The impact of acute bouts of interval and continuous walking on energy-intake and appetite regulation in subjects with type 2 diabetes

Long-term aerobic and combined exercises enhance the satiety response and modulate the energy intake in patients with type 2 diabetes mellitus (T2DM): A randomized controlled trial

BACKGROUND

Energy homeostasis plays a vital role in achieving glycemic control in people with type 2 diabetes mellitus (T2DM). Exercise is known to increase energy expenditure. However, its role in energy intake has not been explored in people with T2DM. Thus, this study aimed at determining the impact of long-term aerobic and combined exercises in modulating hunger, satiety and energy intake in T2DM.

METHODS

A randomized controlled trial, with 108 people with T2DM, aged 35-60 years were assigned into an aerobic, combined (aerobic and resistance) and a control group. Primary outcomes were subjective levels of hunger and satiety measured by a 100 mm visual analogue scale in relation to a standard breakfast meal (453 kcal) and energy and macronutrient intake determined by a 3-day diet diary at 0, 3 and 6 months.

RESULTS

Aerobic and combined groups exhibited reduced hunger and increased satiety at 3 and 6 months (p < 0.05). The combined group demonstrated a profound increase in satiety at 3 and 6 months compared to aerobics (3 months; p = 0.008, 6 months; p = 0.002) and controls (3 months; p = 0.006, 6 months, p = 0.014). Mean daily energy intake was reduced only at 6 months in the aerobic group (p = 0.012), whereas it was reduced in the combined group at 3 and at 6 months compared to controls (3 months: p = 0.026, 6 months: p = 0.022).

CONCLUSIONS

Long-term aerobic and combined exercises produced a reduction in hunger, energy intake and increase satiety in people with T2DM. Despite energy expenditure, exercise seems to play a significant role in reducing energy intake as well. Combined exercises show more advantages over aerobic exercise since combined exercises have a greater impact on satiety and energy intake in people with T2DM.

TRIAL REGISTRATION NUMBER

SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029 .

Psychobiology of Appetite and Food Reward in Adults with Type 1 and Type 2 Diabetes: Is there a Role for Exercise?

Hyperglycemia is the defining feature of type 1 diabetes (T1D) and type 2 diabetes (T2D) and results from deficient insulin production, impaired insulin-stimulated glucose uptake or both. It is now well established that hyperglycemia results in profound metabolic complications, but the effect of diabetes and its associated metabolic effects on homeostatic and hedonic appetite control has received less attention. Inappropriate food choices and excess food intake might promote weight gain, further exacerbating the metabolic consequences of T1D and T2D. The need to control blood glucose through diet, physical activity and/or medication as a consequence of impaired insulin secretion and/or sensitivity adds a further level of physiological and behavioural complexity to the processes underlying food choice and appetite control. Alterations in appetite-related processes have been noted in people with T2D, but the effect of T1D on appetite is largely unexplored. Peripheral neuroendocrine signalling appears disrupted in people with T2D, and brain regions involved in the central modulation of appetite might display central insulin resistance. However, it is difficult to isolate the consequences of T2D from those of obesity. Health-care policy advocates the use of physical activity as a means of preventing and treating T2D via the promotion of weight loss and its independent influence on insulin sensitivity. Exercise-induced perturbations to energy balance can elicit biological and behavioural compensation that attenuates weight loss, and diabetes pathophysiology might alter the strength of such compensation. However, the effect of exercise on appetite in people living with diabetes has yet to be fully explored.

The impact of acute bouts of interval and continuous walking on energy-intake and appetite regulation in subjects with type 2 diabetes

In healthy subjects, it has been suggested that exercise may acutely suppress energy‐intake and appetite, with peak intensity being an important determinant for this effect. In subjects with type 2 diabetes (T2D), the effect of exercise on appetite‐related variables is, however, virtually unknown. We aimed to assess the effects of two exercise interventions, differing with regards to peak intensity, on energy‐intake, satiety and appetite‐related hormones in subjects with T2D. Thirteen subjects with T2D completed three 60‐min interventions with continuous measurement of oxygen consumption in a randomized and counterbalanced order: (1) Control, (2) Continuous walking (CW; intended 73% of VO₂peak), (3) Interval‐walking (IW; repeated cycles of 3 min slow [54% of VO₂peak] and 3 min fast walking [89% of VO₂peak]). Forty‐five minutes after completion of the intervention, a 3‐h liquid mixed meal tolerance test (MMTT, 450 kcal) with regular satiety assessments and blood samples for appetite‐related hormones commenced. An ad libitum meal was served after the MMTT, with subsequent calculation of energy‐intake. Moreover, free‐living diet records were completed for the following ~32 h. Exercise interventions were well‐matched for mean oxygen consumption (CW = 77 ± 2% of VO₂peak; IW = 76 ± 1% of VO₂peak, P > 0.05). No differences in appetite‐related hormones or energy‐intake were found (P > 0.05 for all comparisons). IW increased fullness compared to Control shortly after the intervention (P < 0.05) and tended to reduce hunger 2 h into the MMTT compared to CW and Control (P < 0.10). In conclusion, a single exercise session does not affect energy‐intake during the following ~4–36 h in subjects with T2D. However, satiety may be affected up to ~3 h after the exercise session, dependent on peak intensity.