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Perkins BA, Turner LV, Riddell MC. Applying technologies to simplify strategies for exercise in type 1 diabetes. Diabetologia 2024:10.1007/s00125-024-06229-x. [PMID: 39145882 DOI: 10.1007/s00125-024-06229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 08/16/2024]
Abstract
Challenges and fears related to managing glucose levels around planned and spontaneous exercise affect outcomes and quality of life in people living with type 1 diabetes. Advances in technology, including continuous glucose monitoring, open-loop insulin pump therapy and hybrid closed-loop (HCL) systems for exercise management in type 1 diabetes, address some of these challenges. In this review, three research or clinical experts, each living with type 1 diabetes, leverage published literature and clinical and personal experiences to translate research findings into simplified, patient-centred strategies. With an understanding of limitations in insulin pharmacokinetics, variable intra-individual responses to aerobic and anaerobic exercise, and the features of the technologies, six steps are proposed to guide clinicians in efficiently communicating simplified actions more effectively to individuals with type 1 diabetes. Fundamentally, the six steps centre on two aspects. First, regardless of insulin therapy type, and especially needed for spontaneous exercise, we provide an estimate of glucose disposal into active muscle meant to be consumed as extra carbohydrates for exercise ('ExCarbs'; a common example is 0.5 g/kg body mass per hour for adults and 1.0 g/kg body mass per hour for youth). Second, for planned exercise using open-loop pump therapy or HCL systems, we additionally recommend pre-emptive basal insulin reduction or using HCL exercise modes initiated 90 min (1-2 h) before the start of exercise until the end of exercise. Modifications for aerobic- and anaerobic-type exercise are discussed. The burden of pre-emptive basal insulin reductions and consumption of ExCarbs are the limitations of HCL systems, which may be overcome by future innovations but are unquestionably required for currently available systems.
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Affiliation(s)
- Bruce A Perkins
- Leadership Sinai Centre for Diabetes, Sinai Health, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lauren V Turner
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
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2
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Parent C, Mauvieux B, Lespagnol E, Hingrand C, Vauthier JC, Noirez P, Hurdiel R, Martinet Q, Delaunay PL, Besnard S, Heyman J, Gabel V, Baron P, Gamelin FX, Maboudou P, Rabasa-Lhoret R, Jouffroy R, Heyman E. Glycaemic Effects of a 156-km Ultra-trail Race in Athletes: An Observational Field Study. Sports Med 2024; 54:2169-2184. [PMID: 38555307 DOI: 10.1007/s40279-024-02013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Ultra-trail running races pose appreciable physiological challenges, particularly for glucose metabolism. Previous studies that yielded divergent results only measured glycaemia at isolated times. OBJECTIVES We aimed to explore the impact of an ultra-endurance race on continuously measured glycaemia and to understand potential physiological mechanisms, as well as the consequences for performance and behavioural alertness. METHODS Fifty-five athletes (78% men, 43.7 ± 9.6 years) ran a 156-km ultra-trail race (six 26-km laps, total elevation 6000 m). Participants wore a masked continuous glucose monitoring sensor from the day before the race until 10 days post-race. Blood was taken at rest, during refuelling stops after each lap, and after 24-h recovery. Running intensity (% heart rate reserve), performance (lap times), psychological stress, and behavioural alertness were explored. Linear mixed models and logistic regressions were carried out. RESULTS No higher risk of hypo- or hyperglycaemia was observed during the exercise phases of the race (i.e. excluding stops for scientific measurements and refuelling) compared with resting values. Laps comprising a greater proportion of time spent at maximal aerobic intensity were nevertheless associated with more time > 180 mg/dL (P = 0.021). A major risk of hyperglycaemia appeared during the 48-h post-race period compared with pre-race (P < 0.05), with 31.9% of the participants spending time with values > 180 mg/dL during recovery versus 5.5% during resting. Changes in circulating insulin, cortisol, and free fatty acids followed profiles comparable with those usually observed during traditional aerobic exercise. However, creatine phosphokinase, and to a lesser extent lactate dehydrogenase, increased exponentially during the race (P < 0.001) and remained high at 24-h post-race (P < 0.001; respectively 43.6 and 1.8 times higher vs. resting). Glycaemic metrics did not influence physical performance or behavioural alertness. CONCLUSION Ultra-endurance athletes were exposed to hyperglycaemia during the 48-h post-race period, possibly linked to muscle damage and inflammation. Strategies to mitigate muscle damage or subsequent inflammation before or after ultra-trail races could limit recovery hyperglycaemia and hence its related adverse health consequences. TRIAL REGISTRATION NUMBER NCT05538442 2022-09-21 retrospectively registered.
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Affiliation(s)
- Cassandra Parent
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | | | - Elodie Lespagnol
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | | | - Jean-Charles Vauthier
- Département de Médecine Générale, Faculté de Médecine - Département du Grand Est de Recherche en Soins Primaires, Université de Lorraine, Nancy, France
- Laboratoire Interpsy (UR 4432), Université de Lorraine, Nancy, France
| | - Philippe Noirez
- Institute for Research in bioMedicine and Epidemiology of Sport (IRMES), Paris, France
- T3S, INSERM UMR-S 1124, University of Paris Cité, Paris, France
- Département des Sciences de l'activité Physique, Université du Québec à Montréal, Montreal, Canada
- PSMS, University of Reims Champagne Ardenne, Reims, France
| | - Rémy Hurdiel
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | | | | | - Stéphane Besnard
- UR 7480 Vertex - Université de Caen, Caen, France
- CHU de Caen, Caen, France
| | - Joris Heyman
- CNRS, UMR 6118, Transferts d'eau et de Matière dans les Milieux Hétérogènes Complexes - Géosciences, Université Rennes, Rennes, France
| | | | - Pauline Baron
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | - François-Xavier Gamelin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | - Patrice Maboudou
- Laboratoire de Biochimie et Biologie Moléculaire, CHU de Lille, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | - Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France
- Centre de Recherche en Epidémiologie et Santé des Populations - U1018, INSERM - Paris Saclay University, Paris, France
- EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France.
- Institut Universitaire de France, Paris, France.
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Hiromatsu C, Goto K. Energy Availability and Interstitial Fluid Glucose Changes in Elite Male Japanese Triathletes during Training Camp: A Case Study. Nutrients 2024; 16:2048. [PMID: 38999796 PMCID: PMC11243290 DOI: 10.3390/nu16132048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
This study explored the impact of varying energy availability (EA) on the 24-h interstitial fluid glucose concentration (IGC) in five elite male Japanese triathletes at a training camp. Measurements of IGC, energy and macronutrient intake, and exercise energy expenditure (EEE) through metabolic equivalents (METs) from training logs were conducted. Three subjects were evaluated over two 4-day periods, and two subjects over one 4-day period. Findings revealed significant correlations of daily mean nocturnal IGC with daily EA (r = 0.553, p = 0.001) and energy intake (EI) (r = 0.595, p < 0.001). However, no significant correlation was found between mean daily nocturnal IGC and EEE (r = -0.278, p = 0.124). Daytime IGC was ≥110 mg/dL for >50% of the time in all subjects, except on 1 day in one subject, and never fell <70 mg/dL. Therefore, daily EA may influence nocturnal IGC in elite male triathletes, although high daytime IGC levels were maintained without hypoglycemia.
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Affiliation(s)
- Chiyori Hiromatsu
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga 525-8577, Japan
| | - Kazushige Goto
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga 525-8577, Japan
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Lazić A, Stanković D, Trajković N, Cadenas-Sanchez C. Effects of HIIT Interventions on Cardiorespiratory Fitness and Glycemic Parameters in Adults with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 2024:10.1007/s40279-024-02059-4. [PMID: 38904921 DOI: 10.1007/s40279-024-02059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Individuals with type 1 diabetes mellitus (T1DM) face impaired cardiorespiratory fitness and glycemic control, increasing the risk of cardiovascular complications. High-intensity interval training (HIIT) has emerged as a promising exercise modality with potential benefits for both aspects in this population. OBJECTIVES The primary aim was to investigate the effects of HIIT on cardiorespiratory fitness and glycemic parameters in patients with T1DM. The secondary aim was to examine the most effective HIIT protocol for cardiorespiratory fitness and glycemic parameters in patients with T1DM. DESIGN Systematic review and meta-analysis. DATA SOURCES Two major electronic databases (Web of Science and PubMed) were searched up to February 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and non-randomized trials involving adult patients with T1DM, free of complications and other diseases examining the effects of HIIT (HIIT pre vs. post; HIIT vs. control group or HIIT vs. moderate-intensity continuous training (MICT)) on cardiorespiratory fitness and glycemic parameters were included. RESULTS A total of ten studies met the inclusion criteria. The meta-analysis revealed a significant improvement in cardiorespiratory fitness following HIIT interventions (pre vs. post) in patients with T1DM (standardized mean difference (SMD) = 0.59, 95% confidence interval (CI) = 0.16 to 1, p = 0.01). Furthermore, HIIT (pre vs. post) was associated with significant improvements in 24-h mean glucose control (SMD = - 0.44, 95% CI = - 0.81 to - 0.06, p = 0.02), but the results (pre vs. post) failed to identify significant improvements in fasting glucose (SMD = - 0.26, 95% CI = - 0.78 to 0.24, p = 0.3) and glycated hemoglobin (HbA1C) values (SMD = - 0.28, 95% CI = - 0.61 to 0.05, p = 0.1). However, in comparison with a control group, HIIT showed significantly favorable effects on HbA1C (SMD = - 0.74, 95% CI = - 1.35 to - 0.14, p = 0.02). Finally, the meta-regression analysis did not find any moderating effect of any HIIT characteristics (i.e., intervention duration, session duration, work time, rest time, number of bouts, and intensity) on cardiorespiratory fitness and glycemic parameters. CONCLUSION Our systematic review and meta-analysis show that T1DM patients who performed a HIIT intervention significantly improved cardiorespiratory fitness and reduced their 24-h mean glucose levels, but not their HbA1C and fasting glucose. These findings support the application of HIIT interventions in T1DM patients. However, the guidelines for the most effective protocol remain unclear; hence, future studies are needed.
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Affiliation(s)
- Anja Lazić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Dušan Stanković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Nebojša Trajković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada; CIBEROBN, ISCIII, Granada, Spain.
- Stanford University, Department of Cardiology, Stanford; Veterans Affair Palo Alto Health Care System, Palo Alto, California, USA.
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Reed J, Bain SC, Kanamarlapudi V. The Regulation of Metabolic Homeostasis by Incretins and the Metabolic Hormones Produced by Pancreatic Islets. Diabetes Metab Syndr Obes 2024; 17:2419-2456. [PMID: 38894706 PMCID: PMC11184168 DOI: 10.2147/dmso.s415934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
In healthy humans, the complex biochemical interplay between organs maintains metabolic homeostasis and pathological alterations in this process result in impaired metabolic homeostasis, causing metabolic diseases such as diabetes and obesity, which are major global healthcare burdens. The great advancements made during the last century in understanding both metabolic disease phenotypes and the regulation of metabolic homeostasis in healthy individuals have yielded new therapeutic options for diseases like type 2 diabetes (T2D). However, it is unlikely that highly desirable more efficacious treatments will be developed for metabolic disorders until the complex systemic regulation of metabolic homeostasis becomes more intricately understood. Hormones produced by pancreatic islet beta-cells (insulin) and alpha-cells (glucagon) are pivotal for maintaining metabolic homeostasis; the activity of insulin and glucagon are reciprocally correlated to achieve strict control of glucose levels (normoglycaemia). Metabolic hormones produced by other pancreatic islet cells and incretins produced by the gut are also crucial for maintaining metabolic homeostasis. Recent studies highlighted the incomplete understanding of metabolic hormonal synergism and, therefore, further elucidation of this will likely lead to more efficacious treatments for diseases such as T2D. The objective of this review is to summarise the systemic actions of the incretins and the metabolic hormones produced by the pancreatic islets and their interactions with their respective receptors.
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Affiliation(s)
- Joshua Reed
- Institute of Life Science, Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Stephen C Bain
- Institute of Life Science, Medical School, Swansea University, Swansea, SA2 8PP, UK
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McClure RD, Carr ALJ, Boulé NG, Yardley JE. An Aerobic Cooldown After Morning, Fasted Resistance Exercise Has Limited Impact on Post-exercise Hyperglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Study. Can J Diabetes 2024:S1499-2671(24)00105-9. [PMID: 38735638 DOI: 10.1016/j.jcjd.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/28/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Expert guidelines recommend an aerobic cooldown to lower blood glucose for the management of post-exercise hyperglycemia. This strategy has never been empirically tested. Our aim in this study was to compare the glycemic effects of performing an aerobic cooldown vs not performing a cooldown after a fasted resistance exercise session. We hypothesized that the cooldown would lower blood glucose in the 30 minutes after exercise and would result in less time in hyperglycemia in the 6 hours after exercise. METHODS Participants completed 2 identical resistance exercise sessions. One was followed by a low-intensity (30% of peak oxygen consumption) 10-minute cycle ergometer cooldown, and the other was followed by 10 minutes of sitting. We compared the changes in capillary glucose concentration during these sessions and continuous glucose monitoring (CGM) outcomes over 24 hours post-exercise. RESULTS Sixteen participants completed the trial. Capillary glucose was similar between conditions at the start of exercise (p=0.07). Capillary glucose concentration decreased by 0.6±1.0 mmol/L during the 10-minute cooldown, but it increased by 0.7±1.3 mmol/L during the same time in the no-cooldown condition. The resulting difference in glucose trajectory led to a significant interaction (p=0.02), with no effect from treatment (p=0.7). Capillary glucose values at the end of recovery were similar between conditions (p>0.05). There were no significant differences in CGM outcomes. CONCLUSIONS An aerobic cooldown reduces glucose concentration in the post-exercise period, but the small and brief nature of this reduction makes this strategy unlikely to be an effective treatment for hyperglycemia occurring after fasted exercise.
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Affiliation(s)
- Reid D McClure
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | | | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada; Ecole de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, Québec, Canada; Institut de recherches cliniques de Montréal, Montréal, Québec, Canada.
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Codella R, Gallo G, Meloni A, Luzi L, Filipas L. Elite Cyclists with Type 1 Diabetes Show Acceptable Glycemic Excursions During a Time-Trial Performance Under High-Definition Transcranial Direct Current Stimulation. Endocr Pract 2024; 30:380-383. [PMID: 38307458 DOI: 10.1016/j.eprac.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To evaluate the effects of bilateral dorsolateral prefrontal cortex high-definition transcranial direct current stimulation (HD-tDCS) on glycemic excursions during a time-trial performance in elite cyclists with type 1 diabetes (T1D). METHODS In a double-blind, randomized crossover order, 9 elite cyclists with T1D (no complications) underwent either HD-tDCS (F3 and F4) or control (SHAM) and completed a constant-load trial at 75% of the second ventilatory threshold plus a 15-km cycling time trial. RESULTS Real-time continuous glucose monitoring revealed similar glycemic variability between the 2 conditions, showing a significant effect of time but no interaction (stimulation × time) or stimulation effect. CONCLUSION Because glycemic control is crucial for both health and performance, these findings suggest that HD-tDCS could be safely used to enhance performance in athletes with T1D and potentially in a broader active T1D population.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy.
| | - Gabriele Gallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Andrea Meloni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Luca Filipas
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
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Flockhart M, Larsen FJ. Continuous Glucose Monitoring in Endurance Athletes: Interpretation and Relevance of Measurements for Improving Performance and Health. Sports Med 2024; 54:247-255. [PMID: 37658967 PMCID: PMC10933193 DOI: 10.1007/s40279-023-01910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
Blood glucose regulation has been studied for well over a century as it is intimately related to metabolic health. Research in glucose transport and uptake has also been substantial within the field of exercise physiology as glucose delivery to the working muscles affects exercise capacity and athletic achievements. However, although exceptions exist, less focus has been on blood glucose as a parameter to optimize training and competition outcomes in athletes with normal glucose control. During the last years, measuring glucose has gained popularity within the sports community and successful endurance athletes have been seen with skin-mounted sensors for continuous glucose monitoring (CGM). The technique offers real-time recording of glucose concentrations in the interstitium, which is assumed to be equivalent to concentrations in the blood. Although continuous measurements of a parameter that is intimately connected to metabolism and health can seem appealing, there is no current consensus on how to interpret measurements within this context. Well-defined approaches to use glucose monitoring to improve endurance athletes' performance and health are lacking. In several studies, blood glucose regulation in endurance athletes has been shown to differ from that in healthy controls. Furthermore, endurance athletes regularly perform demanding training sessions and can be exposed to high or low energy and/or carbohydrate availability, which can affect blood glucose levels and regulation. In this current opinion, we aim to discuss blood glucose regulation in endurance athletes and highlight the existing research on glucose monitoring for performance and health in this population.
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Affiliation(s)
- Mikael Flockhart
- The Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences, GIH, 114 33, Stockholm, Sweden.
| | - Filip J Larsen
- The Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences, GIH, 114 33, Stockholm, Sweden.
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9
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Kang J, Fardman BM, Ratamess NA, Faigenbaum AD, Bush JA. Efficacy of Postprandial Exercise in Mitigating Glycemic Responses in Overweight Individuals and Individuals with Obesity and Type 2 Diabetes-A Systematic Review and Meta-Analysis. Nutrients 2023; 15:4489. [PMID: 37892564 PMCID: PMC10610082 DOI: 10.3390/nu15204489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Studies investigating the acute effect of postprandial exercise (PPE) on glucose responses exhibit significant heterogeneity in terms of participant demographic, exercise protocol, and exercise timing post-meal. As such, this study aimed to further analyze the existing literature on the impact of PPE on glycemic control in overweight individuals and individuals with obesity and type 2 diabetes (T2DM). A literature search was conducted through databases such as PubMed, CINAHL, and Google Scholar. Thirty-one original research studies that met the inclusion criteria were selected. A random-effect meta-analysis was performed to compare postprandial glucose area under the curve (AUC) and 24 h mean glucose levels between PPE and the time-matched no-exercise control (CON). Subgroup analyses were conducted to explore whether the glucose-lowering effect of PPE could be influenced by exercise duration, exercise timing post-meal, and the disease status of participants. This study revealed a significantly reduced glucose AUC (Hedges' g = -0.317; SE = 0.057; p < 0.05) and 24 h mean glucose levels (Hedges' g = -0.328; SE = 0.062; p < 0.05) following PPE compared to CON. The reduction in glucose AUC was greater (p < 0.05) following PPE lasting >30 min compared to ≤30 min. The reduction in 24 h mean glucose levels was also greater (p < 0.05) following PPE for ≥60 min compared to <60 min post-meal and in those with T2DM compared to those without T2DM. PPE offers a viable approach for glucose management and can be performed in various forms so long as exercise duration is sufficient. The glucose-lowering effect of PPE may be further enhanced by initiating it after the first hour post-meal. PPE is a promising strategy, particularly for patients with T2DM. This manuscript is registered with Research Registry (UIN: reviewregistry1693).
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Affiliation(s)
- Jie Kang
- Department of Kinesiology and Health Sciences, The College of New Jersey, Ewing, NJ 08618, USA; (N.A.R.); (A.D.F.); (J.A.B.)
| | - Brian M. Fardman
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ 08084, USA;
| | - Nicholas A. Ratamess
- Department of Kinesiology and Health Sciences, The College of New Jersey, Ewing, NJ 08618, USA; (N.A.R.); (A.D.F.); (J.A.B.)
| | - Avery D. Faigenbaum
- Department of Kinesiology and Health Sciences, The College of New Jersey, Ewing, NJ 08618, USA; (N.A.R.); (A.D.F.); (J.A.B.)
| | - Jill A. Bush
- Department of Kinesiology and Health Sciences, The College of New Jersey, Ewing, NJ 08618, USA; (N.A.R.); (A.D.F.); (J.A.B.)
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de Oliveira Fernandes D, César FG, Melo BP, Brandão JDSF, Dos Santos KJ, de Andrade MT, da Fonseca Casteluber MC, de Carvalho MV, de Barcellos LAM, Soares DD, Bohnen Guimarães J. Chronic supplementation of noni in diabetic type 1-STZ rats: effects on glycemic levels, kidney toxicity and exercise performance. Diabetol Metab Syndr 2023; 15:191. [PMID: 37794521 PMCID: PMC10548663 DOI: 10.1186/s13098-023-01171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
Noni is a fruit with potential medicinal use preventing elevated blood glucose levels in diabetes mellitus. Its effects have been attributed to an antioxidant property in several other diseases. However, the effects of noni-chronic supplementation on exercise performance in the presence of diabetes conditions are not known. Thirty-two male Wistar rats were used to verify the effects of chronic noni (Morinda citrifolia L) juice administration on glycemia, triglyceride levels, and its relation to physical performance. In addition, it was verified if chronic noni supplementation is safe for clinical use through kidney morphology analysis. In half of the rats, diabetes mellitus (DM) was induced with STZ. All rats were submitted to an incremental workload running test (IWT) until fatigued so that oxygen consumption and performance indexes (exercise time to fatigue and workload) could be analyzed before noni administration. Then, the control and DM groups received a placebo (saline solution) or noni juice (dilution 2:1) at a dose of 2 mL/kg once a day for 60 days. The result was four groups: control + placebo (CP), control + noni (CN), DM + placebo (DMP), and DM + noni (DMN). Our dose was based on in previous study by Nayak et al. (2011) that observed a significant reduction in glycemia with 2 ml/kg of the noni juice without any toxicity effect cited. Groups were then given a third IWT to verify the effect of the noni juice on exercise performance (exercise time to fatigue, workload, maximal oxygen consumption) and glycemia. Twenty-four hours after the third test, all animals were euthanized and blood and kidneys were removed for posterior analysis. The DM induction with STZ impaired the performance by 39%. Noni administration improved the time to fatigue and workload in DM rats beyond reducing hyperglycemia. These results could be associated with an improved energy efficiency promoted by noni ingestion, since the oxygen consumption was not different between the groups, although the exercise was longer in animals with noni ingestion. Our results provided evidence that chronic noni administration causes kidney damage since increased Bowman's space area in the control rats, suggesting glomerular hyperfiltration at the same magnitude as the non-treated DM group.In conclusion, chronic noni ingestion promoted glycemic control and improved the performance in DM rats but caused kidney toxicity.
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Affiliation(s)
| | | | - Bruno Pereira Melo
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Marcelo Teixeira de Andrade
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Moisés Vieira de Carvalho
- State University of Minas Gerais - Ibirité Unit, Ibirité, Brazil
- Department of Science of Human Movement, State University of Minas Gerais - Ibirité Unit, Av. São Paulo, 3996, Vila do Rosário, Ibirité, 32400-000, Minas Gerais, Brazil
| | - Luiz Alexandre Medrado de Barcellos
- State University of Minas Gerais - Ibirité Unit, Ibirité, Brazil
- Department of Science of Human Movement, State University of Minas Gerais - Ibirité Unit, Av. São Paulo, 3996, Vila do Rosário, Ibirité, 32400-000, Minas Gerais, Brazil
| | - Danusa Dias Soares
- Exercise Physiology Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Bohnen Guimarães
- State University of Minas Gerais - Ibirité Unit, Ibirité, Brazil.
- Department of Science of Human Movement, State University of Minas Gerais - Ibirité Unit, Av. São Paulo, 3996, Vila do Rosário, Ibirité, 32400-000, Minas Gerais, Brazil.
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11
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Moreno-Cabañas A, Morales-Palomo F, Alvarez-Jimenez L, Mora-Gonzalez D, Ortega JF, Mora-Rodriguez R. Metformin and exercise effects on postprandial insulin sensitivity and glucose kinetics in pre-diabetic and diabetic adults. Am J Physiol Endocrinol Metab 2023; 325:E310-E324. [PMID: 37584610 DOI: 10.1152/ajpendo.00118.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
The potential interaction between metformin and exercise on glucose-lowering effects remains controversial. We studied the separated and combined effects of metformin and/or exercise on fasting and postprandial insulin sensitivity in individuals with pre-diabetes and type 2 diabetes (T2D). Eight T2D adults (60 ± 4 yr) with overweight/obesity (32 ± 4 kg·m-2) under chronic metformin treatment (9 ± 6 yr; 1281 ± 524 mg·day-1) underwent four trials; 1) taking their habitual metformin treatment (MET), 2) substituting during 96 h their metformin medication by placebo (PLAC), 3) placebo combined with 50 min bout of high-intensity interval exercise (PLAC + EX), and 4) metformin combined with exercise (MET + EX). Plasma glucose kinetics using stable isotopes (6,6-2H2 and [U-13C] glucose), and glucose oxidation by indirect calorimetry, were assessed at rest, during exercise, and in a subsequent oral glucose tolerance test (OGTT). Postprandial glucose and insulin concentrations were analyzed as mean and incremental area under the curve (iAUC), and insulin sensitivity was calculated (i.e., MATSUDAindex and OGISindex). During OGTT, metformin reduced glucose iAUC (i.e., MET and MET + EX lower than PLAC and PLAC + EX, respectively; P = 0.023). MET + EX increased MATSUDAindex above PLAC (4.8 ± 1.4 vs. 3.3 ± 1.0, respectively; P = 0.018) and OGISindex above PLAC (358 ± 52 vs. 306 ± 46 mL·min-1·m-2, respectively; P = 0.006). Metformin decreased the plasma appearance of the ingested glucose (Ra OGTT; MET vs. PLAC, -3.5; 95% CI -0.1 to -6.8 µmol·kg-1·min-1; P = 0.043). Metformin combined with exercise potentiates insulin sensitivity during an OGTT in individuals with pre-diabetes and type 2 diabetes. Metformin's blood glucose-lowering effect seems mediated by decreased oral glucose entering the circulation (gut-liver effect) an effect partially blunted after exercise.NEW & NOTEWORTHY Metformin is the most prescribed oral antidiabetic medicine in the world but its mechanism of action and its interactions with exercise are not fully understood. Our stable isotope tracer data suggested that metformin reduces the rates of oral glucose entering the circulation (gut-liver effect). Exercise, in turn, tended to reduce postprandial insulin blood levels potentiating metformin improvements in insulin sensitivity. Thus, exercise potentiates metformin improvements in glycemic control and should be advised to metformin users.
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Affiliation(s)
- Alfonso Moreno-Cabañas
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
- Center for Nutrition, Exercise and Metabolism, University of Bath, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Felix Morales-Palomo
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | | | - Diego Mora-Gonzalez
- Department of Nursing, Physiotherapy, and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
| | - Juan Fernando Ortega
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
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12
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Zhang H, Mulya A, Nieuwoudt S, Vandanmagsar B, McDowell R, Heintz EC, Zunica ER, Collier JJ, Bozadjieva-Kramer N, Seeley RJ, Axelrod CL, Kirwan JP. GDF15 Mediates the Effect of Skeletal Muscle Contraction on Glucose-Stimulated Insulin Secretion. Diabetes 2023; 72:1070-1082. [PMID: 37224335 PMCID: PMC10382648 DOI: 10.2337/db22-0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
Exercise is a first-line treatment for type 2 diabetes and preserves β-cell function by hitherto unknown mechanisms. We postulated that proteins from contracting skeletal muscle may act as cellular signals to regulate pancreatic β-cell function. We used electric pulse stimulation (EPS) to induce contraction in C2C12 myotubes and found that treatment of β-cells with EPS-conditioned medium enhanced glucose-stimulated insulin secretion (GSIS). Transcriptomics and subsequent targeted validation revealed growth differentiation factor 15 (GDF15) as a central component of the skeletal muscle secretome. Exposure to recombinant GDF15 enhanced GSIS in cells, islets, and mice. GDF15 enhanced GSIS by upregulating the insulin secretion pathway in β-cells, which was abrogated in the presence of a GDF15 neutralizing antibody. The effect of GDF15 on GSIS was also observed in islets from GFRAL-deficient mice. Circulating GDF15 was incrementally elevated in patients with pre- and type 2 diabetes and positively associated with C-peptide in humans with overweight or obesity. Six weeks of high-intensity exercise training increased circulating GDF15 concentrations, which positively correlated with improvements in β-cell function in patients with type 2 diabetes. Taken together, GDF15 can function as a contraction-induced protein that enhances GSIS through activating the canonical signaling pathway in a GFRAL-independent manner. ARTICLE HIGHLIGHTS Exercise improves glucose-stimulated insulin secretion through direct interorgan communication. Contracting skeletal muscle releases growth differentiation factor 15 (GDF15), which is required to synergistically enhance glucose-stimulated insulin secretion. GDF15 enhances glucose-stimulated insulin secretion by activating the canonical insulin release pathway. Increased levels of circulating GDF15 after exercise training are related to improvements in β-cell function in patients with type 2 diabetes.
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Affiliation(s)
- Hui Zhang
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Anny Mulya
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Stephan Nieuwoudt
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Bolormaa Vandanmagsar
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Ruth McDowell
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Elizabeth C. Heintz
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Elizabeth R.M. Zunica
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - J. Jason Collier
- Islet Biology and Inflammation Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Nadejda Bozadjieva-Kramer
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Research Service, Ann Arbor, MI
| | - Randy J. Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Christopher L. Axelrod
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - John P. Kirwan
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
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13
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Vertyshev AY, Akberdin IR, Kolpakov FA. Numerous Trigger-like Interactions of Kinases/Protein Phosphatases in Human Skeletal Muscles Can Underlie Transient Processes in Activation of Signaling Pathways during Exercise. Int J Mol Sci 2023; 24:11223. [PMID: 37446402 DOI: 10.3390/ijms241311223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Optimizing physical training regimens to increase muscle aerobic capacity requires an understanding of the internal processes that occur during exercise that initiate subsequent adaptation. During exercise, muscle cells undergo a series of metabolic events that trigger downstream signaling pathways and induce the expression of many genes in working muscle fibers. There are a number of studies that show the dependence of changes in the activity of AMP-activated protein kinase (AMPK), one of the mediators of cellular signaling pathways, on the duration and intensity of single exercises. The activity of various AMPK isoforms can change in different directions, increasing for some isoforms and decreasing for others, depending on the intensity and duration of the load. This review summarizes research data on changes in the activity of AMPK, Ca2+/calmodulin-dependent protein kinase II (CaMKII), and other components of the signaling pathways in skeletal muscles during exercise. Based on these data, we hypothesize that the observed changes in AMPK activity may be largely related to metabolic and signaling transients rather than exercise intensity per se. Probably, the main events associated with these transients occur at the beginning of the exercise in a time window of about 1-10 min. We hypothesize that these transients may be partly due to putative trigger-like kinase/protein phosphatase interactions regulated by feedback loops. In addition, numerous dynamically changing factors, such as [Ca2+], metabolite concentration, and reactive oxygen and nitrogen species (RONS), can shift the switching thresholds and change the states of these triggers, thereby affecting the activity of kinases (in particular, AMPK and CaMKII) and phosphatases. The review considers the putative molecular mechanisms underlying trigger-like interactions. The proposed hypothesis allows for a reinterpretation of the experimental data available in the literature as well as the generation of ideas to optimize future training regimens.
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Affiliation(s)
| | - Ilya R Akberdin
- Department of Computational Biology, Scientific Center for Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, 354340 Sochi, Russia
- Biosoft.Ru, Ltd., 630058 Novosibirsk, Russia
- Department of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Fedor A Kolpakov
- Department of Computational Biology, Scientific Center for Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, 354340 Sochi, Russia
- Biosoft.Ru, Ltd., 630058 Novosibirsk, Russia
- Federal Research Center for Information and Computational Technologies, 630090 Novosibirsk, Russia
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14
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Helleputte S, Yardley JE, Scott SN, Stautemas J, Jansseune L, Marlier J, De Backer T, Lapauw B, Calders P. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia 2023; 66:1179-1191. [PMID: 37014379 DOI: 10.1007/s00125-023-05910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
People with type 1 diabetes experience challenges in managing blood glucose around exercise. Previous studies have examined glycaemic responses to different exercise modalities but paid little attention to participants' prandial state, although this is an important consideration and will enhance our understanding of the effects of exercise in order to improve blood glucose management around activity. This review summarises available data on the glycaemic effects of postprandial exercise (i.e. exercise within 2 h after a meal) in people with type 1 diabetes. Using a search strategy on electronic databases, literature was screened until November 2022 to identify clinical trials evaluating acute (during exercise), subacute (≤2 h after exercise) and late (>2 h to ≤24 h after exercise) effects of postprandial exercise in adults with type 1 diabetes. Studies were systematically organised and assessed by exercise modality: (1) walking exercise (WALK); (2) continuous exercise of moderate intensity (CONT MOD); (3) continuous exercise of high intensity (CONT HIGH); and (4) interval training (intermittent high-intensity exercise [IHE] or high-intensity interval training [HIIT]). Primary outcomes were blood glucose change and hypoglycaemia occurrence during and after exercise. All study details and results per outcome were listed in an evidence table. Twenty eligible articles were included: two included WALK sessions, eight included CONT MOD, seven included CONT HIGH, three included IHE and two included HIIT. All exercise modalities caused consistent acute glycaemic declines, with the largest effect size for CONT HIGH and the smallest for HIIT, depending on the duration and intensity of the exercise bout. Pre-exercise mealtime insulin reductions created higher starting blood glucose levels, thereby protecting against hypoglycaemia, in spite of similar declines in blood glucose during activity between the different insulin reduction strategies. Nocturnal hypoglycaemia occurred after higher intensity postprandial exercise, a risk that could be diminished by a post-exercise snack with concomitant bolus insulin reduction. Research on the optimal timing of postprandial exercise is inconclusive. In summary, individuals with type 1 diabetes exercising postprandially should substantially reduce insulin with the pre-exercise meal to avoid exercise-induced hypoglycaemia, with the magnitude of the reduction depending on the exercise duration and intensity. Importantly, pre-exercise blood glucose and timing of exercise should be considered to avoid hyperglycaemia around exercise. To protect against late-onset hypoglycaemia, a post-exercise meal with insulin adjustments might be advisable, especially for exercise in the evening or with a high-intensity component.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Flanders, Belgium.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Sam N Scott
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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15
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Miyata T, Kawai S, Yasuki A, Ishioka K. Changes in physiological parameters in healthy dogs on an underwater treadmill when the water level is set at the hip joint. Res Vet Sci 2023; 161:20-22. [PMID: 37301050 DOI: 10.1016/j.rvsc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Understanding internal and external loading in exercise is important for safe rehabilitation. The physiological parameters of dogs have been studied in swimming, but those of dogs walking on an underwater treadmill have not been documented. In this study, four healthy beagle dogs were examined for changes in physiological parameters before and after walking in water for 20 min at a speed of 4 km/h with the water level set at the height of the hip joint as an external load. Statistical analysis of the results was performed using paired sample t-tests. Results indicated that heart rate (125 ± 11.8 beat/min to 163 ± 9.5 beat/min) and lactate levels (2 ± 0.1 mmol/L to 2.4 ± 0.2 mmol/ L) significantly increased from before to after walking on an underwater treadmill. Additional research is needed on internal loading when using underwater treadmills, which would further contribute to the safety of rehabilitation.
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Affiliation(s)
- Takuma Miyata
- School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan.
| | - Saya Kawai
- School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Aoi Yasuki
- School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Katsumi Ishioka
- School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
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16
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Deichmann J, Bachmann S, Burckhardt MA, Pfister M, Szinnai G, Kaltenbach HM. New model of glucose-insulin regulation characterizes effects of physical activity and facilitates personalized treatment evaluation in children and adults with type 1 diabetes. PLoS Comput Biol 2023; 19:e1010289. [PMID: 36791144 PMCID: PMC9974135 DOI: 10.1371/journal.pcbi.1010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/28/2023] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Accurate treatment adjustment to physical activity (PA) remains a challenging problem in type 1 diabetes (T1D) management. Exercise-driven effects on glucose metabolism depend strongly on duration and intensity of the activity, and are highly variable between patients. In-silico evaluation can support the development of improved treatment strategies, and can facilitate personalized treatment optimization. This requires models of the glucose-insulin system that capture relevant exercise-related processes. We developed a model of glucose-insulin regulation that describes changes in glucose metabolism for aerobic moderate- to high-intensity PA of short and prolonged duration. In particular, we incorporated the insulin-independent increase in glucose uptake and production, including glycogen depletion, and the prolonged rise in insulin sensitivity. The model further includes meal absorption and insulin kinetics, allowing simulation of everyday scenarios. The model accurately predicts glucose dynamics for varying PA scenarios in a range of independent validation data sets, and full-day simulations with PA of different timing, duration and intensity agree with clinical observations. We personalized the model on data from a multi-day free-living study of children with T1D by adjusting a small number of model parameters to each child. To assess the use of the personalized models for individual treatment evaluation, we compared subject-specific treatment options for PA management in replay simulations of the recorded data with altered meal, insulin and PA inputs.
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Affiliation(s)
- Julia Deichmann
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Switzerland
- Life Science Zurich Graduate School, Zurich, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Hans-Michael Kaltenbach
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Switzerland
- * E-mail:
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17
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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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18
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Milovančev A, Miljković T, Ilić A, Stojšić Milosavljević A, Petrović M, Roklicer R, Lakičević N, Trivić T, Drid P. Disrupting arrhythmia in a professional male wrestler athlete after rapid weight loss and high-intensity training-Case report. Front Cardiovasc Med 2023; 10:1091603. [PMID: 36760566 PMCID: PMC9905426 DOI: 10.3389/fcvm.2023.1091603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Physiological heart adaptations may lead to increased susceptibility to arrhythmia in athletes. Furthermore, vigorous training and method like rapid weight loss (RWL) in combat sports could pose additional risks. This case represents how routine cardiovascular screening during high-risk methods like RWL and high-intensity training (HIT) reveal abrupt ventricular arrhythmias in a young athlete. Case report We report a case of a 20-year-old male wrestler athlete who developed disrupting arrhythmia during RWL and HIT. The study included: a medical exam, 12 lead electrocardiograms (ECG), transthoracic echocardiogram (ECHO), and 24 h of continuous ECG monitoring in baseline, phase one (P1), (in which the athlete had to simulate RWL through vigorous training and dietary intervention and HIT) and phase two (P2), (with the same HIT protocol performed without the RWL procedure). Baseline laboratory analyses were without abnormalities, ECG showed sinus rhythm with one premature atrial contraction (PAC) and ECHO showed signs of concentric remodeling with preserved systolic, diastolic function, and global longitudinal strain. After P1 RWL simulation, he lost 5.15% of body weight in 3 days, which resulted in lower blood glucose levels, higher urea, creatinine, creatine kinase (CK), CK-MB levels, and slightly increased levels of NT pro-BNP, ECG revealed sinus rhythm with one ventricular premature beat (VPB), 24-h continuous electrocardiogram (ECG) revealed frequent ventricular premature beats (PVB) 2,150/ 24 h, with two couplets, and 8 PAC. After an advised 4-week period of de-training continuous 24 h, ECG monitoring was improved with only occasional PVB. The 24 h continuous ECG monitoring was repeated after HIT and revealed even more frequent PVB, 5% of all beats for 24 h, 4,205 in total, and almost all VPB were in bigeminy and trigeminy. The athlete was advised against RWL and extremely vigorous exercise and for regular, frequent checkups with occasional ECG monitoring during and after exercise. Conclusion The short and long-term implication of abrupt ventricular arrhythmias provoked by intensive training and methods like RWL is unknown. We postulate that cardiovascular screening is necessitated, especially during high-risk methods like RWL and HIT, in helping us prevent adverse outcomes and come to individual-based clinical making decisions for each athlete.
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Affiliation(s)
- Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia,*Correspondence: Aleksandra Milovančev ✉
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Ilić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia,Milovan Petrović ✉
| | - Roberto Roklicer
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nemanja Lakičević
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Tatjana Trivić
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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19
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Haganes KL, Silva CP, Eyjólfsdóttir SK, Steen S, Grindberg M, Lydersen S, Hawley JA, Moholdt T. Time-restricted eating and exercise training improve HbA1c and body composition in women with overweight/obesity: A randomized controlled trial. Cell Metab 2022; 34:1457-1471.e4. [PMID: 36198292 DOI: 10.1016/j.cmet.2022.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 09/08/2022] [Indexed: 12/25/2022]
Abstract
Diet modification and exercise training are primary lifestyle strategies for obesity management, but poor adherence rates limit their effectiveness. Time-restricted eating (TRE) and high-intensity interval training (HIIT) improve cardiometabolic health in at-risk individuals, but whether these two interventions combined induce superior improvements in glycemic control than each individual intervention is not known. In this four-armed randomized controlled trial (ClinicalTrials.gov NCT04019860), we determined the isolated and combined effects of 7 weeks of TRE (≤10-h daily eating window, with ad libitum energy intake) and HIIT (three exercise sessions per week), compared with a non-intervention control group, on glycemic control and secondary cardiometabolic outcomes in 131 women (36.2 ± 6.2 years) with overweight/obesity. There were no statistically significant effects after isolated TRE, HIIT, or a combination (TREHIIT) on glucose area under the curve during an oral glucose tolerance test (the primary outcome) compared with the control group (TRE, -26.3 mmol/L; 95% confidence interval [CI], -82.3 to 29.7, p = 0.36; HIIT, -53.8 mmol/L; 95% CI, -109.2 to 1.6, p = 0.057; TREHIIT, -41.3 mmol/L; 95% CI, -96.4 to 13.8, p = 0.14). However, TREHIIT improved HbA1c and induced superior reductions in total and visceral fat mass compared with TRE and HIIT alone. High participant adherence rates suggest that TRE, HIIT, and a combination thereof may be realistic diet-exercise strategies for improving markers of metabolic health in women at risk of cardiometabolic disease.
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Affiliation(s)
- Kamilla L Haganes
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway; Women's Clinic, St. Olav's Hospital, Trondheim 7006, Norway.
| | - Catalina P Silva
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Svala K Eyjólfsdóttir
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Sandra Steen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Martine Grindberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - John A Hawley
- Exercise & Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim 7491, Norway; Women's Clinic, St. Olav's Hospital, Trondheim 7006, Norway.
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20
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Palermi S, Iacono O, Sirico F, Modestino M, Ruosi C, Spera R, De Luca M. The complex relationship between physical activity and diabetes: an overview. J Basic Clin Physiol Pharmacol 2022; 33:535-547. [PMID: 34592073 DOI: 10.1515/jbcpp-2021-0279] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
Diabetes mellitus (DM) is a widespread condition, representing a challenging disease to manage. Exercise is being increasingly recommended as part of the therapeutic regimen for DM but the management of different forms of physical activity is difficult for individuals with diabetes, trainers, and physicians. Regular exercise can improve health and well-being, helping individuals to achieve their target lipid profile, body composition, cardio-respiratory fitness, and glycemic goals. People with diabetes tend to be as inactive as the general population, with a large percentage of individuals not achieving the minimum amount of recommended physical activity levels. Indeed, several barriers to exercise exist for persons with diabetes, including sports eligibility, multi-modality management of diabetic athletes, and inadequate knowledge about adequate type and intensity of exercise. The aim of the present review is to provide the current understanding of mechanisms, recommendations, and beneficial effects of different modalities of exercise for the treatment of DM.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University Federico II, Naples, Italy
| | - Olimpia Iacono
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Felice Sirico
- Public Health Department, University Federico II, Naples, Italy
| | - Michele Modestino
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carlo Ruosi
- Public Health Department, University Federico II, Naples, Italy
| | - Rocco Spera
- Public Health Department, University Federico II, Naples, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
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21
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Park S, Moon HY. Urinary extracellular vesicle as a potential biomarker of exercise-induced fatigue in young adult males. Eur J Appl Physiol 2022; 122:2175-2188. [PMID: 35781843 PMCID: PMC9463341 DOI: 10.1007/s00421-022-04995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
Purpose Previous studies have suggested that circulating extracellular vesicles (EVs) arise after high intensity exercise and urine could reflect the plasma proteome. Herein, we investigated the characteristic of urinary EVs from healthy young adult males who had completed a maximal effort exercise test. Methods Thirteen healthy men completed a 20 m shuttle run test (20 m SRT). Fresh urine samples were collected at first morning, right after, and 1 h rest after 20 m SRT. Also, blood lactate, heart rate, rating of perceived exertion, and blood pressure were measured before, right after, and 1 h rest after 20 m SRT. Urinary EVs were analyzed using Exoview instrument and microRNAs (miRNAs) sequencing on urinary EVs were performed. Results Urinary EVs increased significantly after exercise and returned to baseline value after 1 h of rest. miRNA sequencing on urinary EV revealed alterations in four miRNAs (1 up and 3 down) and nine miRNAs (2 up and 7 down) in pre- vs. post- and post- vs. post-1 h samples, respectively. Lastly, bioinformatic analysis of urinary EV miRNA suggests that predicted target genes could affect PI3K-Akt, mitogen-activated protein kinase, and insulin pathways by exercise. Conclusions Exercise to voluntary exhaustion increased the number of EVs in urine. Also, miRNAs in urinary EVs were altered after exercise. These findings could indicate the possibility of using the urinary EVs as a novel biomarker of acute exercise-induced fatigue.
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Affiliation(s)
- Suhong Park
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Hyo Youl Moon
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea. .,Institute of Sport Science, Seoul National University, 71-1, 407, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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22
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Leohr J, Kjellsson MC. Impact of Obesity on Postprandial Triglyceride Contribution to Glucose Homeostasis, Assessed with a Semimechanistic Model. Clin Pharmacol Ther 2022; 112:112-124. [PMID: 35388464 PMCID: PMC9322341 DOI: 10.1002/cpt.2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
The integrated glucose-insulin model is a semimechanistic model describing glucose and insulin after a glucose challenge. Similarly, a semiphysiologic model of the postprandial triglyceride (TG) response in chylomicrons and VLDL-V6 was recently published. We have developed the triglyceride-insulin-glucose-GLP-1 (TIGG) model by integrating these models and active GLP-1. The aim was to characterize, using the TIGG model, the postprandial response over 13 hours following a high-fat meal in 3 study populations based on body mass index categories: lean, obese, and very obese. Differential glucose and lipid regulation were observed between the lean population and obese or very obese populations. A population comparison revealed further that fasting glucose and insulin were elevated in obese and very obese when compared with lean; and euglycemia was achieved at different times postmeal between the obese and very obese populations. Postprandial insulin was incrementally elevated in the obese and very obese populations compared with lean. Postprandial chylomicrons TGs were similar across populations, whereas the postprandial TGs in VLDL-V6 were increased in the obese and very obese populations compared with lean. Postprandial active GLP-1 was diminished in the very obese population compared with lean or obese. The TIGG model described the response following a high-fat meal in individuals who are lean, obese, and very obese and provided insight into the possible regulation of glucose homeostasis in the extended period after the meal by utilizing lipids. The TIGG-model is the first model to integrate glucose and insulin regulation, incretin effect, and postprandial TGs response in chylomicrons and VLDL-V6.
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Affiliation(s)
- Jennifer Leohr
- Department of Pharmacokinetics/Pharmacodynamics, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Maria C Kjellsson
- Pharmacometrics Research Group, Department of Pharmacy, Uppsala University, Uppsala, Sweden
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23
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Dietary pH Enhancement Improves Metabolic Outcomes in Diet-Induced Obese Male and Female Mice: Effects of Beef vs. Casein Proteins. Nutrients 2022; 14:nu14132583. [PMID: 35807769 PMCID: PMC9268221 DOI: 10.3390/nu14132583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Consumption of diets that are caloric dense but not nutrient dense have been implicated in metabolic diseases, in part through low-grade metabolic acidosis. Mitigation strategies through dietary intervention to alleviate acidosis have not been previously reported. Our objective is to determine the effects of pH enhancement (with ammonia) in high fat diet-induced obese mice that were fed beef or casein as protein sources compared to low fat diet-fed mice. (2) Methods: B6 male and female mice were randomized (n = 10) into eight diets that differ in protein source, pH enhancement of the protein, and fat content, and fed for 13 weeks: low fat (11% fat) casein (LFC), LF casein pH-enhanced (LFCN), LF lean beef (LFB), LFBN, high fat (46%) casein (HFC), HFCN, HF beef (HFB), and HFBN. Body weights and composition, and glucose tolerance tests were conducted along with terminal serum analyses. Three-way ANOVA was performed. (3) Results: A significant effect of dietary fat (LF vs. HF) was observed across all variables in both sexes (final body weight, fat mass, glucose clearance, and serum leptin). Importantly, pH enhancement significantly reduced adiposity (males only) and final body weights (females only) and significantly improved glucose clearance in both sexes. Lastly, clear sex differences were observed across all variables. (4) Conclusions: Our findings demonstrate metabolic benefits of increasing dietary pH using ammonia, while high fat intake per se (not protein source) is the major contributor to metabolic dysfunctions. Additional research is warranted to determine mechanisms underlying the beneficial effects of pH enhancement, and interactions with dietary fat content and proteins.
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24
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Stanton KM, Kienzle V, Dinnes DLM, Kotchetkov I, Jessup W, Kritharides L, Celermajer DS, Rye KA. Moderate- and High-Intensity Exercise Improves Lipoprotein Profile and Cholesterol Efflux Capacity in Healthy Young Men. J Am Heart Assoc 2022; 11:e023386. [PMID: 35699182 PMCID: PMC9238648 DOI: 10.1161/jaha.121.023386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Exercise is associated with a reduced risk of cardiovascular disease. Increased high‐density lipoprotein cholesterol (HDL‐C) levels are thought to contribute to these benefits, but much of the research in this area has been limited by lack of well‐controlled subject selection and exercise interventions. We sought to study the effect of moderate and high‐intensity exercise on HDL function, lipid/lipoprotein profile, and other cardiometabolic parameters in a homogeneous population where exercise, daily routine, sleep patterns, and living conditions were carefully controlled. Methods and Results Male Army recruits (n=115, age 22±0.3 years) completed a 12‐week moderate‐intensity exercise program. A subset of 51 subsequently completed a 15‐week high‐intensity exercise program. Fitness increased and body fat decreased after moderate‐ and high‐intensity exercise (P<0.001). Moderate‐intensity exercise increased HDL‐C and apolipoprotein A‐I levels (6.6%, 11.6% respectively), and decreased low‐density lipoprotein cholesterol and apolipoprotein B levels (7.2%, 4.9% respectively) (all P<0.01). HDL‐C and apolipoprotein A‐I levels further increased by 8.2% (P<0.001) and 6.3% (P<0.05) after high‐intensity exercise. Moderate‐intensity exercise increased ABCA‐1 (ATP‐binding cassette transporter A1) mediated cholesterol efflux by 13.5% (P<0.001), which was sustained after high‐intensity exercise. In a selected subset the ability of HDLs to inhibit ICAM‐1 (intercellular adhesion molecule‐1) expression decreased after the high (P<0.001) but not the moderate‐intensity exercise program. Conclusions When controlling for exercise patterns, diet, and sleep, moderate‐intensity exercise improved HDL function, lipid/lipoprotein profile, fitness, and body composition. A sequential moderate followed by high‐intensity exercise program showed sustained or incremental benefits in these parameters. Improved HDL function may be part of the mechanism by which exercise reduces cardiovascular disease risk.
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Affiliation(s)
- Kelly M Stanton
- Heart Research Institute Sydney New South Wales Australia.,The University of Sydney New South Wales Australia.,Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Vivian Kienzle
- Heart Research Institute Sydney New South Wales Australia
| | | | | | - Wendy Jessup
- The ANZAC Research Institute Concord New South Wales Australia
| | - Leonard Kritharides
- Heart Research Institute Sydney New South Wales Australia.,The ANZAC Research Institute Concord New South Wales Australia
| | - David S Celermajer
- Heart Research Institute Sydney New South Wales Australia.,The University of Sydney New South Wales Australia.,Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Kerry-Anne Rye
- The University of New South Wales Sydney New South Wales Australia
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25
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A Comparative Study on Relieving Exercise-Induced Fatigue by Inhalation of Different Citrus Essential Oils. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27103239. [PMID: 35630716 PMCID: PMC9145370 DOI: 10.3390/molecules27103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Citrus essential oils (CEOs) possess physiological functions due to diverse aroma components. However, evidence for the effects of CEOs on exercise performance and exercise-induced fatigue is limited. The CEOs with discrepancies in components may exert different effects on the amelioration of exercise-induced fatigue. In this study, sweet orange (Citrus sinensis L.) essential oil (SEO), lemon (Citrus limon Osbeck) essential oil (LEO), and bergamot (Citrus bergamia Risso and Poit) essential oil (BEO) were chosen to explore the effect on amelioration of exercise-induced fatigue. Our results demonstrated that SEO and LEO increased the swimming time by 276% and 46.5%, while BEO did not. Moreover, the three CEOs exerted varying effects on mitigating exercise-induced fatigue via inhibiting oxidative stress, protecting muscle injury, and promoting glucose-dependent energy supply. Accordingly, BEO showed the best efficiency. Moreover, the GC-MS and Pearson correlation analysis of BEO showed that the contents of the major components, such as (±)-limonene (32.9%), linalyl butyrate (17.8%), and linalool (7.7%), were significantly positively correlated with relieving exercise-induced fatigue.
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26
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Álvarez-Jimenez L, Moreno-Cabañas A, Morales-Palomo F, Mora-Rodriguez R. Effects of metabolic syndrome on fuel utilization during exercise on middle-aged moderately trained individuals. J Appl Physiol (1985) 2022; 132:1423-1431. [PMID: 35511719 DOI: 10.1152/japplphysiol.00040.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
People with the metabolic syndrome (MetS) may have blunted exercise stimulation of metabolism explaining their resistance to lower blood glucose and triglycerides with exercise training. Glycerol and glucose rate of appearance (Ra) in plasma and substrate oxidation were determined at rest and during cycle ergometer exercise at three increasing intensities (55, 80 and 95% of maximal heart rate) in 9 middle-aged (61±7 yr) individuals with MetS. Data were compared to 8 healthy-younger (29±10 yr) individuals matched for habitual exercise training and fat free mass (Healthy-young). At rest, fasting plasma triglycerides (TG), blood glucose and insulin were higher in MetS than in Healthy-young (38%, 42% and 85%, respectively; all p<0.05). At rest, and during low intensity exercise (32-43% VO2MAX), plasma glycerol Ra (index of whole-body lipolysis) and glucose Ra and Rd (index of glucose appearance and disposal) were similar in MetS and Healthy-young. Fat oxidation peaked at low intensity exercise similarly in MetS and Healthy-young (0.273±0.082 vs 0.272±0.078 g·min-1, respectively; p = 0.961). Ra glycerol increased with exercise intensity but was lower in MetS at moderate and high exercise intensities (i.e., 60-100% VO2MAX; p<0.05). Metabolic clearance rate of glucose at high intensity (85-100% VO2MAX) was lower in MetS compared to Healthy-young (p = 0.029). The MetS that develops in middle adulthood, reduces exercise lipolysis and plasma glucose clearance at high exercise intensities, but does not blunt fat or carbohydrate metabolism at low exercise intensity.
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27
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Ogando PHM, Silveira-Rodrigues JG, Melo BP, Campos BT, Silva ADC, Barbosa EG, Aleixo IMS, Soares DD. Effects of high- and moderate-intensity resistance training sessions on glycemia of insulin-treated and non-insulin-treated type 2 diabetes mellitus individuals. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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28
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Rahimpour Z, Hoseini R, Behpour N. Effect of Short-term Vitamin D Supplementation on the Alterations of Glycemic Variables in Response to Exhaustive Eccentric Exercise in Patients with Non-alcoholic Fatty Liver. Middle East J Dig Dis 2022; 14:229-234. [PMID: 36619147 PMCID: PMC9489312 DOI: 10.34172/mejdd.2022.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: Exhaustive eccentric exercise (EEE), along with a positive role in weight loss and physiological adaptation, increases liver enzymes and disturbs glucose homeostasis. Many studies have been considered to neutralize the adverse effects of EEE, including vitamin D (Vit D) supplementation. The present study aimed to investigate the effect of short-term Vit D supplementation on the alteration of glycemic variables in response to EEE in patients with non-alcoholic fatty liver disease (NAFLD). METHODS: In this clinical trial, 22 overweight women with NAFLD were randomly assigned to control (C; n=11) and experimental (Exp; n=11) groups. C group received a lactose placebo daily with the same color, shape, and warmth percentage; Exp group received 2000 IU of Vit D daily for 6 weeks (42 days). Blood samples were taken to measure the liver enzymes, lipid profile, and Vit D levels alteration at four stages: Pre1(before the first EEE session), post 1 (after the first EEE session), pre 2 (before the second EEE session), and post 2 (after the second EEE session). Repeated measures ANOVA and independent t test were used to analyze the data using SPSS software (version 26) at a significance level of P < 0.05. RESULTS: The results show a significant increase in glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) levels in both C and Exp groups following the EEE (comparing pre 1 and post 1). Also, after 6 weeks of Vit D supplementation, glucose, insulin, and HOMA-IR increased significantly in both C (P = 0.001, P = 0.001, and P = 0.001, respectively) and Exp (P = 0.001, P = 0.001, and P = 0.001, respectively) groups following EEE (comparison of pre 2 and post 2). However, these increases were significantly lower in Exp group compared with the C group (comparing post 2). CONCLUSION: Short-term Vit D supplementation downregulates the increased glucose, insulin, and insulin resistance induced by EEE in patients with NAFLD.
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Affiliation(s)
- Zahra Rahimpour
- MSc of Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Rastegar Hoseini
- Assistant Professor of Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran,Corresponding Author: Rastegar Hoseini, PhD Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran, P.O.Box. 6714414971 Tel: + 98 83 34283267 Fax: + 98 83 34279245
| | - Nasser Behpour
- Associate Professor of Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
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29
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Watanabe H, Takahara M, Katakami N, Kanamoto T, Nakata K, Shimomura I. Acute effects of whole body vibration exercise on post-load glucose metabolism in healthy men: a pilot randomized crossover trial. Endocrine 2022; 75:752-759. [PMID: 34599693 PMCID: PMC8487236 DOI: 10.1007/s12020-021-02893-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Exercise on a whole body vibration (WBV) platform, namely WBV exercise (WBVE), has long-term beneficial effects on glucose metabolism, similarly to conventional moderate-intensity exercise. Conventional moderate-intensity exercise reduces post-load plasma glucose levels at the acute phase. This study aimed to reveal acute effects of WBVE on post-load glucose metabolism. METHODS This randomized crossover trial enrolled 18 healthy men. They completed the following three interventions in a random order: (1) a 2-hour 75-g oral glucose tolerance test (OGTT) without WBVE (OGTT-alone), (2) 20-minute WBVE before an OGTT (WBVE → OGTT), and (3) 20-minute WBVE during an OGTT (OGTT → WBVE). Post-load glucose metabolism in the WBVE → OGTT and OGTT → WBVE interventions were compared with that in the OGTT-alone intervention. RESULTS Plasma glucose levels in the WBVE → OGTT and OGTT → WBVE interventions were not significantly different from those in the OGTT-alone intervention at any time point except 15 min, wherein the WBVE → OGTT intervention had higher glucose levels (111 [interquartile range, 102-122] mg/dL vs 122 [111-134] mg/dL, P = 0.026). Higher plasma glucagon levels were observed at 0 min in the WBVE → OGTT intervention and at 60 min in the OGTT → WBVE intervention (P = 0.010 and 0.015). Cortisol, Growth hormone, and adrenaline levels were significantly increased after WBVE, whereas noradrenaline levels were not. Serum insulin levels in the WBVE → OGTT intervention were significantly higher than those in the OGTT-alone intervention at 0 min (P = 0.008). CONCLUSIONS WBVE did not decrease post-load plasma glucose levels at the acute phase. Acute effects of WBVE on post-load glucose metabolism would not be identical to those of conventional exercise. The unique trial number and the name of the registry: UMIN000036520, www.umin.ac.jp , date of registration, June 12, 2019.
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Affiliation(s)
- Hirotaka Watanabe
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Kanamoto
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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30
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Kistner TM, Pedersen BK, Lieberman DE. Interleukin 6 as an energy allocator in muscle tissue. Nat Metab 2022; 4:170-179. [PMID: 35210610 DOI: 10.1038/s42255-022-00538-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/21/2022] [Indexed: 12/31/2022]
Abstract
Extensive research has shown that interleukin 6 (IL-6) is a multifunctional molecule that is both proinflammatory and anti-inflammatory, depending on the context. Here, we combine an evolutionary perspective with physiological data to propose that IL-6's context-dependent effects on metabolism reflect its adaptive role for short-term energy allocation. This energy-allocation role is especially salient during physical activity, when skeletal muscle releases large amounts of IL-6. We predict that during bouts of physical activity, myokine IL-6 fulfills the three main characteristics of a short-term energy allocator: it is secreted from muscle in response to an energy deficit, it liberates somatic energy through lipolysis and it enhances muscular energy uptake and transiently downregulates immune function. We then extend this model of energy allocation beyond myokine IL-6 to reinterpret the roles that IL-6 plays in chronic inflammation, as well as during COVID-19-associated hyperinflammation and multiorgan failure.
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Affiliation(s)
- Timothy M Kistner
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA.
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism/Centre for Physical Activity Research (CIM/CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA.
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31
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Norman D, Drott CJ, Carlsson PO, Espes D. Irisin-A Pancreatic Islet Hormone. Biomedicines 2022; 10:biomedicines10020258. [PMID: 35203466 PMCID: PMC8869325 DOI: 10.3390/biomedicines10020258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
Irisin is a myokine involved in glucose homeostasis. It is primarily expressed in skeletal muscle, but also in the pancreas. This study aimed to elucidate its presence and role in the islets of Langerhans-i.e., its effect on insulin and glucagon secretion as well as on blood flow in the pancreas. The precursor of irisin, fibronectin type III domain-containing protein 5 (FNDC5), was identified in rat and human islets by both qPCR and immunohistochemistry. Both α- and β-cells stained positive for FNDC5. In human islets, we found that irisin was secreted in a glucose-dependent manner. Neither irisin nor an irisin-neutralizing antibody affected insulin or glucagon secretion from human or rat islets in vitro. The insulin and glucagon content in islets was not altered by irisin. The intravenous infusion of irisin in Sprague Dawley rats resulted in nearly 50% reduction in islet blood flow compared to the control. We conclude that irisin is an islet hormone that has a novel role in pancreatic islet physiology, exerting local vascular effects by diminishing islet blood flow without affecting insulin secretion per se.
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Affiliation(s)
- Daniel Norman
- Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden; (D.N.); (C.J.D.); (P.-O.C.)
| | - Carl Johan Drott
- Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden; (D.N.); (C.J.D.); (P.-O.C.)
| | - Per-Ola Carlsson
- Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden; (D.N.); (C.J.D.); (P.-O.C.)
- Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
| | - Daniel Espes
- Science for Life Laboratory, Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
- Correspondence: ; Tel.: +46-18-471-4397
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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Comparison of physiological and clinical markers for chronic sprint-interval training exercise performed either in the fasted or fed states among healthy adults. Curr Res Physiol 2021; 4:192-201. [PMID: 34746838 PMCID: PMC8562244 DOI: 10.1016/j.crphys.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
Sprint-interval training (SIT) and intermittent fasting are effective independent methods in achieving clinical health outcomes. However, the impact of both modalities when performed concurrently is unclear. The aim of this study was to compare the effects of 6 weeks of SIT performed in the fasted versus fed state on physiological and clinical health markers in healthy adults. Methods. Thirty recreationally-active participants were equally randomised into either the fasted (FAS; 4 males, 11 females) or the fed (FED; 6 males, 9 females) group. For all exercise sessions, FAS participants had to fast ≥10 h prior to exercising while FED participants had to consume food within 3 h to exercise. All participants underwent three sessions of SIT per week for 6 weeks. Each session consists of repeated bouts of 30-s Wingate Anaerobic cycle exercise. Pre- and post-training peak oxygen uptake (VO2peak), isokinetic leg strength, insulin sensitivity, blood pressure and serum lipid levels were assessed. Results. There were no differences in baseline physiological and clinical measures between both groups (all p > 0.05). VO2peak improved by 6.0 ± 8.8% in the FAS group and 5.3 ± 10.6% in the FED group (both p < 0.05), however the difference in improvement between groups was not statistically significant (p > 0.05). A similar pattern of results was seen for knee flexion maximum voluntary contraction at 300°·s−1. SIT training in either fasted or fed state had no impact on insulin sensitivity (both p > 0.05). There was significant reduction in diastolic blood pressure (8.2 ± 4.2%) and mean arterial pressure (7.0 ± 3.2%) in the FAS group (both p < 0.05) but not FED group (both p > 0.05). Conclusion. VO2peak and leg strength improved with SIT regardless of whether participants trained in the fasted or fed state. Chronic SIT in the fasted state may potentially reduce blood pressure to a greater extent than the same chronic SIT in the fed state. SIT in the fasted state leads to a significant decrease in blood pressure. VO2peak and leg strength improves with SIT, regardless of nutrition status. SIT, performed in fasted or fed state, does not improve insulin sensitivity, body fat percentage or lipid profile.
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Kulawiec DG, Zhou T, Knopp JL, Chase JG. Continuous glucose monitoring to measure metabolic impact and recovery in sub-elite endurance athletes. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.103059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Franc S, Benhamou P, Borot S, Chaillous L, Delemer B, Doron M, Guerci B, Hanaire H, Huneker E, Jeandidier N, Amadou C, Renard E, Reznik Y, Schaepelynck P, Simon C, Thivolet C, Thomas C, Hannaert P, Charpentier G. No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed-loop system for 12 weeks: A post hoc secondary analysis of the multicentre, randomized controlled Diabeloop WP7 trial. Diabetes Obes Metab 2021; 23:2170-2176. [PMID: 34009725 PMCID: PMC8453744 DOI: 10.1111/dom.14442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022]
Abstract
A post hoc analysis of the Diabeloop WP7 multicentre, randomized controlled trial was performed to investigate the efficacy of the Diabeloop Generation-1 (DBLG1) closed-loop system in controlling the hypoglycaemia induced by physical activity (PA) in real-life conditions. Glycaemic outcomes were compared between days with and without PA in 56 patients with type 1 diabetes (T1D) using DBLG1 for 12 weeks. After the patient announces a PA, DBLG1 reduces insulin delivery and, if necessary, calculates the amount of preventive carbohydrates (CHO). Daily time spent in the interstitial glucose range less than 70 mg/dL was not significantly different between days with and without PA (2.0% ± 1.5% vs. 2.2% ± 1.1%), regardless of the intensity or duration of the PA. Preventive CHO intake recommended by the system was significantly higher in days with PA (41.1 ± 35.5 vs. 21.8 ± 28.5 g/day; P < .0001), and insulin delivery was significantly lower (31.5 ± 10.5 vs. 34.0 ± 10.5 U/day; P < .0001). The time spent in hyperglycaemia and the glycaemic variation coefficient increased significantly on days with PA. In real-life conditions, the use of DBLG1 avoids PA-induced hypoglycaemia. Insulin adjustments and preventive CHO recommendation may explain this therapeutic benefit.
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Affiliation(s)
- Sylvia Franc
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | | | - Sophie Borot
- Department of Endocrinology, Metabolism, Diabetes and NutritionCentre Hospitalier Universitaire Jean MinjozBesançonFrance
| | | | - Brigitte Delemer
- Department of Endocrinology, Diabetes and NutritionReims University HospitalReimsFrance
| | - Maeva Doron
- Université Grenoble Alpes, Commissariat à l'Energie Atomique, Laboratoire d'électronique et de technologie de l'information, Département micro Technologies pour la Biologie et la SantéGrenobleFrance
| | - Bruno Guerci
- Endocrinology‐Diabetes Care UnitUniversity of LorraineVandoeuvre Lès NancyFrance
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and NutritionCHU Toulouse, University of ToulouseToulouseFrance
| | | | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and NutritionCHRU of Strasbourg (UDS)StrasbourgFrance
| | - Coralie Amadou
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
- University Paris‐SaclayOrsayFrance
| | - Eric Renard
- Department of Endocrinology, Diabetes and NutritionMontpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of MontpellierMontpellierFrance
| | - Yves Reznik
- Department of EndocrinologyUniversity of Caen Côte de Nacre Regional Hospital CenterCaenFrance
| | - Pauline Schaepelynck
- Department of Nutrition‐Endocrinology‐Metabolic DisordersMarseille University Hospital, Sainte Marguerite HospitalMarseilleFrance
| | - Chantal Simon
- Department of Endocrinology, Diabetes and NutritionCentre Hospitalier Lyon SudLyonFrance
| | | | - Claire Thomas
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
| | - Patrick Hannaert
- School of Medicine and Pharmacy of PoitiersIschémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1082PoitiersFrance
| | - Guillaume Charpentier
- Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD)EvryFrance
- Laboratoire de Biologie de l'Exercice pour la Performance et la Santé, Université Evry Val d'Essonne, Institut de Recherches Biomédicales des Armées, Université Paris SaclayEvryFrance
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Miyamoto T, Shimizu Y, Matsuo Y, Otaru T, Kanzawa Y, Miyamae N, Yamada E, Katsuno T. Effects of exercise intensity and duration on a myokine, secreted protein acidic and rich in cysteine. Eur J Sport Sci 2021; 22:1401-1410. [PMID: 34228591 DOI: 10.1080/17461391.2021.1953152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Secreted protein acidic and rich in cysteine (SPARC), an exercise-induced myokine, has been suggested as a potential endogenous factor that suppresses colon tumorigenesis. However, the effects of different exercise protocols on circulating SPARC levels are unclear. The main purpose of this study was to examine the effects of both exercise intensity and duration on circulating SPARC levels. This study also examined the relationship between responsiveness of SPARC levels and physical characteristics, including body composition and skeletal muscle function. Nineteen healthy adult men participated in four experimental interventions: two 30-min exercises at workloads corresponding to 60% (W60) and 40% (W40) peak oxygen uptake (VO2peak), a 45-min session of W40, and a 30-min session of complete rest. Blood SPARC and lactate concentrations were measured before and after each session. Only W60 significantly increased serum SPARC levels (p < 0.05), and a significant correlation was found between changes in SPARC levels and lactate concentrations (r = 0.411, p < 0.05). The relative changes in SPARC levels during W60 demonstrated significant positive correlations with skeletal muscle mass and knee extensor muscle strength (both p < 0.05). The increase in serum SPARC levels might be mediated by lactate accumulation and might not, hence, be induced during exercise at the intensity of the first ventilatory threshold levels even though the duration is prolonged. Our results provide fundamental insight into exercise prescription of both exercise intensity and duration for SPARC response, leading to a better understanding of the preventive effects of exercise on colon cancer.Highlight This study found that the increase in serum secreted protein acidic and rich in cysteine (SPARC) levels might be mediated by lactate accumulation and might, hence, be influenced by exercise intensity rather than exercise duration.An association was found between SPARC response to exercise and skeletal muscle mass.Our results provide a better understanding of the preventive effects of exercise on colon cancer.
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Affiliation(s)
- Toshiaki Miyamoto
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yurika Shimizu
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yuka Matsuo
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Taiki Otaru
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yuto Kanzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Nao Miyamae
- School of Nursing, Hyogo University of Health Sciences, Kobe, Japan
| | - Eri Yamada
- School of Nursing, Hyogo University of Health Sciences, Kobe, Japan
| | - Tomoyuki Katsuno
- Department of Occupational Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
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Antidiuretic hormone and the activation of glucose production during high intensity aerobic exercise. Metabol Open 2021; 11:100113. [PMID: 34381988 PMCID: PMC8333141 DOI: 10.1016/j.metop.2021.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the role that antidiuretic hormone (ADH) may play in the activation of glucose production during high intensity aerobic exercise. Materials/methods This study was part of larger study based on a repeated measures cross-over study design and involved ten adult participants who exercised in the morning at 80 % V̇O2peak for up to 40 min or until exhaustion. During and after exercise, the participants were subjected to a morning euglycaemic/euinsulinaemic clamp while [6,6-2H2]glucose was infused and blood sampled to measure the endogenous rate of glucose appearance (Ra) and ADH levels. Results The levels of plasma ADH were 1.8 ± 0.2 pmol/L (mean ± SEM) at rest and increased to 10.5 ± 2.1 pmol/L at the end of exercise (mean ± SEM), which lasted 8.5–40 min. In response to exercise, glucose Ra also rose significantly (p < 0.05), but there was no significant association between changes in ADH levels and glucose Ra (r = 0.49; p = 0.150). Conclusions Although the significant increase in glucose Ra and ADH levels during high intensity aerobic exercise suggest for the first time that these processes may be causally related, there was no significant association between these variables, maybe because of the small sample size and varying exercise durations. Hence, the importance of the causal role that ADH may play in the exercise-mediated activation of hepatic glucose production warrants further in depth investigations. Intense aerobic exercise in T1D causes a significant increase in plasma ADH level and endogenous glucose production rate. This study raises the possibility of a causal relationship between these variables during intense exercise in humans. The role of ADH in activation of endogenous glucose production during intense exercise warrants further investigations.
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Hassabi M, Esteghamati A, Halabchi F, Abedi-Yekta AH, Mahdaviani B, Hassanmirzaie B, Hosseinpanah F, Valizadeh M. Iranian National Clinical Practice Guideline for Exercise in Patients with Diabetes. Int J Endocrinol Metab 2021; 19:e109021. [PMID: 34567134 PMCID: PMC8453655 DOI: 10.5812/ijem.109021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/04/2021] [Accepted: 04/10/2021] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Growing evidence highlights the importance of physical activity as a critical element for the prevention and control of diabetes. However, there is no clinical practice guideline focusing on the different aspects of exercise in patients with diabetes, especially for the Iranian population. OBJECTIVE We aimed to prepare and adopt a clinical practice guideline to provide well-defined, simple, and concise responses to certain questions related to physical activity and exercise in all patients with diabetes, including type 1, 2, and gestational diabetes mellitus (GDM). EVIDENCE ACQUISITION A multidisciplinary team of experts in various fields (sports medicine specialists, endocrinologists, and cardiologists) developed the guideline. This group did the task in four stages: (1) identifying and refining the subject area using 17 clinical questions; (2) appraising evidence through a systematic review of the literature; (3) extracting recommendations from evidence and grading them as A, B, C, or D based on the quality, quantity, and consistency of existing evidence; and (4) subjecting the guideline to external review and finally selecting the recommendations with high scores of appropriateness and agreement. The final version was evaluated and approved by the National Deputy for Curative Affairs - Ministry of Health and Medical Education and has also been endorsed by the Iran Endocrine Society (IES) and Iranian Association of Sports and Exercise Medicine (IASEM). RESULTS The guideline consists of 52 recommendations addressing 17 important questions concerning different aspects of exercise prescription in Iranian patients with diabetes. CONCLUSIONS The guideline provides evidence-based information that may help physicians to prescribe exercise for Iranian patients with diabetes safely and effectively.
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Affiliation(s)
- Mohammad Hassabi
- Department of Sports and Exercise Medicine, Taleghani Hospital Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Sports and Exercise Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Hosein Abedi-Yekta
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Mahdaviani
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Hassanmirzaie
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hatamoto Y, Yoshimura E, Takae R, Komiyama T, Matsumoto M, Higaki Y, Tanaka H. The effects of breaking sedentary time with different intensity exercise bouts on energy metabolism: A randomized cross-over controlled trial. Nutr Metab Cardiovasc Dis 2021; 31:1879-1889. [PMID: 33992509 DOI: 10.1016/j.numecd.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Breaking up sedentary periods, particularly with light activity, increases total energy expenditure (EE), and helps provide better glycemic control. However, the effects of activities of various intensities to interrupt prolonged sedentary time are unclear. The purpose of the present study was to examine potential differences in glycemic control and EE from breaking up sedentary time with short exercise bouts of different intensities. METHODS AND RESULTS Nine overweight/obesity young men underwent whole body indirect calorimetry at 19:00 on day 1 and stayed overnight. After awakening on day 2, they performed short duration jogging every 30 min over 8 h (16-time bouts in total) under 3 different conditions with the same running distance: (1) lactate threshold (LT) for 2 min, (2) 60% LT for 200 s, and (3) onset of blood lactate accumulation (OBLA) for 75 s. The 24-h EE and interstitial glucose concentration (from 8:00 to 19:00 on day 2) was continuously measured throughout the trials. The standard deviation during intervention and indexes of postprandial of the interstitial glucose concentration was significantly lower at LT and OBLA than at 60% LT (p < 0.05). The 24-h EE was not significantly different among conditions, but EE at OBLA during intervention was slightly but significantly higher than at 60% LT and LT. CONCLUSION Breaking up sedentary time with short-duration jogging at LT and with OBLA intensities may have better glycemic control and increased use of carbohydrate as a fuel, while short-duration a jogging at OBLA intensity may increase EE. TRIAL REGISTRATION UMIN000041361.
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Affiliation(s)
- Yoichi Hatamoto
- The Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan; Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.
| | - Eiichi Yoshimura
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.
| | - Rie Takae
- The Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan; Faculty of Nursing and Nutrition, University of Nagasaki, Siebold, 1-1-1 Manabino, Nagayo-cho, Nishi-Sonogi-gun, Nagasaki, 851-2195, Japan.
| | - Takaaki Komiyama
- Center for Education in Liberal Arts and Sciences, Osaka University, 1-17 Machikaneyama, Toyonaka, 560-0043, Osaka, Japan.
| | - Mai Matsumoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.
| | - Yasuki Higaki
- The Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Hiroaki Tanaka
- The Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Särnblad S, Ponsot E, Leprêtre PM, Kadi F. Acute effects of aerobic continuous, intermittent, and resistance exercise on glycemia in adolescents males with type 1 diabetes. Pediatr Diabetes 2021; 22:610-617. [PMID: 33650298 DOI: 10.1111/pedi.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Increased levels of physical activity is often associated with reduced HbA1c in individuals with diabetes. However, the effect on glycemic control differs between different programs of exercise. The aim of this study was to compare the acute effects on glycemia of resistance and two aerobic continuous and intermittent exercise bouts in adolescent males with type 1 diabetes. RESEARCH DESIGN AND METHODS Eight active males with type 1 diabetes (17.5 ± 0.8 years, BMI: 20.8 ± 2.2 kg/m2 , HbA1c: 7.2 ± 0.5% [54.9 ± 5.3 mmol/mol]) performed four experimental sessions-nonexercise (control), resistance exercise (RE) and two isocaloric continuous (CE) and intermittent (IE) cycling exercise trials-in a randomized order. Each session consisted of 45 min of exercise (except for the control modality) and 60 min of passive recovery. Venous blood was drawn for assessment of plasma glucose (PG). A two-way repeated-measures ANOVA was used for statistical comparisons. RESULTS A significant time-to-exercise interaction effect on PG was detected. PG significantly decreased during IE (-5.1 ± 1.6 mmol/L) and CE (-5.4 ± 1.8 mmol/L) but not during RE (-1.0 ± 1.4 mmol/L, ns). Additionally, decreases in PG after IE and CE were sustained throughout the recovery period. CONCLUSIONS While intermittent and continuous aerobic exercises are associated with a lowering of glycemia in male adolescents with type 1 diabetes, glycemia remained stable without significant alterations after resistance exercise. These findings hold important implications related to clinical exercise advice and disease management in adolescents with type 1 diabetes.
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Affiliation(s)
- Stefan Särnblad
- Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, SE, Sweden
| | - Elodie Ponsot
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
| | - Pierre-Marie Leprêtre
- School of Health Sciences, Örebro University, Örebro, SE, Sweden.,Faculty of Sport Sciences, University of Picardie Jules Verne, Amiens, France.,Cardiovascular Rehabilitation Unit, Hospital center of Corbie, Corbie, France
| | - Fawzi Kadi
- School of Health Sciences, Örebro University, Örebro, SE, Sweden
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Malone JJ, Hulton AT, MacLaren DPM. Exogenous carbohydrate and regulation of muscle carbohydrate utilisation during exercise. Eur J Appl Physiol 2021; 121:1255-1269. [PMID: 33544230 PMCID: PMC8064975 DOI: 10.1007/s00421-021-04609-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/17/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Carbohydrates (CHO) are one of the fundamental energy sources during prolonged steady state and intermittent exercise. The consumption of exogenous CHO during exercise is common place, with the aim to enhance sporting performance. Despite the popularity around exogenous CHO use, the process by which CHO is regulated from intake to its use in the working muscle is still not fully appreciated. Recent studies utilizing the hyperglycaemic glucose clamp technique have shed light on some of the potential barriers to CHO utilisation during exercise. The present review addresses the role of exogenous CHO utilisation during exercise, with a focus on potential mechanisms involved, from glucose uptake to glucose delivery and oxidation at the different stages of regulation. METHODS Narrative review. RESULTS A number of potential barriers were identified, including gastric emptying, intestinal absorption, blood flow (splanchnic and muscle), muscle uptake and oxidation. The relocation of glucose transporters plays a key role in the regulation of CHO, particularly in epithelial cells and subsequent transport into the blood. Limitations are also apparent when CHO is infused, particularly with regards to blood flow and uptake within the muscle. CONCLUSION We highlight a number of potential barriers involved with the regulation of both ingested and infused CHO during exercise. Future work on the influence of longitudinal training within the regulation processes (such as the gut) is warranted to further understand the optimal type, dose and method of CHO delivery to enhance sporting performance.
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Affiliation(s)
- James J Malone
- School of Health Sciences, Liverpool Hope University, Taggart Avenue, Liverpool, L16 9JD, UK.
| | - Andrew T Hulton
- Department of Nutritional Sciences, University of Surrey, Guildford, UK
| | - Don P M MacLaren
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Molveau J, Rabasa-Lhoret R, Taleb N, Heyman E, Myette-Côté É, Suppère C, Berthoin S, Tagougui S. Minimizing the Risk of Exercise-Induced Glucose Fluctuations in People Living With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion: An Overview of Strategies. Can J Diabetes 2021; 45:666-676. [PMID: 33744123 DOI: 10.1016/j.jcjd.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
Physical activity (PA) is important for individuals living with type 1 diabetes (T1D) due to its various health benefits. Nonetheless, maintaining adequate glycemic control around PA remains a challenge for many individuals living with T1D because of the difficulty in properly managing circulating insulin levels around PA. Although the most common problem is increased incidence of hypoglycemia during and after most types of PA, hyperglycemia can also occur. Accordingly, a large proportion of people living with T1D are sedentary partly due to the fear of PA-associated hypoglycemia. Continuous subcutaneous insulin infusion (CSII) offers a higher precision and flexibility to adjust insulin basal rates and boluses according to the individual's specific needs around PA practice. Indeed, for physically active patients with T1D, CSII can be a preferred option to facilitate glucose regulation. To our knowledge, there are no guidelines to manage exercise-induced hypoglycemia during PA, specifically for individuals living with T1D and using CSII. In this review, we highlight the current state of knowledge on exercise-related glucose variations, especially hypoglycemic risk and its underlying physiology. We also detail the current recommendations for insulin modulations according to the different PA modalities (type, intensity, duration, frequency) in individuals living with T1D using CSII.
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Affiliation(s)
- Joséphine Molveau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Division of Endocrinology, McGill University, Montreal, Québec, Canada; Endocrinology Division, Montreal Diabetes Research Center, Montreal, Québec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada
| | - Elsa Heyman
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Étienne Myette-Côté
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Corinne Suppère
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Serge Berthoin
- Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France
| | - Sémah Tagougui
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montreal, Québec, Canada; Université Lille, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Université Artois, Artois, France; Université Littoral Côte d'Opale, Dunkerque, France.
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Zając-Gawlak I, Pelclová J, Groffik D, Přidalová M, Nawrat-Szołtysik A, Kroemeke A, Gába A, Sadowska-Krępa E. Does physical activity lower the risk for metabolic syndrome: a longitudinal study of physically active older women. BMC Geriatr 2021; 21:11. [PMID: 33407205 PMCID: PMC7789662 DOI: 10.1186/s12877-020-01952-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background The associations between physical activity and metabolic syndrome (MetS) have been mainly found in cross-sectional studies. The aim of this longitudinal study was to examine the relationship between meeting step-based guidelines and changes in the risk of metabolic syndrome. Methods This study included data from older women (baseline age 62.9 ± 4.3 years) from a 7-year longitudinal study in Central Europe. At baseline and follow-up, physical activity was measured by an accelerometer, and the risk for MetS was assessed according to the NCEP-ATP III criteria. In 59 women, multivariate repeated measures ANOVA was used to compare differences in changes in the risk of MetS in groups based on meeting step-based guidelines (10,000 steps/day and 9000 steps/day for women aged <65 and ≥ 65 years, respectively). Results Over 7 years, steps/day increased from 10,944 ± 3560 to 11,652 ± 4865, and the risk of MetS decreased from 41 to 12% in our sample. Women who longitudinally met step-based guidelines had a significantly higher mean concentration of high-density cholesterol (HDL-C) (64.5 and 80.3 mg/dL at baseline and follow-up, respectively) and a lower concentration of triglycerides (TGs) (158.3 and 123.8 mg/dL at baseline and follow-up, respectively) at follow-up compared to baseline. Moreover, women who increased their daily steps over 7 years to the recommended steps/day value significantly decreased the concentration of TGs (158.3 mg/dL and 123.8 mg/dL at baseline and follow-up, respectively). Conclusions Our study might suggest that the long-term meeting of step-based guidelines or an increase in daily steps/day to achieve the recommended value could be related to a lower risk of MetS, specifically in concentrations of HDL-C and TG. These findings may help in designing interventions aiming to decrease the risk of MetS in older women.
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Affiliation(s)
- Izabela Zając-Gawlak
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Mikołowska 72A, 40-065, Katowice, Poland.
| | - Jana Pelclová
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 779 00, Olomouc, Czech Republic
| | - Dorota Groffik
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Miroslava Přidalová
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 779 00, Olomouc, Czech Republic
| | - Agnieszka Nawrat-Szołtysik
- Institute of Physioterapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Aleksandra Kroemeke
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland
| | - Aleš Gába
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 779 00, Olomouc, Czech Republic
| | - Ewa Sadowska-Krępa
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Mikołowska 72A, 40-065, Katowice, Poland
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44
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Frank S, Jbaily A, Hinshaw L, Basu R, Basu A, Szeri AJ. Modeling the acute effects of exercise on glucose dynamics in healthy nondiabetic subjects. J Pharmacokinet Pharmacodyn 2021; 48:225-239. [PMID: 33394220 DOI: 10.1007/s10928-020-09726-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
To shed light on how acute exercise affects blood glucose (BG) concentrations in nondiabetic subjects, we develop a physiological pharmacokinetic/pharmacodynamic model of postprandial glucose dynamics during exercise. We unify several concepts of exercise physiology to derive a multiscale model that includes three important effects of exercise on glucose dynamics: increased endogenous glucose production (EGP), increased glucose uptake in skeletal muscle (SM), and increased glucose delivery to SM by capillary recruitment (i.e. an increase in surface area and blood flow in capillary beds). We compare simulations to experimental observations taken in two cohorts of healthy nondiabetic subjects (resting subjects (n = 12) and exercising subjects (n = 12)) who were each given a mixed-meal tolerance test. Metabolic tracers were used to quantify the glucose flux. Simulations reasonably agree with postprandial measurements of BG concentration and EGP during exercise. Exercise-induced capillary recruitment is predicted to increase glucose transport to SM by 100%, causing hypoglycemia. When recruitment is blunted, as in those with capillary dysfunction, the opposite occurs and higher than expected BG levels are predicted. Model simulations show how three important exercise-induced phenomena interact, impacting BG concentrations. This model describes nondiabetic subjects, but it is a first step to a model that describes glucose dynamics during exercise in those with type 1 diabetes (T1D). Clinicians and engineers can use the insights gained from the model simulations to better understand the connection between exercise and glucose dynamics and ultimately help patients with T1D make more informed insulin dosing decisions around exercise.
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Affiliation(s)
- Spencer Frank
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA.
- Dexcom in San Diego, San Diego, CA, USA.
| | - Abdulrahman Jbaily
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA
- Dexcom in San Diego, San Diego, CA, USA
| | - Ling Hinshaw
- Division of Endocrinology at Mayo Clinic, Rochester, USA
| | - Rita Basu
- Division of Endocrinology at the University of Virginia School of Medicine, Charlottesville, USA
| | - Ananda Basu
- Division of Endocrinology at the University of Virginia School of Medicine, Charlottesville, USA
| | - Andrew J Szeri
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA
- Department of Mechanical Engineering at the University of British Columbia, Vancouver, Canada
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45
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Lindinger MI, Cairns SP. Regulation of muscle potassium: exercise performance, fatigue and health implications. Eur J Appl Physiol 2021; 121:721-748. [PMID: 33392745 DOI: 10.1007/s00421-020-04546-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
This review integrates from the single muscle fibre to exercising human the current understanding of the role of skeletal muscle for whole-body potassium (K+) regulation, and specifically the regulation of skeletal muscle [K+]. We describe the K+ transport proteins in skeletal muscle and how they contribute to, or modulate, K+ disturbances during exercise. Muscle and plasma K+ balance are markedly altered during and after high-intensity dynamic exercise (including sports), static contractions and ischaemia, which have implications for skeletal and cardiac muscle contractile performance. Moderate elevations of plasma and interstitial [K+] during exercise have beneficial effects on multiple physiological systems. Severe reductions of the trans-sarcolemmal K+ gradient likely contributes to muscle and whole-body fatigue, i.e. impaired exercise performance. Chronic or acute changes of arterial plasma [K+] (hyperkalaemia or hypokalaemia) have dangerous health implications for cardiac function. The current mechanisms to explain how raised extracellular [K+] impairs cardiac and skeletal muscle function are discussed, along with the latest cell physiology research explaining how calcium, β-adrenergic agonists, insulin or glucose act as clinical treatments for hyperkalaemia to protect the heart and skeletal muscle in vivo. Finally, whether these agents can also modulate K+-induced muscle fatigue are evaluated.
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Affiliation(s)
- Michael I Lindinger
- Research and Development, The Nutraceutical Alliance, Burlington, ON, L7N 2Z9, Canada
| | - Simeon P Cairns
- SPRINZ, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
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46
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Jabbour G, Bragazzi NL. Continuous Blood Glucose Monitoring Increases Vigorous Physical Activity Levels and Is Associated With Reduced Hypoglycemia Avoidance Behavior In Youth With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:722123. [PMID: 34557162 PMCID: PMC8454404 DOI: 10.3389/fendo.2021.722123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
The primary goal of this study was to explore physical activity (PA) levels, hypoglycemia fear scores and hypoglycemia episodes according to insulin administration and blood glucose monitoring methods in youth with type 1 diabetes (T1D). A self-administered questionnaire was completed by 28 children and 33 adolescents with T1D, and their PA was assessed. Hypoglycemia episodes, fear of hypoglycemia scores, insulin therapy (pump vs. injection) and blood glucose monitoring (continuous blood glucose monitors [CGMs] vs. blood glucose meters) methods are reported in the present work. There were no significant differences in the number of hypoglycemic episodes, child hypoglycemia fear survey behavior or total scores, or any components of the PA profile between youth using injections and those using a pump. However, these variables differed significantly when compared according to blood glucose monitoring method (CGMs vs. blood glucose meters): 41.2 vs. 81.8, p<0.01; 1.03 ± 0.05 vs. 2.6 ± 0.63, p<0.01; 1.09 ± 0.43 vs. 2.94 ± 0.22, p<0.01; and 222 ± 18 vs. 49 ± 11, p<0.01 (for total time in vigorous PA in minutes per week), respectively. CGM use correlated significantly with VPA levels (β=0.6; p=0.04). Higher VPA levels were associated with higher child hypoglycemia fear survey behavior scores (β=0.52; p=0.04). The latter correlates negatively with the number of episodes of hypoglycemia in the past 12 months in all category groups. The type of insulin injection was not associated with more activity in youth with T1D. In contrast, CGM use may be associated with increased vigorous PA among T1D youth. Those with higher hypoglycemia fear survey behavior scores engaged in more VPA and had fewer hypoglycemia episodes. Although CGM use ensures continuous monitoring of glycemia during exercise, increasing hypoglycemia avoidance behavior is still a necessary part of exercise management strategies in active youth with T1D.
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Affiliation(s)
- Georges Jabbour
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
- *Correspondence: Georges Jabbour, ,
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
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47
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Shetty VB, Fournier PA, Paramalingam N, Soon W, Roby HC, Jones TW, Davis EA. Effect of Exercise Intensity on Exogenous Glucose Requirements to Maintain Stable Glycemia At High Insulin Levels in Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:e83-e93. [PMID: 33097945 DOI: 10.1210/clinem/dgaa768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT Under basal insulin levels, there is an inverted U relationship between exercise intensity and exogenous glucose requirements to maintain stable blood glucose levels in type 1 diabetes (T1D), with no glucose required for intense exercise (80% V̇O2 peak), implying that high-intensity exercise is not conducive to hypoglycemia. OBJECTIVE This work aimed to test the hypothesis that a similar inverted U relationship exists under hyperinsulinemic conditions, with high-intensity aerobic exercise not being conducive to hypoglycemia. METHODS Nine young adults with T1D (mean ± SD age, 22.6 ± 4.7 years; glycated hemoglobin, 61 ± 14 mmol/mol; body mass index, 24.0 ± 3.3 kg/m2, V̇O2 peak, 36.6 ± 8.0 mL·kg-1 min-1) underwent a hyperinsulinemic-euglycemic clamp to maintain stable glycemia (5-6 mmol·L-1), and exercised for 40 minutes at 4 intensities (35%, 50%, 65%, and 80% V̇O2peak) on separate days following a randomized counterbalanced study design. MAIN OUTCOME MEASURES Glucose infusion rates (GIR) and glucoregulatory hormones levels were measured. RESULTS The GIR (± SEM) to maintain euglycemia was 4.4 ± 0.4 mg·kg-1 min-1 prior to exercise, and increased significantly by 1.8 ± 0.4, 3.0 ± 0.4, 4.2 ± 0.7, and 3.5 ± 0.7 mg·kg-1 min-1 during exercise at 35%, 50%, 65%, and 80% V̇O2 peak, respectively, with no significant differences between the 2 highest exercise intensities (P > .05), despite differences in catecholamine levels (P < .05). During the 2-hour period after exercise at 65% and 80% V̇O2 peak, GIRs did not differ from those during exercise (P > .05). CONCLUSIONS Under hyperinsulinemic conditions, the exogenous glucose requirements to maintain stable glycemia during and after exercise increase with exercise intensity then plateau with exercise performed at above moderate intensity ( > 65% V̇O2 peak). High-intensity exercise confers no protection against hypoglycemia.
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Affiliation(s)
- Vinutha B Shetty
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Fournier
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Nirubasini Paramalingam
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Wayne Soon
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Heather C Roby
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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48
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Deichmann J, Bachmann S, Burckhardt MA, Szinnai G, Kaltenbach HM. Simulation-Based Evaluation of Treatment Adjustment to Exercise in Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:723812. [PMID: 34489869 PMCID: PMC8417413 DOI: 10.3389/fendo.2021.723812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 01/26/2023] Open
Abstract
Regular exercise is beneficial and recommended for people with type 1 diabetes, but increased glucose demand and changes in insulin sensitivity require treatment adjustments to prevent exercise-induced hypoglycemia. Several different adjustment strategies based on insulin bolus reductions and additional carbohydrate intake have been proposed, but large inter- and intraindividual variability and studies using different exercise duration, intensity, and timing impede a direct comparison of their effects. In this study, we use a mathematical model of the glucoregulatory system and implement published guidelines and strategies in-silico to provide a direct comparison on a single 'typical' person on a standard day with three meals. We augment this day by a broad range of exercise scenarios combining different intensity and duration of the exercise session, and different timing with respect to adjacent meals. We compare the resulting blood glucose trajectories and use summary measures to evaluate the time-in-range and risk scores for hypo- and hyperglycemic events for each simulation scenario, and to determine factors that impede prevention of hypoglycemia events. Our simulations suggest that the considered strategies and guidelines successfully minimize the risk for acute hypoglycemia. At the same time, all adjustments substantially increase the risk of late-onset hypoglycemia compared to no adjustment in many cases. We also find that timing between exercise and meals and additional carbohydrate intake during exercise can lead to non-intuitive behavior due to superposition of meal- and exercise-related glucose dynamics. Increased insulin sensitivity appears as a major driver of non-acute hypoglycemic events. Overall, our results indicate that further treatment adjustment might be required both immediately following exercise and up to several hours later, but that the intricate interplay between different dynamics makes it difficult to provide generic recommendations. However, our simulation scenarios extend substantially beyond the original scope of each model component and proper model validation is warranted before applying our in-silico results in a clinical setting.
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Affiliation(s)
- Julia Deichmann
- Department of Biosystems Science and Engineering and Swiss Institute of Bioinformatics (SIB), ETH Zurich, Basel, Switzerland
- Life Science Zurich Graduate School, Zurich, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans-Michael Kaltenbach
- Department of Biosystems Science and Engineering and Swiss Institute of Bioinformatics (SIB), ETH Zurich, Basel, Switzerland
- *Correspondence: Hans-Michael Kaltenbach,
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49
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Roberts AJ, Taplin CE, Isom S, Divers J, Saydah S, Jensen ET, Mayer-Davis EJ, Reid LA, Liese AD, Dolan LM, Dabelea D, Lawrence JM, Pihoker C. Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: The SEARCH for diabetes in youth study. Pediatr Diabetes 2020; 21:1277-1284. [PMID: 32738012 PMCID: PMC7855399 DOI: 10.1111/pedi.13092] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Youth with type 1 diabetes (T1D) are encouraged to participate in physical activity (PA). Studies have identified fear of hypoglycemia (FOH) as a barrier to participating in PA. OBJECTIVES To examine (a) PA patterns in youth with T1D by age group and (b) the relationship between both parental and youth FOH and youth PA. METHODS A cross-sectional analysis from the SEARCH cohort study visit of youth ages 10 to 17 years with T1D (n = 1129) was conducted. Linear regression models estimated the association between self-reported number of days of vigorous PA (VPA) and moderate PA (MPA) and both youth- and parent-reported FOH. Multivariable models were adjusted for age, sex, race, duration of T1D, HbA1c, use of continuous glucose monitoring (CGM), recent severe hypoglycemia, primary insulin regimen, and BMI. RESULTS Participants were 52% female, had mean (sd) age 14.4 (4.2) years, diabetes duration 7.5 years (1.8), HbA1c 9.2% (1.7). Older youth were less likely to engage in VPA (P < .01), or sports teams (P < .01), but more likely to engage in MPA (P < .01). Higher youth FOH (behavior subscale) was associated with increased levels of VPA (β (se) 0.30 (0.11), P = .01) but not significantly associated with MPA (P = .06). There was no statistically significant association between parental FOH and youth PA. CONCLUSIONS In SEARCH participants with T1D, VPA, and team sports participation declined with age, while MPA increased. We observed that higher scores on the youth FOH behavioral subscale were associated with increased VPA levels, suggesting that FOH may be less of a barrier to PA than previously thought.
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Affiliation(s)
| | - Craig E. Taplin
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Scott Isom
- Department of Statistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Atlanta, GA
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Lauren A. Reid
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC
| | - Angela D. Liese
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC
| | - Larry M. Dolan
- Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena CA
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50
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Swim therapy-induced tissue specific metabolic responses in male rats. Life Sci 2020; 262:118516. [PMID: 33011220 DOI: 10.1016/j.lfs.2020.118516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/03/2023]
Abstract
Swim therapy in the form of moderate physical activity has general health benefits. Regular exercise prevents the progression of chronic diseases affecting the different bodily systems. The metabolic alterations associated with following such lifestyle remain not fully understood. The aim of the present study was to elucidate the metabolic changes following prolonged swim therapy. Twenty-four Sprague Dawley rats were divided into sedentary and exercise groups. Our results revealed that regular exercise significantly increased the serum levels of growth hormone (GH), glucagon and corticosterone. A reduction in the circulating levels of irisin and insulin hormones, and glucose were noticed alongside with an upregulation in the mRNA expression levels of FNDC5, PGC-1α, GLUT-4 and preptin receptors with downregulation in the expression of Enho gene in the heart of exercised rats. Liver of the exercised rats showed elevation in the transcriptional levels of Enho gene, PPARα, and preptin with reduction in the transcriptional levels of preptin receptors. Exercise induced an increase in the pancreatic mRNA of Enho gene, preptin and preptin receptors, and a reduction in FNDC5, PPARα and PGC-1α. An elevation in the gastrocnemius muscle PGC-1α mRNA expression and a decline in the soleus muscle Enho mRNA were found. Exercise diminishes the activities of SOD, CAT and GPx in the gastrocnemius muscle, liver and pancreas. Myogenin expression increased in all examined skeletal muscles. This study takes into account the complex crosstalk between different signaling pathways in skeletal muscles, heart, liver and pancreas as well as the metabolic alterations in response to regular exercise.
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