Exercise prior to a freely requested meal modifies pre and postprandial glucose profile, substrate oxidation and sympathovagal balance

The Effect of a Single Bout of Continuous Aerobic Exercise on Glucose, Insulin and Glucagon Concentrations Compared to Resting Conditions in Healthy Adults: A Systematic Review, Meta-Analysis and Meta-Regression

Background

Elevated glucose and insulin levels are major risk factors in the development of cardiometabolic disease. Aerobic exercise is widely recommended to improve glycaemic control, yet its acute effect on glycaemia and glucoregulatory hormones has not been systematically reviewed and analysed in healthy adults.

Objective

To determine the effect of a single bout of continuous aerobic exercise on circulating glucose, insulin, and glucagon concentrations in healthy adults.

Methods

CENTRAL, CINAHL, Embase, Global Health, HMIC, Medline, PubMed, PsycINFO, ScienceDirect, Scopus and Web of Science databases were searched from inception to May 2020. Papers were included if they reported a randomised, crossover study measuring glucose and/or insulin and/or glucagon concentrations before and immediately after a single bout of continuous aerobic exercise (≥ 30 min) compared to a time-matched, resting control arm in healthy adults. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and GRADE approach, respectively. Random-effects meta-analyses were performed for glucose, insulin, and glucagon. Sub-group meta-analyses and meta-regression were performed for categorical (metabolic state [postprandial or fasted], exercise mode [cycle ergometer or treadmill]) and continuous (age, body mass index, % males, maximal aerobic capacity, exercise duration, exercise intensity) covariates, respectively.

Results

42 papers (51 studies) were considered eligible: glucose (45 studies, 391 participants), insulin (38 studies, 377 participants) and glucagon (5 studies, 47 participants). Acute aerobic exercise had no significant effect on glucose concentrations (mean difference: − 0.05 mmol/L; 95% CI, − 0.22 to 0.13 mmol/L; P = 0.589; I²: 91.08%, large heterogeneity; moderate-quality evidence). Acute aerobic exercise significantly decreased insulin concentrations (mean difference: − 18.07 pmol/L; 95% CI, − 30.47 to − 5.66 pmol/L; P = 0.004; I²: 95.39%, large heterogeneity; moderate-quality evidence) and significantly increased glucagon concentrations (mean difference: 24.60 ng/L; 95% CI, 16.25 to 32.95 ng/L; P < 0.001; I²: 79.36%, large heterogeneity; moderate-quality evidence). Sub-group meta-analyses identified that metabolic state modified glucose and insulin responses, in which aerobic exercise significantly decreased glucose (mean difference: − 0.27 mmol/L; 95% CI, − 0.55 to − 0.00 mmol/L; P = 0.049; I²: 89.72%, large heterogeneity) and insulin (mean difference: − 42.63 pmol/L; 95% CI, − 66.18 to − 19.09 pmol/L; P < 0.001; I²: 81.29%, large heterogeneity) concentrations in the postprandial but not fasted state. Meta-regression revealed that the glucose concentrations were also moderated by exercise duration and maximal aerobic capacity.

Conclusions

Acute aerobic exercise performed in the postprandial state decreases glucose and insulin concentrations in healthy adults. Acute aerobic exercise also increases glucagon concentrations irrespective of metabolic state. Therefore, aerobic exercise undertaken in the postprandial state is an effective strategy to improve acute glycaemic control in healthy adults, supporting the role of aerobic exercise in reducing cardiometabolic disease incidence.

PROSPERO registration number

CRD42020191345.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01473-2.

Walking Initiated 20 Minutes before the Time of Individual Postprandial Glucose Peak Reduces the Glucose Response in Young Men with Overweight or Obesity: A Randomized Crossover Study

BACKGROUND

Although a single bout of postmeal exercise can lower postprandial glucose (PPG), its optimal timing remains unclear.

OBJECTIVE

This study aimed to investigate the effect of exercise timing using an individualized approach on PPG in overweight or obese young men.

METHODS

Twenty men [age: 23.0 ± 4.3 y; BMI (kg/m2): 27.4 ± 2.8] each completed three 240-min trials in a randomized order separated by 6-14 d: 1) sitting (SIT), 2) walking initiated at each participant's PPG-peak time (PPGP) (iP), and 3) walking initiated 20 min before the PPGP (20iP). For each participant, PPGP was predetermined using continuous glucose monitoring. Walking was performed at 50% maximal oxygen consumption for 30 min. Venous blood was collected at 15- and 30-min intervals for 0-120 min and 120-240 min, respectively. The primary outcome was plasma PPG. Generalized estimating equations were used for comparison between trials.

RESULTS

Compared with SIT, the 4-h incremental AUCs (iAUCs) for plasma PPG (-0.6 mmol · L-1 · h; P = 0.047) and insulin (-28.7%, P < 0.001) were reduced in 20iP only, and C-peptide concentrations were lower after iP (-14.9%, P = 0.001) and 20iP (-28.7%, P < 0.001). Plasma insulin (-11.1%, P = 0.006) and C-peptide (-8.3%, P = 0.012) were lower due to the 20iP compared with iP treatment. Finally, PPG reductions due to iP and 20iP occurred only in men with a BMI > 27.5 kg/m2 (iP, -11.2%; 20iP, -14.7%; P = 0.047) and higher glucose iAUC values during SIT (iP, -25.5%; 20iP, -25.7%; P < 0.001).

CONCLUSIONS

Walking initiated 20 min before PPGP lowered PPG and plasma insulin and C-peptide concentrations in young men with overweight or obesity, in particular in those with high BMI or glucose iAUC values during SIT; it also lowered plasma insulin and C-peptide concentrations more effectively than did exercise initiated at PPGP. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) as ChiCTR1900023175.

Comparison of energy-matched high-intensity interval and moderate-intensity continuous exercise sessions on latency to eat, energy intake, and appetite

High-intensity interval exercises (HIIex) have gained popularity but their effects on eating behavior are poorly known. The aim of this study was to evaluate whether the effects of HIIex on the 3 main components of eating behavior (appetite, intake, and latency to eat) differ from those of moderate-intensity continuous exercises (MICex) for the same energy expenditure. Fifteen young normal-weight males completed 3 sessions in a counterbalanced order: HIIex (30-s bouts at 90% of maximal oxygen uptake interceded with 60-s bouts at 35% of maximal oxygen uptake for 20 min), MICex (42% of maximal oxygen uptake for 40 min), and a resting session (REST). Trials were scheduled 80 and 100 min after a standard breakfast for MICex and HIIex, respectively. At 120 min, participants were isolated until they asked for lunch. Appetite was rated on 4 visual analog scales (hunger, desire to eat, fullness, and prospective consumption) every 15 min until meal request. Results showed that the mean latency of requesting lunch was significantly longer after HIIex than after REST (+17.3 ± 4.3 min, P = 0.004), but not after MICex (P = 0.686). Energy intake was not different between conditions, leading to a negative energy balance in the 2 exercise sessions. Thus, the effects of HIIex on eating behavior are likely primarily mediated through the latency of meal initiation. However, inter-individual variability was large and further studies are needed to identify the predictive factors of this response.

Physiology of energy homeostasis: Models, actors, challenges and the glucoadipostatic loop

The aim of this review is to discuss the physiology of energy homeostasis (EH), which is a debated concept. Thus, we will see that the set-point theory is highly challenged and that other models integrating an anticipative component, such as energy allostasis, seem more relevant to experimental reports and life preservation. Moreover, the current obesity epidemic suggests that EH is poorly efficient in the modern human dietary environment. Non-homeostatic phenomena linked to hedonism and reward seem to profoundly impair EH. In this review, the apparent failed homeostatic responses to energy challenges such as exercise, cafeteria diet, overfeeding and diet-induced weight loss, as well as their putative determinants, are analyzed to highlight the mechanisms of EH. Then, the hormonal, neuronal, and metabolic factors of energy intake or energy expenditure are briefly presented. Last, this review focuses on the contributions of two of the most pivotal and often overlooked determinants of EH: the availability of endogenous energy and the pattern of energy intake. A glucoadipostatic loop model is finally proposed to link energy stored in adipose tissue to EH through changes in eating behavior via leptin and sympathetic nervous system activity.

The Timing of Activity after Eating Affects the Glycaemic Response of Healthy Adults: A Randomised Controlled Trial

There is scant information on how a time lag between the cessation of eating and commencement of physical activity affects postprandial glycaemia. Starting at baseline (t = 0), participants ingested white bread containing 50 g of available carbohydrates within 10 min. Using two crossover conditions, we tested the effect over 2 h on postprandial glycaemia of participants undertaking light activity at 15 or 45 min following baseline and compared it with a sedentary control condition. The activity involved cycling on a stationary ergometer for 10 min at 40 revolutions per min with zero resistance. Seventy-eight healthy adults were randomized to the 15 or 45 min activity arm and then randomised to the order in which they undertook the active and sedentary conditions. Cycling 45 min after baseline changed the course of the blood glucose response (likelihood ratio chi square = 31.47, p < 0.01) and reduced mean blood glucose by 0.44 mmol/L (95% confidence interval 0.14 to 0.74) at 60 min when compared with the sedentary control. No differences in postprandial blood glucose response were observed when cycling started 15 min after baseline compared with the sedentary control. Undertaking activity after waiting for 30 min following eating might be optimal in modifying the glycaemic response.

Breaks in Sitting Time: Effects on Continuously Monitored Glucose and Blood Pressure

PURPOSE

We examined the effects of interrupting prolonged sitting with multiple 2-min walking breaks or one 30-min continuous walking session on glucose control and ambulatory blood pressure (ABP).

METHODS

Ten overweight/obese, physically inactive participants (five men; 32 ± 5 yr; BMI, 30.3 ± 4.6 kg·m) participated in this randomized four-trial crossover study, with each trial performed on a separate, simulated workday lasting 9 h: 1) 30 min of continuous moderate-intensity (30-min MOD) walking at 71% ± 4% HRmax; 2) 21 × 2 min bouts of moderate-intensity (2-min MOD) walking at 53% ± 5% HRmax, each performed every 20 min (42 min total); 3) 8 × 2 min bouts of vigorous-intensity (2-min VIG) walking at 79% ± 4% HRmax, each performed every hour (16 min total); 4) 9 h of prolonged sitting (SIT). Participants underwent continuous interstitial glucose monitoring and ABP monitoring during and after the simulated workday spent in the laboratory, with primary data analysis from 12:30 h to 07:00 h the next morning.

RESULTS

Compared with SIT (5.6 ± 1.1 mmol·L), mean 18.7-h glucose was lower during the 2-min MOD (5.2 ± 1.1 mmol·L) and 2-min VIG (5.4 ± 0.9 mmol·L) trials and mean 18.7-h glucose during the 30-min MOD trial (5.1 ± 0.8 mmol·L) was lower than all other trials (P < 0.001). Postprandial glucose was approximately 7% to 13% lower during all trials compared with SIT (P < 0.001), with 30-min MOD having the greatest effect. Only the 30-min MOD trial was effective in reducing systolic ABP from 12:30 to 07:00 h (119 ± 15 mm Hg) when compared with SIT (122 ± 16 mm Hg; P < 0.05).

CONCLUSIONS

Replacing sitting with 2-min MOD walking every 20 min or 2 min of vigorous-intensity walking every hour during a simulated workday reduced 18.7 h and postprandial glucose, but only 30-min MOD walking was effective for reducing both glucose and systolic ABP.

Noninvasive measurements to evaluate the effects of military training on the human autonomic nervous system

Background: Chinese university freshmen receive 4-weeks military training that involved moderate to intense physical exercise. Studies have demonstrated heterogeneous effects of exercise on the autonomic nervous system.

Objective: To evaluate the effects of training on the autonomic nervous system noninvasively using electrogastrograms, heart rate variability (HRV), pulse rate, and the sympathetic skin response (SSR).

Methods: Twenty freshmen received all assessments in the fasting state and after a standard meal: (1) one week before the training, (2) at the end of the second week of the training, and (3) one week after the training.

Results: (1) The training had a significant effect on meal-induced gastric pacemaker activity. Before the training, a standard meal did not increase the dominant frequency of gastric slow waves, but the frequency increased during and after the training; (2) The preprandial high frequency (HF), low frequency (LF), and very low frequency (VLF) components of heart rate variability decreased significantly after the training. The ratio of the LF and HF (LF/HF) of the heart rate variability (HRV) did not significantly change after a meal or training condition. The basal pulse rate did not change. The latencies of the sympathetic skin response (SSR), as measured in the arm muscle, increased in response to the training.

Conclusion: Military training affects meal-induced changes in gastric pacemaker activity, causes a marked reduction of the vagal tone to the heart with maintenance of the vagal-sympathetic balance, and its effects on SSR may reflect a reduction in sympathetic tone.

Concentric and eccentric exercise, glycemic responses to a postexercise meal, and inflammation in women with high versus low waist circumference

Carbohydrate ingestion and level of concentric versus eccentric muscle activity may alter exercise-induced health benefits for individuals who have high waist circumference as a metabolic risk factor. The purpose of this study was to determine whether metabolic and inflammation responses to an exercise recovery meal differ between women with lower (Lo-WC, <80 cm) compared with higher (Hi-WC) waist circumference when the exercise is primarily concentric (uphill walking; UPHILL) versus primarily eccentric (downhill walking; DOWNHILL). Recreationally active women (age, 18-39 years; body mass index, 19-35.4 m·kg^-2; Lo-WC, n = 13; Hi-WC, n = 10) completed UPHILL, DOWNHILL, and resting (CONTROL) conditions followed 30 min later by a mixed meal tolerance test (MMTT) with carbohydrates to protein ratio of 4:1, and blood glucose, insulin, and inflammation markers were compared across conditions. Compared with Lo-WC, the Hi-WC group had higher (p < 0.05) (i) insulin during the MMTT in CONTROL (mean ± SE; 48.5 ± 8.2 vs 22.9 ± 2.8 pmol·L^-1), (ii) baseline (0.7 ± 0.4 vs 2.0 ± 1.7 pg·mL^-1) interleukin-6 (IL-6), and (iii) IL-6 responses 8 h after UPHILL and CONTROL. Both groups had (i) increases in IL-6 at 0 h after UPHILL and at 8 h after DOWNHILL, and (ii) lower glycemic responses in UPHILL. Women with Hi-WC had higher IL-6 at rest and delayed increases in IL-6 after a high-carbohydrate meal in all conditions. This is consistent with an inflammation response to the meal and or uphill walking exercise. However, both concentrically and eccentrically biased exercises offered benefits to insulin responses to a high carbohydrate meal for Hi-WC.

Two weeks of high-intensity interval training improves novel but not traditional cardiovascular disease risk factors in adolescents

High-intensity interval training (HIIT) improves traditional cardiovascular disease (CVD) risk factors in adolescents, but no study has identified the influence of HIIT on endothelial and autonomic function in this group. Thirteen 13- to 14-yr-old adolescents (6 girls) completed six HIIT sessions over 2 wk. Each training session consisted of eight to ten 1-min repetitions of cycling at 90% peak power interspersed with 75 s of unloaded cycling. Traditional (triglycerides, cholesterol, glucose, insulin, and blood pressure) and novel [flow-mediated dilation (FMD), heart rate variability (HRV)] CVD risk factors were assessed in a fasted and postprandial state before (PRE), 1 day after (POST-1D), and 3 days after (POST-3D) training. Aerobic fitness was determined PRE and POST-3D. Two weeks of HIIT had no effect on aerobic fitness or traditional CVD risk factors determined in the fasted or postprandial state ( P > 0.15). Compared with PRE, fasted FMD was improved POST-1D [ P = 0.003, effect size (ES) = 0.70] but not POST-3D ( P = 0.32, ES = 0.22). Fasted FMD was greater POST-1D compared with POST-3D ( P = 0.04, ES = 0.48). Compared with PRE, postprandial FMD was greater POST-1D ( P < 0.001, ES = 1.01) and POST-3D ( P = 0.01, ES = 0.60). Fasted HRV was greater POST-1D ( P = 0.001, ES = 0.71) and POST-3D ( P = 0.02, ES = 0.44). The test meal lowered HRV in all laboratory visits ( P < 0.001, ES = 0.59), but there were no differences in postprandial HRV between visits ( P > 0.32 for all). Two weeks of HIIT enhanced endothelial function and HRV without improvements in traditional CVD risk factors. However, most of this favorable adaptation was lost POST-3D, suggesting that regularly performing high-intensity exercise is needed to maintain these benefits.

Energy compensation after an aerobic exercise session in high-fat/low-fit and low-fat/high-fit young male subjects

There is general agreement that exercise-induced energy expenditure is not entirely compensated for at the next meal or over the following 24 h, but inter-individual variability is high. The role of ‘fatness and fitness’ in this variability has never been assessed. Therefore, eighteen non-obese male subjects aged 22·2 (sd2·0) years were selected and separated into a ‘high-fatness and low-fitness’ (Hfat/Lfit,n9) and a ‘low-fatness and high-fitness’ (Lfat/Hfit,n9) group, according to three criteria: maximal oxygen uptake; weekly hours of physical activity; fat mass index. At 1 h before lunch, they were subjected to 60 min of exercise on a cycle ergometer (70 % VO2max), or stayed at rest. Then, they self-reported food intake in diaries until the next breakfast. Intake at lunch was not different between conditions, but was higher after exercise than after rest over the 24 h, leading to a significant but partial mean level of compensation of 49·8 (sem16·5) and 37·8 (sem24·6) % for the Hfat/Lfit and Lfat/Hfit groups, respectively. Energy compensation at lunch and over the 24 h were strongly correlated (r0·76,P< 0·001). Both groups consumed more fat and protein after exercise than after rest over the 24 h, but the percentage of energy derived from fat increased only in the Hfat/Lfit group (2·1 (sem0·6) %,P= 0·026). Thus, the energy cost of an aerobic exercise session was partially compensated over the next 24 h independently of the ‘fatness and fitness’ status, but ‘high-fat and low-fit’ individuals compensated more specifically on fats.

Exercising for metabolic control: is timing important?

Atherosclerosis-related cardiovascular disease and diabetes mellitus are leading causes of mortality in the world and both disorders are closely related to the postprandial phenomena. Regular exercise is being strongly advocated as a precious tool in easing the global burden of chronic disease. Although exercise intensity, duration and frequency are well established in current guidelines for healthy and diabetic individuals, there is still no consensus on the optimal timing of exercise in relation to the last meal. The present paper reviews the existing literature on the 'when?' of aerobic exercise for metabolic control in healthy and diabetic individuals. Effective control of postprandial phenomena might prove to be a useful tool in the prevention of chronic disease. Exercise appears to influence glycemic and triglyceridemic responses differently depending on the meal composition and time lapse from meals. In healthy individuals, fasted-state exercise favors postprandial triglyceridemic control and the insulin sensitivity related to it. However, there is a lack of data on this matter in diabetic patients. On the other hand, when postprandial glycemia is of concern, aerobic exercise works better when performed after a meal, both in healthy and in diabetic patients.

Effects of exercise before or after meal ingestion on fat balance and postprandial metabolism in overweight men

It is unclear how timing of exercise relative to meal ingestion influences substrate balance and metabolic responses. The present study aimed to compare the effects of exercise performed before or after breakfast on fat balance and postprandial metabolism. A total of ten sedentary overweight men (aged 28·1 (sem 10·7) years, BMI 29·0 (sem 2·8) kg/m2) underwent three trials in random order involving: (1) performing no exercise (CON), or walking for 60 min at 50 % maximal O2 uptake either (2) before (Ex-Meal) or (3) after (Meal-Ex) consuming a standardised breakfast meal. In each trial an ad libitum lunch was provided 3·5 h after breakfast. Substrate utilisation was assessed by indirect calorimetry and blood was taken at regular intervals over an 8·5 h observation period. At the end of the observation period, fat balances in the Ex-Meal ( − 1043 (sem 270) kJ) and Meal-Ex ( − 697 (sem 201) kJ) trials were both significantly lower than CON (204 (sem 165) kJ) and fat balance in the Ex-Meal trial was significantly lower than in the Meal-Ex trial (all P <0·0001). Compared with the CON trial, the 8·5 h postprandial TAG response was only significantly lowered in the Ex-Meal trial ( − 17 %, P =0·025) and not in the Meal-Ex trial ( − 11 %, P =0·20). Both the Ex-Meal and Meal-Ex trials showed significantly lowered insulin responses relative to the CON trial (by 19 and 24 %, respectively, P <0·01 for both). There were no differences in lunch energy intake between trials. The present findings suggest that there may be an advantage for body fat regulation and lipid metabolism in exercising before compared with after breakfast. However, further study is needed to determine whether the present findings extend over the long term under free-living conditions.