Effect of intensity of resistance exercise on postprandial lipemia

Effect of Prior Exercise on Postprandial Lipemia: An Updated Meta-Analysis and Systematic Review

The purpose of this systematic review was to synthesize the results from current literature examining the effects of prior exercise on the postprandial triglyceride (TG) response to evaluate current literature and provide future direction. A quantitative review was performed using meta-analytic methods to quantify individual effect sizes. A moderator analysis was performed to investigate potential variables that could influence the effect of prior exercise on postprandial TG response. Two hundred and seventy-nine effects were retrieved from 165 studies for the total TG response and 142 effects from 87 studies for the incremental area under the curve TG response. There was a moderate effect of exercise on the total TG response (Cohen's d = -0.47; p < .0001). Moderator analysis revealed exercise energy expenditure significantly moderated the effect of prior exercise on the total TG response (p < .0001). Exercise modality (e.g., cardiovascular, resistance, combination of both cardiovascular and resistance, or standing), cardiovascular exercise type (e.g., continuous, interval, concurrent, or combined), and timing of exercise prior to meal administration significantly affected the total TG response (p < .001). Additionally, exercise had a moderate effect on the incremental area under the curve TG response (Cohen's d = -0.40; p < .0001). The current analysis reveals a more homogeneous data set than previously reported. The attenuation of postprandial TG appears largely dependent on exercise energy expenditure (∼2 MJ) and the timing of exercise. The effect of prior exercise on the postprandial TG response appears to be transient; therefore, exercise should be frequent to elicit an adaptation.

Acute exercise improves glucose and TAG metabolism in young and older adults following high-fat, high-carbohydrate meal intake

A single high-fat, high-carbohydrate meal (HFHC) results in elevated postprandial glucose (GLU), triglycerides (TAG) and metabolic load index (MLI; TAG (mg/dl) + GLU (mg/dl)) that contributes to chronic disease risk. While disease risk is higher in older adults (OA) compared to younger adults (YA), the acute effects of exercise on these outcomes in OA is understudied. Twelve YA (age 23.3 ± 3.9 yrs, n = 5 M/7 F) and 12 OA (age 67·7 ± 6.0 yrs, n = 8 M/4 F) visited the laboratory in random order to complete a HFHC with no exercise (NE) or acute exercise (EX) condition. EX was performed 12 hours prior to HFHC at an intensity of 65 % of maximal heart rate to expend 75 % of the kcals consumed in HFHC (Marie Callender's Chocolate Satin Pie; 12 kcal/kgbw; 57 % fat, 37 % CHO). Blood samples were taken at 0, 30, 60, 90 minutes, and then every hour until 6 hours post-meal. TAG levels increased to a larger magnitude in OA (Δ∼61 ± 31 %) compared to YA (Δ∼37 ± 34 %, P < 0·001), which were attenuated in EX compared to NE (P < 0·05) independent of age. There was no difference in GLU between OA and YA after the HFM, however, EX had attenuated GLU independent of age (NE: Δ∼21 ± 26 %; EX: Δ∼12 ± 18 %, P = 0·027). MLI was significantly lower after EX compared to NE in OA and YA (P < 0·001). Pre-prandial EX reduced TAG, GLU and MLI post-HFHC independent of age.

Acute Resistance Exercise Reduces Postprandial Lipemia and Oxidative Stress in Resistance-Trained Men

McAllister, MJ, Steadman, KS, Renteria, LI, Case, MJ, Butawan, MB, Bloomer, RJ, and McCurdy, KW. Acute resistance exercise reduces postprandial lipemia and oxidative stress in resistance-trained men. J Strength Cond Res XX(X): 000-000, 2020-Acute ingestion of a high-fat meal (HFM) results in significant increases in postprandial triacylglycerols (TAG) and markers of oxidative stress (OS). Combined aerobic and resistance exercise can attenuate postprandial lipemia; however, it is not clear if acute resistance exercise alone can reduce postprandial OS. The purpose of this study was to determine if acute resistance exercise can attenuate postprandial OS and to compare the effects of moderate versus high-intensity resistance exercise in this regard. Nine (n = 9) moderately resistance-trained individuals completed 3 testing conditions in a randomized order as follows: (a) rest (no exercise), (b) moderate intensity (3 sets of 10 repetitions at 68% 1 repetition maximum [RM]), and (c) high-intensity resistance exercise (4 sets of 6 repetitions at 85% 1RM). Exercises included barbell back squat, bench press, straight leg deadlift, lat pull-down, upright row, and sit-ups. A HFM was ingested 12 hours after each condition. Blood samples were collected immediately before as well as 2 and 4 hours after ingestion and analyzed for TAG, cholesterol (CHOL), insulin, malondialdehyde (MDA), total nitrate/nitrite (NOx), glutathione (GSH), and advanced oxidation protein products (AOPP). When comparing 4 hour area under curve (AUC) data between conditions, AOPP demonstrated a significantly lower AUC after the moderate-intensity condition compared with resting condition. In addition, resistance exercise resulted in significantly higher plasma NOx concentrations as well as lower TAG and CHOL concentrations after HFM ingestion. Resistance exercise also prevented a decline in GSH that was induced by the HFM. These results demonstrate that acute resistance exercise can attenuate postprandial OS.

Efectos agudos del ejercicio resistido en la lipemia postprandial de mujeres postmenopáusicas con sobrepeso

Introducción. La magnitud de la lipemia postprandial es un indicador de riesgo cardiovascular, en especial en mujeres con actividad hormonal reducida. Los ejercicios resistidos (ER) podrían ser un factor que influencie las concentraciones de lípidos después de consumir alimentos.Objetivo. Determinar los efectos agudos sobre la lipemia postprandial de mujeres postmenopáusicas que tiene la realización de sesiones de ER de alto y bajo volumen, en comparación a un grupo control.Materiales y métodos. Después de una evaluación inicial (antropometría, perfil lipídico y fitness muscular), 32 mujeres fueron divididas aleatoriamente en tres grupos: uno con ER de alto volumen (n=11), otro con ER de bajo volumen (n=11) y un grupo control sin ER (n=10). 12 horas después de los ejercicios se suministró un compuesto nutricional hiperlipídico y se analizó la lipemia postprandial cada hora durante 5 horas.Resultados. Los diferentes volúmenes de ER no redujeron de manera importante los marcadores lipémicos (colesterol total, triglicéridos, LDL y VLDL) (p>0.05) ni aumentaron las concentraciones plasmáticas de HDL (p>0.05).Conclusiones. Las sesiones de ER no afectaron los marcadores lipémicos postprandiales, aunque sí mostraron resultados clínicos relevantes en los grupos experimentales (reducción de LDL-VLDL y aumento de HDL en momentos específicos).

Postprandial hormone response after endurance or resistance exercise in obese women

Physiological changes with endurance exercise (EE) and resistance training (RT) are likely influenced by the metabolic and hormonal response to each exercise bout, but may be blunted in obese individuals. To compare acute effects of EE, RT, and a control upon hormonal changes in obese women, sedentary, obese women (n=12) participated in a randomised crossover-design study on 3 occasions. EE consisted of treadmill walking (65% VO2max for 1 h). A total-body RT workout consisted of 3 sets of 10 repetitions, 90 s rest for 8 exercises at 90-100% of 10RM. Blood samples were taken 30 min before exercise (0 min), 30 min post-exercise (120 min), and again at 200, 280, and 520 min to assess changes in growth hormone (GH), cortisol, and insulin throughout the postprandial period. A 20 kcal/kg fat-free mass (FFM) meal was given after post-exercise blood sample. There was a main effect of condition for GH ΔAUC (change in area under the curve), with both RT and EE significantly different from the control (RT = 463.0±138.2; EE = 243.2±131.6; Control = -90.4±157.6 ng/ml * 400 min, P<0.02, Control vs EE, effect size (ES) = 2.3; Control vs RT, ES=3.7; EE vs RT, ES=1.6). There were no condition effects for cortisol or insulin ΔAUC. There were no significant time-by-condition interactions for any variables. In obese women, circulating GH concentration is enhanced in the postprandial state following a single bout of either EE or RT, with the GH response being more robust than cortisol or insulin. As circulating GH has shown to be reduced in obesity, the present observations could be considered beneficial, particularly alongside the absence of enhanced cortisol level after exercise.

Postprandial lipemic and inflammatory responses to high-fat meals: a review of the roles of acute and chronic exercise

Postprandial lipemia is an independent risk factor for development of cardiovascular disease. Postprandial inflammation following the prolonged elevation of triglycerides occurring subsequent to ingestion of high-fat meals, provides a likely explanation for increased disease risk. Substantial evidence has shown that acute exercise is an effective modality for attenuation of postprandial lipemia following a high-fat meal. However, much of the evidence pertaining to exercise intensity, duration, and overall energy expenditure for reducing postprandial lipemia is inconsistent. The effects of these different exercise variables on postprandial inflammation is largely unknown. Long-term, frequent exercise, however, appears to effectively reduce systemic inflammation, especially in at-risk or diseased individuals. With regard to an acute postprandial response, without a recent bout of exercise, high levels of chronic exercise do not appear to reduce postprandial lipemia. This review summarizes the current literature on postprandial and inflammatory responses to high-fat meals, and the roles that both acute and chronic exercise play. This review may be valuable for health professionals who wish to provide evidence-based, pragmatic advice for reducing postprandial lipemia and cardiovascular disease risk for their patients. A brief review of proposed mechanisms explaining how high-fat meals may result in pro-inflammatory and pro-atherosclerotic environments is also included.

Acute and chronic effects of sprint interval exercise on postprandial lipemia in women at-risk for the metabolic syndrome

Individuals diagnosed with the metabolic syndrome (MetS) exhibit elevated postprandial lipemia (PPL). The aims of this investigation were to determine 1) if an acute bout of sprint interval training (SIT) attenuates PPL; and 2) if the attenuation of PPL following 6 wk of SIT is magnified compared with a single session of SIT prior to training in women at-risk for MetS (n = 45; 30-65 yr). Women were randomized to SIT (n = 22) or a nonexercise control (n = 23; CON) for 6 wk. Postprandial responses to a high-fat meal challenge (HFMC) were assessed in the CON group before (B-HFMC) and after (Post-HFMC) without prior exercise and in the SIT group at baseline (B-HFMC) without prior exercise, after an acute bout of SIT (four 30-s all-out sprints with 4-min recovery) prior to (Pre-HFMC), and after the 6-wk intervention (Post-HFMC). Responses to the HFMC were assessed by collecting venous blood samples in the fasted state and at 0, 30, 60, 120, and 180 min postprandial. Compared with baseline, an acute bout of SIT before (Pre-HFMC) and after the 6-wk intervention (Post-HFMC) significantly attenuated fasted TG (P < 0.05; 16.6% and 12.3%, respectively) and postprandial area under the curve (13.1% and 9.7%, respectively; tAUC) TG responses. There was no difference in fasted or tAUC TG responses between Pre-HFMC and Post-HFMC. SIT is an effective mode of exercise to reduce fasted and postprandial TG concentrations in women at-risk for MetS. Six weeks of SIT does not magnify the attenuation of PPL in response to a single session of SIT.

Impact of range of motion during ecologically valid resistance training protocols on muscle size, subcutaneous fat, and strength

The impact of using different resistance training (RT) kinematics, which therefore alters RT mechanics, and their subsequent effect on adaptations remain largely unreported. The aim of this study was to identify the differences to training at a longer (LR) compared with a shorter (SR) range of motion (ROM) and the time course of any changes during detraining. Recreationally active participants in LR (aged 19 ± 2.6 years; n = 8) and SR (aged 19 ± 3.4 years; n = 8) groups undertook 8 weeks of RT and 4 weeks of detraining. Muscle size, architecture, subcutaneous fat, and strength were measured at weeks 0, 8, 10, and 12 (repeated measures). A control group (aged 23 ± 2.4 years; n = 10) was also monitored during this period. Significant (p > 0.05) posttraining differences existed in strength (on average 4 ± 2 vs. 18 ± 2%), distal anatomical cross-sectional area (59 ± 15 vs. 16 ± 10%), fascicle length (23 ± 5 vs. 10 ± 2%), and subcutaneous fat (22 ± 8 vs. 5 ± 2%), with LR exhibiting greater adaptations than SR. Detraining resulted in significant (p > 0.05) deteriorations in all muscle parameters measured in both groups, with the SR group experiencing a more rapid relative loss of postexercise increases in strength than that experienced by the LR group (p > 0.05). Greater morphological and architectural RT adaptations in the LR (owing to higher mechanical stress) result in a more significant increase in strength compared with that of the SR. The practical implications for this body of work follow that LR should be observed in RT where increased muscle strength and size are the objective, because we demonstrate here that ROM should not be compromised for greater external loading.

Exercise and dietary-mediated reductions in postprandial lipemia

Postprandial hyperlipemia produces long-term derangements in lipid/lipoprotein metabolism, vascular endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity which are strongly linked to atherogenesis. The purpose of this review is to (1) provide a qualitative analysis of the available literature examining the dysregulation of postprandial lipid metabolism in the presence of obesity, (2) inspect the role of adiposity distribution and sex on postprandial lipid metabolism, and (3) examine the role of energy deficit (exercise- and/or energy restriction-mediated), isoenergetic low-carbohydrate diets, and omega-3 (n-3) fatty acid supplementation on postprandial lipid metabolism. We conclude from the literature that central adiposity primarily accounts for sex-related differences in postprandial lipemia and that aerobic exercise attenuates this response in obese or lean men and women to a similar extent through potentially unique mechanisms. In contrast, energy restriction produces only mild reductions in postprandial lipemia suggesting that exercise may be superior to energy restriction alone as a strategy for lowering postprandial lipemia. However, isoenergetic very low-carbohydrate diets and n-3 fatty acid supplementation reduce postprandial lipemia indicating that macronutrient manipulations reduce postprandial lipemia in the absence of energy restriction. Therefore, interactions between exercise/energy restriction and alterations in macronutrient content remain top priorities for the field to identify optimal behavioral treatments to reduce postprandial lipemia.

Postprandial lipemia and cardiovascular diseases: the beneficial role of strength exercise

Development of cardiovascular diseases (CVD) has been linked with changes to the lipid profile that can be observed during the postprandial period, a phenomenon known as postprandial lipemia (PL). Physical exercise is currently the number one non-pharmacological intervention employed for prevention and reduction of risk factors for the development of CVD. This in turn has created a growing interest in the effects of physical exercise on regulation and equilibrium of lipid metabolism. In this review we compare the results of studies that have investigated the beneficial effects of strength training on PL. We analyzed articles identified in the PubMed, Scopus and EBSCO databases published from 1975 to 2013 in international journals. Studies were selected for review if they covered at least two of four keywords. The results of these studies lead to the conclusion that strength training is effective for reduction of postprandial lipemia because it increases baseline energy expenditure. This type of training can be prescribed as an important element in strategies to treat chronic diseases, such as atherosclerosis.

Resistance exercise at variable volume does not reduce postprandial lipemia in postmenopausal women

The aim of this study was to investigate the acute effects of resistance exercise sessions (RESs) performed at different levels of high-volume resistance exercise (HVRE) and low-volume resistance exercise (LVRE) on postprandial lipemia (PPL) in postmenopausal women. Thirty-nine healthy unconditioned postmenopausal women (59.5 ± 4.8 years of age, body mass 69.6 ± 9.1 kg, height 157.9 ± 7.2 cm, BMI 27.6 ± 4.1 kg m(-2), waist circumference 76.1 ± 9.7 cm, VO2max 18.7 ± 1.4 mL kg(-1) min(-1)) were assigned to a LVRE (n = 12), HVRE (n = 14), and control group (CG, n = 13). Experimental groups performed one RES involving eight exercises. The HVRE group performed three sets with a maximum of 15 repetitions, and the LVRE group performed one set with a maximum of 15 repetitions. Approximately 16 h after a RES, all of the groups were given an oral fat tolerance test (OFTT). During the RES, we evaluated the energy expenditure (EE) of the resistance session and excess postexercise oxygen consumption (EPOC); following the RES and the OFTT, we evaluated lipid profiles (total cholesterol, HDL, LDL, and triglycerides). While the study groups did not demonstrate significant differences in lipid profiles, the total energy expenditure (EE + EPOC) of the session exercise treatments was significantly higher for HVRE than for LVRE (0.60 ± 0.12 and 0.31 ± 0.11 MJ, respectively, p < 0.001). Different levels of resistance exercise do not lower basal triglyceride concentration and postprandial lipid profile parameters at approximately 16 h following resistance exercise in untrained postmenopausal women.

Effect of prior exercise on postprandial lipemia: an updated quantitative review

Reducing postprandial triglycerides (TG) can lower the risk for cardiovascular disease. The purpose of this study was to perform a meta-analytic review of the literature to estimate the effect of prior exercise on postprandial lipemia. A total of 121 effects were found from 76 studies for the total TG response and 70 effects from 44 studies for the incremental area under the curve (iAUC) TG response. The weighted mean effect was moderate for the total TG response, Cohen's d = −0.60 ( P < 0.0001), and for the iAUC response, Cohen's d = −0.59 ( P < 0.0001). Moderator analysis revealed women exhibited a larger reduction ( P < .01) in the total TG response following exercise ( d = −0.96) than men ( d = −0.57); high-intensity interval training induced a larger reduction ( P < .05) in the iAUC response ( d = −1.49) than aerobic ( d = −0.58) or resistance ( d = −0.13) exercise, and participants maintaining an energy deficit following exercise exhibited a greater reduction in the iAUC response ( d = −0.67) compared with participants in energy balance ( d = −0.28). We conclude that prior acute exercise reduces postprandial lipemia, with the magnitude of effect influenced by sex, type of exercise, and energy deficit following exercise.

Sexual dimorphism in the effects of exercise on metabolism of lipids to support resting metabolism

Exercise training is generally a healthful activity and an effective intervention for reducing the risk of numerous chronic diseases including cardiovascular disease and diabetes. This is likely both a result of prevention of weight gain over time and direct effects of exercise on metabolism of lipids and the other macronutrient classes. Importantly, a single bout of exercise can alter lipid metabolism and metabolic rate for hours and even into the day following exercise, so individuals who regularly exercise, even if not performed every single day, overall could experience a substantial change in their resting metabolism that would reduce risk for metabolic diseases. However, resting metabolism does not respond similarly in all individuals to exercise participation, and indeed gender or sex is a major determinant of the response of resting lipid metabolism to prior exercise. In order to fully appreciate the metabolic effects and health benefits of exercise, the differences between men and women must be considered. In this article, the differences in the effects of exercise on resting metabolic rate, fuel selection after exercise, as well as the shuttling of triglyceride and fatty acids between tissues are discussed. Furthermore, concepts related to sex differences in the precision of homeostatic control and sex differences in the integration of metabolism between various organs are considered.

The latest on the effect of prior exercise on postprandial lipaemia

This review examines the effect of prior exercise on postprandial triacylglycerol (pTAG) concentrations, an independent risk factor for cardiovascular diseases. Numerous studies have shown that a single bout of exercise reduces pTAG concentrations; however, several modulators such as exercise energy expenditure/deficit, mode of exercise (aerobic/resistance/high intensity/intermittent exercise or combinations), type of meal (moderate or high fat), time frame between exercise and meal and target group may individually or in conjunction influence this effect. On the other hand, at least for aerobic exercise, training reduces pTAG concentrations transiently (~2 days); therefore, exercise sessions should be frequent enough to maintain this clinically significant improvement. For the healthy population, it seems that a subject's preference and ability determine which type of exercise to undertake to attenuate pTAG concentrations; an energy expenditure of ~30 kJ/kg of body mass (or ~2-2.5 MJ) not combined with a corresponding increase in energy intake is required; for resistance or intermittent exercise, for those following a moderate rather than a high-fat diet, and for those with obesity (expressed as kJ/kg of body mass), a smaller energy expenditure is probably sufficient. More studies are needed to investigate dose-response/plateau effects, as well as the threshold of energy expenditure in those with diabetes mellitus and other high-risk populations. Finally, investigation of the underlying mechanisms may be clinically helpful in individualizing the appropriate intervention.

The effect of aerobic exercise intensity on attenuation of postprandial lipemia is dependent on apolipoprotein E genotype

OBJECTIVE

To investigate the effect of aerobic exercise intensity on postprandial lipemia according to allelic variants of the apolipoprotein E gene.

METHODS

Three groups of 10 healthy men each were formed based genotyping of the APOE gene, rested or performed 500 Kcal tests in a random sequence separated by a minimum 48 h interval, as follows: (a) no exercise (control), (b) intense intermittent exercise, (c) moderate continuous exercise. Each test series was completed 30-min before ingestion of a high-fat meal (1 g fat/kg). Venous blood was collected before and at 1, 2, 3 and 4 h after the high-fat meal. Postprandial lipemia was assessed using the area under the curve approach as well as the kinetic profile of mean lipid variables. Statistical significance was adopted at P ≤ 0.05 level.

RESULTS

The main results show that, in the moderate continuous exercise, total postprandial cholesterolemia was higher in ɛ4 than in ɛ2 carriers, whereas under intense intermittent exercise, total and LDL cholesterolemia were higher in ɛ4 than in ɛ2 and ɛ3 carriers. There was no difference in the lipemic profile of the subjects across APOE genotypes at baseline.

CONCLUSION

Moderate and intense exercise were effective in attenuating PPL in both ɛ2 and ɛ3 subjects, with ɛ2 subjects being more susceptible to the lipid lowering effect of moderate training than ɛ3 subjects. Carriers of the ɛ4 allele, however, showed no attenuation of postprandial lipemia.

Postprandial triglyceride and free fatty acid metabolism in obese women after either endurance or resistance exercise

We investigated the effects of two exercise modalities on postprandial triglyceride (TG) and free fatty acid (FFA) metabolism. Sedentary, obese women were studied on three occasions in randomized order: endurance exercise for 60 min at 60-65% aerobic capacity (E), ~60 min high-intensity resistance exercise (R), and a sedentary control trial (C). After exercise, a liquid-mixed meal containing [U-(13)C]palmitate was consumed, and subjects were studied over 7 h. Isotopic enrichment (IE) of plasma TG, plasma FFA, and breath carbon dioxide compared with meal IE indicated the contribution of dietary fat to each pool. Total and endogenously derived plasma TG content was reduced significantly in both E and R compared with C (P < 0.05), with no effect of exercise on circulating exogenous (meal-derived) TG content. Exogenous plasma FFA content was increased significantly following both E and R compared with C (P < 0.05), whereas total and endogenous FFA concentrations were elevated only in E (P < 0.05) compared with C. Fatty acid (FA) oxidation rates were increased significantly after E and R compared with C (P < 0.05), with no difference between exercise modalities. The present results indicate that E and R may be equally effective in reducing postprandial plasma TG concentration and enhancing lipid oxidation when the exercise sessions are matched for duration rather than for energy expenditure. Importantly, tracer results indicated that the reduction in postprandial lipemia after E and R exercise bouts is not achieved by enhanced clearance of dietary fat but rather, is achieved by reduced abundance of endogenous FA in plasma TG.

Acute high-intensity endurance exercise is more effective than moderate-intensity exercise for attenuation of postprandial triglyceride elevation

Acute exercise has been shown to attenuate postprandial plasma triglyceride elevation (PPTG). However, the direct contribution of exercise intensity is less well understood. The purpose of this study was to examine the effects of exercise intensity on PPTG and postprandial fat oxidation. One of three experimental treatments was performed in healthy young men ( n = 6): nonexercise control (CON), moderate-intensity exercise (MIE; 50% V̇o2peak for 60 min), or isoenergetic high-intensity exercise (HIE; alternating 2 min at 25% and 2 min at 90% V̇o2peak). The morning after the exercise, a standardized meal was provided (16 kcal/kg BM, 1.02 g fat/kg, 1.36 g CHO/kg, 0.31 g PRO/kg), and measurements of plasma concentrations of triglyceride (TG), glucose, insulin, and β-hydroxybutyrate were made in the fasted condition and hourly for 6 h postprandial. Indirect calorimetry was used to determine fat oxidation in the fasted condition and 2, 4, and 6 h postprandial. Compared with CON, both MIE and HIE significantly attenuated PPTG [incremental AUC; 75.2 (15.5%), P = 0.033, and 54.9 (13.5%), P = 0.001], with HIE also significantly lower than MIE ( P = 0.03). Postprandial fat oxidation was significantly higher in MIE [83.3 (10.6%) of total energy expenditure] and HIE [89.1 (9.8) %total] compared with CON [69.0 (16.1) %total, P = 0.039, and P = 0.018, respectively], with HIE significantly greater than MIE ( P = 0.012). We conclude that, despite similar energy expenditure, HIE was more effective than MIE for lowering PPTG and increasing postprandial fat oxidation.

Nutrition and physical activity programs for obesity treatment (PRONAF study): methodological approach of the project

BACKGROUND

At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study.

METHODS/DESIGN

One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18-50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29-34% of the total energy intake came from fat, 14-20% from protein, and 50-55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%).

DISCUSSION

Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01116856.

Postprandial dyslipidaemia and diabetes: mechanistic and therapeutic aspects

PURPOSE OF REVIEW

There has been a resurgence of interest in the role of triglyceride-rich lipoproteins in the development of atherosclerosis and cardiovascular disease, and this is particularly relevant to diabetes mellitus and the postprandial state.

RECENT FINDINGS

Recent evidence suggests that insulin resistance in diabetes induces postprandial dyslipidemia by increasing the enterocytic production of chylomicrons and their remnant particles, but an impaired clearance capacity is also involved. Postprandial dyslipidaemia in diabetes induces oxidative stress, inflammation and endothelial dysfunction and this may be compounded by dysglycaemia. New guidelines for managing hypertriglyceridaemia in diabetes have been published, first-line therapies being improved glycaemic control, treatment of other secondary causes of dyslipidaemia and statin therapy, followed by judicious use of fibrates, n-3 fatty acids or niacin. A new role for incretin-based therapies in regulating dyslipidaemia has been identified.

SUMMARY

Postprandial dyslipidaemia is a pivotal mechanism whereby diabetes can induce and accelerate atherosclerosis. Regulating the plasma concentrations of triglyceride-rich lipoproteins may decrease the cardiovascular complications of diabetes. The mechanisms of action of incretin-based treatments on dyslipidaemia and endothelial dysfunction need further investigation. The efficacy of new therapies targeted at postprandial dysmetabolism in diabetes need to be confirmed, against best current levels of care, in clinical endpoint trials.

Effect of Spirulina maxima on postprandial lipemia in young runners: a preliminary report

Trained people exhibit low plasma concentrations of triacylglcyerols in both fasting and postprandial states. Exercise practice is commonly believed to improve postprandial lipemia. In addition, elevated postprandial lipemia is an indicator of poor lipid clearance, and it has been associated with atherosclerosis, insulin resistance, and obesity. Spirulina maxima is an edible microorganism with a high nutritional value. When it is consumed, beneficial properties to health have been demonstrated, such as hypolipemic and antihypertensive properties in human beings. This work evaluates the effects of orally administrated S. maxima on postprandial lipemia in a young Mexican sporting population after 15 days of consumption, as a possible alternative treatment to improve their lipid clearance. Forty-one runners (10-26 years old; 21 men and 20 women) volunteered to participate in the study. All of them were physically active for at least 1 year before the study and were not undergoing training during the study. The subjects consumed 5 g of Spirulina during 15 days. Before and after the treatment with Spirulina, they consumed (12 h fasting) a standardized meal with high fat content (53.2% total calories). Postprandial lipemia was measured at 1.5, 3, and 4.5 h after the fatty meal. Fasting plasma triacylglycerol (TAG) concentrations were lower after Spirulina treatment than before treatment. In addition, the postprandial area under the curve of TAG concentrations was lower after the treatment with Spirulina. Sixty-two percent of the youngest runners (10-16 years) studied exhibited the best response to the treatment. Orally administered S. maxima decreased postprandial lipemia in sporting teenagers. The youngest people were the most responsive to the beneficial effects of Spirulina on postprandial lipemia.

Effects of acute sprint interval cycling and energy replacement on postprandial lipemia

High postprandial blood triglyceride (TG) levels increase cardiovascular disease risk. Exercise interventions may be effective in reducing postprandial blood TG. The purpose of this study was to determine the effects of sprint interval cycling (SIC), with and without replacement of the energy deficit, on postprandial lipemia. In a repeated-measures crossover design, six men and six women participated in three trials, each taking place over 2 days. On the evening of the first day of each trial, the participants either did SIC without replacing the energy deficit (Ex-Def), did SIC and replaced the energy deficit (Ex-Bal), or did not exercise (control). SIC was performed on a cycle ergometer and involved four 30-s all-out sprints with 4-min active recovery. In the morning of day 2, responses to a high-fat meal were measured. Venous blood samples were collected in the fasted state and at 0, 30, 60, 120, and 180 min postprandial. There was a trend toward a reduction with treatment in fasting TG ( P = 0.068), but no significant treatment effect for fasting insulin, glucose, nonesterified fatty acids, or betahydroxybutryrate ( P > 0.05). The postprandial area under the curve (mmol·l−1·3 h−1) TG response was significantly lower in Ex-Def (21%, P = 0.006) and Ex-Bal (10%, P = 0.044) than in control, and significantly lower in Ex-Def (12%, P = 0.032) than in Ex-Bal. There was no treatment effect ( P > 0.05) observed for area under the curve responses of insulin, glucose, nonesterified fatty acids, or betahydroxybutryrate. SIC reduces postprandial lipemia, but the energy deficit alone does not fully explain the decrease observed.

Physical activity and postprandial lipidemia: are energy expenditure and lipoprotein lipase activity the real modulators of the positive effect?

Historically, the link between elevated cholesterol and increased risk of cardiovascular disease has been based on fasting measurements. This is appropriate for total, low-density lipoprotein and high-density lipoprotein cholesterol. However, triglyceride concentrations vary considerably throughout the day in response to the regular consumption of food and drink. Recent findings indicate that postprandial triglyceride concentrations independently predict future cardiovascular risk. Potential modulators of postprandial lipidemia include meal composition and physical activity. Early cross sectional studies indicated that physically active individuals had a lower postprandial lipidemic response compared to inactive individuals. However, the effect of physical activity on postprandial lipidemia is an acute phenomenon, which dissipates within 60 h of a single bout of exercise. Total exercise induced energy expenditure, rather than duration or intensity of the physical activity is commonly reported to be a potent modulator of postprandial lipidemia. However, the pooled results of studies in this area suggest that energy expenditure exerts most of its influence on fasting triglyceride concentrations rather than on the incremental change in triglyceride concentrations seen following meal consumption. It seems more likely that energy expenditure is one component of a multifactorial list of mediators that may include local muscle contractile activity, and other yet to be elucidated mechanisms.

Understanding postprandial inflammation and its relationship to lifestyle behaviour and metabolic diseases

Postprandial hyperlipidemia with accumulation of remnant lipoproteins is a common metabolic disturbance associated with atherosclerosis and vascular dysfunction, particularly during chronic disease states such as obesity, the metabolic syndrome and, diabetes. Remnant lipoproteins become attached to the vascular wall, where they can penetrate intact endothelium causing foam cell formation. Postprandial remnant lipoproteins can activate circulating leukocytes, upregulate the expression of endothelial adhesion molecules, facilitate adhesion and migration of inflammatory cells into the subendothelial space, and activate the complement system. Since humans are postprandial most of the day, the continuous generation of remnants after each meal may be one of the triggers for the development of atherosclerosis. Modulation of postprandial lipemia by lifestyle changes and pharmacological interventions could result in a further decrease of cardiovascular mortality and morbidity. This paper will provide an update on current concepts concerning the relationship between postprandial lipemia, inflammation, vascular function, and therapeutic options.

Prior endurance exercise prevents postprandial lipaemia-induced increases in reactive oxygen species in circulating CD31+ cells

We hypothesized that prior exercise would prevent postprandial lipaemia (PPL)-induced increases in intracellular reactive oxygen species (ROS) in three distinct circulating angiogenic cell (CAC) subpopulations. CD34(+), CD31(+)/CD14(-)/CD34(-), and CD31(+)/CD14(+)/CD34(-) CACs were isolated from blood samples obtained from 10 healthy men before and 4 h after ingesting a high fat meal with or without ∼50 min of prior endurance exercise. Significant PPL-induced increases in ROS production in both sets of CD31(+) cells were abolished by prior exercise. Experimental ex vivo inhibition of NADPH oxidase activity and mitochondrial ROS production indicated that mitochondria were the primary source of PPL-induced oxidative stress. The attenuated increases in ROS with prior exercise were associated with increased antioxidant gene expression in CD31(+)/CD14(-)/CD34(-) cells and reduced intracellular lipid uptake in CD31(+)/CD14(+)/CD34(-) cells. These findings were associated with systemic cardiovascular benefits of exercise, as serum triglyceride, oxidized low density lipoprotein-cholesterol, and plasma endothelial microparticle concentrations were lower in the prior exercise trial than the control trial. In conclusion, prior exercise completely prevents PPL-induced increases in ROS in CD31(+)/CD14(-)/CD34(-) and CD31(+)/CD14(+)/CD34(-) cells. The mechanisms underlying the effects of exercise on CAC function appear to vary among specific CAC types.

The influence of intense intermittent versus moderate continuous exercise on postprandial lipemia

INTRODUCTION

Postprandial lipemia is characterized by an increased concentration of circulating lipids after fat intake and is an independent risk factor for cardiovascular disease. Exercise is known to reduce postprandial lipemia and its negative clinical outcomes.

OBJECTIVE

This study investigated the effect of intense intermittent versus moderate continuous exercise using the same energy expenditure in postprandial lipemia.

MATERIALS AND METHODS

Twenty healthy men (aged 21.5 ± 3.5 years) performed a random sequence of either rest or 500 Kcal tests separated by a minimum 48 h interval as follows: (a) no exercise (control), (b) intense intermittent exercise, or (c) moderate continuous exercise. Each test series was completed 30 min before ingestion of a high-fat meal (1 g fat/kg). Venous blood was collected before and at 1, 2, 3 and 4 hours after the high-fat meal. Postprandial lipemia was assessed using the area under the curve approach as well as a kinetic profile of mean lipid variables. Statistical significance was tested at the p<0.05 level.

RESULTS

With both statistical approaches, intense intermittent and moderate continuous exercises were both effective in reducing postprandial triglycerides; however, only intense intermittent exercise reduced the levels of postprandial very low density lipoprotein. Intense intermittent and continuous exercise produced lower levels of insulinemia using the area under the curve analysis only.

CONCLUSION

Intense intermittent or continuous exercise with an energy expenditure of 500 kcal completed 30 min before ingestion of high-fat meal reduced postprandial lipid levels to different levels in physically active men. Understanding these relevant differences will enable clinicians to provide the best exercise prescription for patients.

Effects of energy balance on postprandial triacylglycerol metabolism

PURPOSE OF REVIEW

To present the effect of negative energy balance on postprandial triacylglycerol concentrations (pTAG), an independent risk factor for the development of cardiovascular disease.

RECENT FINDINGS

Aerobic exercise reduces pTAG; however, recent findings confirm that this effect is only evident with an accompanying energy deficit. Moreover, a recent study showed that acute diet-induced energy deficit also reduces pTAG. The extent of energy deficit required to significantly attenuate pTAG depends on the type of given meal, the type of deficit (aerobic/resistance exercise, diet, or combination of diet and exercise), and patients' health status. Apart from the acute effects, prolonged energy deficit leading to moderate weight loss attenuates pTAG, when it is combined with other known hypotriacylglycerolemic agents, such as carbohydrate restriction.

SUMMARY

For healthy population, it seems that it is up to patient's preference and ability which type of energy deficit will follow to attenuate pTAG; an energy deficit of approximately 30 kJ/kg of body mass is required; for resistance exercise a smaller deficit is probably sufficient. More studies are needed to investigate dose-response/plateau effects, the effects of energy deficit-energy surplus every other day, and the threshold of energy deficit-weight loss in diabetics and other high-risk populations. Finally, investigation of the underlying mechanisms may be clinicall helpful in individualizing the appropriate intervention.

Acute resistance exercise attenuates fasting and postprandial triglyceridemia in women by reducing triglyceride concentrations in triglyceride-rich lipoproteins

A single bout of endurance exercise lowers fasting and postprandial triglyceride (TG) concentrations in both men and women, by reducing TG in triglyceride-rich lipoproteins (TRLs). The effect of resistance exercise on TRL-TG metabolism is not known; previous studies only measured total plasma TG concentrations and provide conflicting results. Furthermore, none has specifically examined women. We therefore sought to evaluate the effect of a single bout of resistance exercise on TRL-TG metabolism in women. We measured the concentrations of TG in total plasma and TRLs in the fasting state and during an oral fat tolerance test in five healthy untrained women (age: 32 ± 5 years; body mass index: 21.5 ± 1.7 kg/m(2); peak oxygen consumption: 31 ± 4 mL/kg min) in the morning, on two separate occasions: once after a single ~95-min bout of moderate-intensity whole-body resistance exercise (energy expenditure: 2.9 ± 0.1 MJ) and once after an equivalent period of rest, on the preceding afternoon. Fasting plasma TG and TRL-TG concentrations were 22 ± 12 and 40 ± 21% lower, respectively, and postprandial plasma TG and TRL-TG areas-under-the-curve were 24 ± 13 and 27 ± 10% lower, respectively, after exercise than rest (all P values <0.05). Effect sizes ranged from -0.52 to -0.90. Non-TRL-TG concentrations in the fasting and postprandial states were not different between trials (P > 0.60). We conclude that a single bout of resistance exercise attenuates fasting and postprandial triglyceridemia in women by reducing TRL-TG concentrations.