifted insulin-mediated glucose disposal toward increased storage and away from oxidation.

Effects of short-term exercise and energy surplus on hormones related to regulation of energy balance

Energy surplus raises circulating concentrations of leptin and insulin while lowering plasma ghrelin. Exercise has the opposite effects. The purpose of this study was to determine whether exercise counters the hormonal effects of energy surplus independent of changes in energy balance. To do that, we assessed plasma concentrations of leptin, insulin, and ghrelin at baseline, after overfeeding, and after overfeeding plus exercise. Baseline (B) leptin and insulin concentrations and ghrelin area under the curve were measured during an oral glucose challenge in 9 healthy, active subjects (6 male, 3 female) after 2 days in energy balance without exercise. Measurements were repeated after subjects were overfed by +3213 +/- 849 kJ/d for 3 more sedentary days (OF). In the third condition, the same net energy surplus (+3125 +/- 933 kJ/d) was generated for 24 hours by doubling the overfeeding (+6284 +/- 1669 kJ/d) and countering it with a bout of exercise (expenditure = 3063 +/- 803 kJ); and measurements were made the next day (OF + EX). Compared with B, leptin went up (5.8 +/- 8.2 to 7.6 +/- 10.6 ng/mL) after OF, but was not significantly higher after OF + EX (7.1 +/- 10.2 ng/mL). Compared with B, insulin was +36% and +43% higher after OF and OF + EX, respectively. In contrast, ghrelin area under the curve did not change after OF but was significantly lower (-14%) than B or OF after OF + EX (indicating greater suppression). These data suggest that the effect of short-term exercise on fasting leptin and insulin depends on energy balance but the ghrelin response may be partially mediated by effects of exercise independent of energy balance.

Acute exercise increases triglyceride synthesis in skeletal muscle and prevents fatty acid-induced insulin resistance

Fatty acid oversupply is a key mediator of skeletal muscle insulin resistance in obesity, primarily via accumulation of fatty acid metabolites and activation of proinflammatory pathways. Herein, we demonstrate that fatty acid-induced insulin resistance in humans is completely prevented the day after 1 session of endurance exercise. Because skeletal muscle is the primary site for systemic glucose disposal and is highly susceptible to impaired insulin action by elevated fatty acid availability, we obtained skeletal muscle samples to investigate possible mechanisms mediating this protective effect of exercise. Prevention of fatty acid-induced insulin resistance after exercise accompanied enhanced skeletal muscle protein expression of key lipogenic enzymes and an increase in muscle triglyceride synthesis. Partitioning more fatty acids toward triglyceride synthesis within muscle reduced the accumulation of fatty acid metabolites and suppressed the proinflammatory response in skeletal muscle, as evidenced by decreased phosphorylation and activation of JNK and increased abundance of inhibitor of NF-kappaB alpha (I kappa B-alpha) and I kappa B-beta. We believe this is the first study to demonstrate that 1 session of exercise completely reverses fatty acid-induced insulin resistance in humans. Reversal of insulin resistance accompanied enhanced lipogenic capacity within skeletal muscle, reduced accumulation of highly bioactive fatty acid metabolites, and suppressed activation of proinflammatory pathways known to impair insulin action.

Effect of short-term starvationversushigh-fat diet on intramyocellular triglyceride accumulation and insulin resistance in physically fit men

It is currently believed that intramyocellular triglyceride (IMTG) accumulation and insulin resistance are a consequence of dietary fat ingestion and/or the elevated circulating lipid levels associated with chronic fat surplus. The purpose of this study was to compare the effect of short-term starvation versus low-carbohydrate (CHO)/high-fat diet on IMTG accumulation and the development of insulin resistance in physically fit men. Intramyocellular triglyceride content, measured as intramyocellular lipid (IMCL) by proton magnetic resonance spectroscopy (1H-MRS), and glucose tolerance/insulin sensitivity, assessed by frequently sampled intravenous glucose tolerance test (IVGTT), were determined after 67 h of: (a) water-only starvation (S); and (b) very low-CHO/high-fat diet (LC). These diets had in common significant restriction of CHO availability but large differences in fat content. All results were compared with those measured after a mixed CHO diet (C). Dietary interventions were administered by cross-over design. The level of dietary-induced IMTG accumulation (P = 0.46), insulin resistance (P = 0.27) and glucose intolerance (P = 0.29) was not different between S and LC treatments. Intramyocellular triglyceride content and insulin sensitivity were negatively correlated (r = -0.63, P < 0.01). Therefore, whilst insulin resistance may be due to fat accumulation at a cellular level, in the integrated human organism this outcome is not exclusively a function of dietary fat intake. The comparable level of IMTG accumulation and insulin resistance following S and LC may suggest that these metabolic perturbations are largely a consequence of the increased lipolytic response associated with CHO restriction.

Interactions between energy surplus and short-term exercise on glucose and insulin responses in healthy people with induced, mild insulin insensitivity

Short-term exercise can enhance insulin action, but the effect may be negated by the opposing action of energy surplus. The purpose of this investigation was to test the hypothesis that a single exercise bout would increase insulin action, even when opposed by a concurrent energy surplus. After 2 days in energy balance without exercise, baseline glucose and insulin areas under the curve and the insulin sensitivity index (C-ISI) were measured during an oral glucose tolerance test in 9 healthy, habitually active subjects (6 males, 3 females). A state of relative insulin insensitivity was then induced by systematic overfeeding (OF) to generate a daily energy surplus of 768 +/- 203 kcal/d for 3 days, and the oral glucose tolerance test was repeated. In the following 24 hours, the OF was increased approximately 2-fold (+6284 +/- 1669 kJ/d) and subjects performed a single bout of exercise (expenditure = 3063 +/- 803 kJ) to maintain the same energy surplus (+3125 +/- 933 kJ/d; OF and exercise) as OF. After OF, fasting insulin tended to be higher (+36%, P = .099), insulin AUC rose by 38% (P = .002), and C-ISI declined from 6.6 +/- 3.1 to 4.6 +/- 1.8 (P = .007) compared with baseline. After OF and exercise, fasting insulin remained elevated (+43% compared with baseline; P = .043) and C-ISI rose only slightly (4.6 +/- 1.8 to 5.2 +/- 2.3; P = .058), but insulin AUC declined by 20% (P = .048) compared with OF. A single exercise bout, opposed by a concurrent energy surplus, decreased the insulin response to a glucose challenge, but only partially restored the insulin AUC to baseline and had no impact on C-ISI or fasting insulin concentrations.

Energy well spent fighting the diabetes epidemic

As the global burden of type 2 diabetes increases, medical science races to comprehensively understand its molecular aetiology. We suggest that the apparent struggle to seek a pharmacological or molecular victory to the diabetes epidemic is a flawed strategy given that evolution has already provided us with the best medicine. Recent molecular evidence highlights the interaction between muscle fatty acid kinetics in dictating whole body insulin action. Insights from an evolutionary perspective suggest that the ability of the body to evoke insulin resistance and store energy as fat within muscle cells is a normal physiological response to aid our survival during food or carbohydrate scarcity, but this 'hunter-gatherer physiology' predisposes to diabetes in a modern environment characterized by ample food availability and muscle inactivity. We contend that the true value of physical activity in the prevention and treatment of insulin resistance has been missed by the medical community because scientific investigation has been constructed upon physical activity recommendations that were never intended for this purpose. These recommendations provide a level of metabolic stress insufficient to be compatible with the expectations of our genes.

Improved insulin action following short-term exercise training: role of energy and carbohydrate balance

Short-term exercise training improves insulin action, but the impact of replacing the energy expended during exercise to prevent energy deficit is unclear. The purpose of this study was to establish the role of an energy deficit in mediating improved insulin action after short-term exercise training. Two groups of previously sedentary, overweight/obese subjects performed 6 consecutive days of moderate-intensity walking to expend approximately 500 kcal/day. In one group, energy and carbohydrate expended during exercise was replaced [balance group (BAL), n = 8] and in the other group, energy was not replaced [deficit group (DEF), n = 8]. Insulin action (blood glucose uptake during glucose infusion) and selected lipids and adipokines were measured pre- and posttraining. Training increased estimated daily energy expenditure by approximately 500 kcal/day (DEF = 469 +/- 45, BAL = 521 +/- 48), generating an energy deficit in DEF (-481 +/- 24 kcal/day) but not BAL (+8 +/- 20 kcal/day). Insulin action increased 40% in DEF (P = 0.032) but not BAL (-8.4%, P = 0.107). Hepatic glucose production was suppressed during glucose infusion in DEF (30.2 +/- 9.5%, P = 0.037) but not BAL (-10.0 +/- 7.4%, P = 0.417). Fasting leptin concentrations declined in DEF but not BAL. Six days of exercise training without energy replacement significantly increased insulin action. Restoring energy balance by refeeding the energy and carbohydrate expended during exercise resulted in no change in insulin action. These findings suggest that changes in short-term energy and/or carbohydrate balance play a key role in mediating the beneficial effects of exercise on whole body and hepatic insulin action.

Energy deficit without reducing dietary carbohydrate alters resting carbohydrate oxidation and fatty acid availability

Reduced carbohydrate (CHO) availability after exercise has a potent influence on the regulation of substrate metabolism, but little is known about the impact of fat availability and/or energy deficit on fuel metabolism when dietary CHO availability is not reduced. The purpose of this study was to determine the influence of a postexercise energy deficit, independent of CHO availability, on plasma substrate concentrations and substrate oxidation. Seven moderately trained men (peak oxygen uptake: 56 ± 2 ml·kg−1·min−1) performed exhaustive cycling exercise on two separate occasions. The two trials differed only by the meals ingested after exercise: 1) a high-fat diet designed to maintain energy balance or 2) a low-fat diet designed to elicit energy deficit. The CHO and protein contents of the diets were identical. The next morning, we measured plasma substrate and insulin concentrations and CHO oxidation, and we obtained muscle biopsies from the vastus lateralis for measurement of pyruvate dehydrogenase kinase (PDK)-2 and PDK-4 mRNA expression by using RT-PCR. Despite identical blood glucose (5.0 ± 0.1 and 4.9 ± 0.1 mM) and insulin (7.9 ± 1.1 and 8.4 ± 0.9 μU/ml) concentrations, plasma fatty acid and glycerol concentrations were elevated three- to fourfold during energy deficit compared with energy balance and CHO oxidation was 40% lower ( P < 0.01) the morning after energy deficit compared with energy balance (328 ± 69 and 565 ± 89 μmol/min). The lower CHO oxidation was accompanied by a 7.3 ± 2.5-fold increase in PDK-4 mRNA expression after energy deficit ( P < 0.05), whereas PDK-2 mRNA was similar between the trials. In conclusion, energy deficit increases fatty acid availability, increases PDK-4 mRNA expression, and suppresses CHO oxidation even when dietary CHO content is not reduced.

Postexercise insulin sensitivity is not impaired after an overnight lipid infusion

High plasma fatty acid availability and a positive energy balance in sedentary individuals reduce insulin sensitivity. This study's purpose was to determine whether high plasma fatty acid availability and systemic caloric excess after exercise also impair insulin sensitivity. On two separate occasions, seven nonobese women performed 90 min of exercise at approximately 65% peak oxygen uptake. In one trial, a lipid + heparin emulsion (Lipid) was infused overnight to increase plasma fatty acid availability. In the other trial, saline was infused as control. The next morning, a muscle biopsy was taken to measure muscle glycogen and intramuscular triglyceride (IMTG) concentrations. Three hours after the overnight infusion was stopped, insulin sensitivity was assessed with an intravenous glucose tolerance test, using minimal model analysis (Si). During the overnight infusions, plasma fatty acid concentration was approximately fourfold higher [means (SD): 0.84 (0.36) vs. 0.22 (0.09) mmol/l; P = 0.003], and the next morning IMTG concentration was approximately 30% greater [49.2 (6.6) vs. 38.3 (7.7) mmol/kg dry wt; P = 0.036] in Lipid compared with saline. However, muscle glycogen concentration was not different between trials (P = 0.82). Lipid caused a 24-h surplus of approximately 1100 kcal above energy balance (P = 0.00001), whereas energy balance was maintained in saline. Despite these differences in fatty acid and energy availability, Si the morning after exercise was not different between trials (P = 0.72). Thus insulin sensitivity the morning after a single exercise session was not reduced despite overnight exposure to a fourfold increase in plasma fatty acid concentration, elevated IMTG concentration, and systemic delivery of approximately 1,100-kcal excess.