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Colosio AL, Spigolon G, Bacchi E, Moghetti P, Pogliaghi S. Monitoring exercise intensity in diabetes: applicability of "heart rate-index" to estimate oxygen consumption during aerobic and resistance training. J Endocrinol Invest 2020; 43:623-630. [PMID: 31782111 DOI: 10.1007/s40618-019-01150-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Accurate quantification and monitoring of exercise "dose", described by oxygen consumption (VO2), is necessary for exercise prescription and individualization. However, due to the complexity and elevated cost of direct, gold-standard methods, this is rarely done outside research laboratories. Heart rate-index (HRindex) is a new simple method to estimate VO2 in healthy and clinical populations. We tested the performance of HRindex to estimate VO2 in diabetic patients during aerobic (AT) and isotonic training (IT). METHODS Data from 12 males (age: 64 ± 5 years; BMI: 26 ± 12) with type 2 diabetes were analysed. VO2 and heart rate were measured during one AT and one IT session. Furthermore, VO2 was indirectly estimated based on HRindex. Then, the correspondence between measured and estimated VO2 was evaluated by two-way RM-ANOVA, correlation and Bland-Altman analysis. RESULTS Estimated average VO2 values during AT (1292 ± 366 ml/min) were not different from (p = 0.243) and highly correlated with (r = 0.87, p < 0.001) the measured values (1369 ± 417 ml/min), with a small bias and imprecision. Conversely during IT, HRindex overestimated VO2 compared to the actual measures (1048 ± 404 vs 667 ± 230 ml/min, p ≤ 0.001) and only a moderate correlation was found between values (r = 0.43, p ≤ 0.001), with a large bias and imprecision. CONCLUSION VO2 of aerobic exercises can be accurately estimated in diabetes patients using HRindex. During isotonic exercise, this method is not recommended for monitoring metabolic intensity due to large overestimation and imprecision. In aerobic exercise, HRindex offers a simple and valid alternative to the direct VO2 determination and may favour the applicability of time-resolved measures of exercise "dose".
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Affiliation(s)
- A L Colosio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
| | - G Spigolon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy
| | - E Bacchi
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University and AOUI of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - P Moghetti
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University and AOUI of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - S Pogliaghi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati 43, 37131, Verona, Italy.
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Olioso D, Dauriz M, Bacchi E, Negri C, Santi L, Bonora E, Moghetti P. Effects of Aerobic and Resistance Training on Circulating Micro-RNA Expression Profile in Subjects With Type 2 Diabetes. J Clin Endocrinol Metab 2019; 104:1119-1130. [PMID: 30445461 DOI: 10.1210/jc.2018-01820] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/09/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT Structured exercise programs are of great benefit for the treatment of type 2 diabetes (T2DM). However, whether aerobic (AER) or resistance (RES) exercise training exerts specific epigenetic changes through the expression profile of circulating miRNAs (c-miRNAs) is still largely unknown. OBJECTIVE To assess whether the c-miRNAs profile changes after either AER or RES training in subjects with T2DM. DESIGN Twenty-four patients with T2DM randomized to AER or RES training protocols were randomly selected from the Resistance vs. Aerobic Exercise in Type 2 Diabetes (RAED2) Trial (NAER = 12; NRES = 12). The baseline and post-training levels of 179 c-miRNAs were initially measured by RT-PCR in 6 individuals (NAER = 3; NRES = 3). C-miRNAs exhibiting ≥40% fold change variation and/or nominal significance from baseline were measured in the whole group. RESULTS Nineteen c-miRNAs were eventually assessed in the whole group. Compared with baseline, the post-training levels of miR-423-3p, miR-451a, and miR-766-3p were significantly up-regulated, irrespective of exercise type (P < 0.0026; 0.05/19), and targeted upstream pathways relevant to fatty acids biosynthesis and metabolic regulation. MiR-451a and miR-423-3p were significantly correlated with fat loss (ρ = 0.45 and 0.43, respectively) and resulted, alone or in combination, in being predictors of fat loss in generalized linear regression models including exercise type as covariate. Only the association with miR-451a eventually retained significance after further correction for age, sex, body mass index, and HbA1c. CONCLUSIONS Exercise training in T2DM is associated with substantial c-miRNAs profile changes, irrespective of exercise type and other relevant metabolic covariates. The mechanistic significance of the observed relationship between fat loss and the epigenetic modifications induced by exercise warrants further investigation in larger datasets.
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Affiliation(s)
- Debora Olioso
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Dauriz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Elisabetta Bacchi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Carlo Negri
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Lorenza Santi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Enzo Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Moghetti
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
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Indelicato L, Dauriz M, Bacchi E, Donà S, Santi L, Negri C, Cacciatori V, Bonora E, Nouwen A, Moghetti P. Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes. Acta Diabetol 2018; 55:627-635. [PMID: 29582161 DOI: 10.1007/s00592-018-1132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
AIM To assess the association of psychological variables on leisure-time physical activity and sedentary time in men and women with type 2 diabetes mellitus (T2D). METHODS In this cross-sectional study, we evaluated 163 patients with T2D, consecutively recruited at the Diabetes Centre of the Verona General Hospital. Scores on depression and anxiety symptoms, psychosocial factors (including self-efficacy, perceived interference, perceived severity, social support, misguided support behaviour, spouse's positive behaviour), physical activity and time spent sitting were ascertained using questionnaires responses to the Beck Depression Inventory-II, Beck Anxiety Inventory, Multidimensional Diabetes Questionnaire, International Physical Activity Questionnaire. RESULTS Physical activity was significantly associated with higher social support in women and with increased self-efficacy in men. Sedentary time was significantly associated with higher perceived interference, anxiety and depressive symptoms, and with reduced diabetes self-efficacy in women, while it was associated solely with anxiety in men. Depressive symptoms and self-efficacy in women and anxiety symptoms in men were independent predictors of sedentary time when entered in a multivariable regression model also including age, BMI, haemoglobin A1c, diabetes duration, perceived interference and self-efficacy as covariates. CONCLUSIONS Lower self-efficacy and higher symptoms of depression were closely associated with increased sedentary time in women, but not in men, with T2D. It is possible that individualized behavioural interventions designed to reduce depressive symptoms and to improve diabetes self-efficacy would ultimately reduce sedentary behaviours, particularly in women with T2D.
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Affiliation(s)
- Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Elisabetta Bacchi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Silvia Donà
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Vittorio Cacciatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, UK
| | - Paolo Moghetti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
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Dauriz M, Bacchi E, Boselli L, Santi L, Negri C, Trombetta M, Bonadonna RC, Bonora E, Moghetti P. Association of free-living physical activity measures with metabolic phenotypes in type 2 diabetes at the time of diagnosis. The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS). Nutr Metab Cardiovasc Dis 2018; 28:343-351. [PMID: 29477578 DOI: 10.1016/j.numecd.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/07/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Lifestyle is considered a major determinant of risk of type 2 diabetes (T2D). We investigated whether daily physical activity (DPA) is associated with beta-cell function (BF) and/or insulin sensitivity (IS) in patients with T2D at the time of diagnosis. METHODS AND RESULTS In 41 subjects enrolled in the Verona Newly-Diagnosed Type 2 Diabetes Study we assessed: (1) IS, by euglycaemic insulin clamp; (2) BF, estimated by prolonged-OGTT minimal modeling and expressed as derivative and proportional control; (3) DPA and energy expenditure (EE), assessed over 48-h monitoring by a validated wearable armband system. Study participants (median [IQR]; age: 62 [53-67] years, BMI: 30.8 [26.5-34.3] Kg m-2, HbA1c: 6.7 [6.3-7.3]%; 49.7 [45.4-56.3] mmol/mol) were moderately active (footsteps/day: 7773 [5748-10,927]; DPA≥3MET: 70 [38-125] min/day), but none of them exercised above 6 metabolic equivalents (MET). EE, expressed as EETOT (total daily-EE) and EE≥3MET (EE due to DPA≥3MET) were 2398 [2226-2801] and 364 [238-617] Kcal/day, respectively. IS (M-clamp 630 [371-878] μmol/min/m2) was positively associated with DPA and EE, independent of age, sex and BMI (p < 0.05). Among the DPA and EE parameters assessed, DPA≥3MET and EETOT were independent predictors of IS in multivariable regression analyses, adjusted for age, sex, BMI (R2 = 16%, R2 = 19%, respectively; p < 0.01). None of model-derived components of BF was significantly associated with DPA or accompanying EE. CONCLUSIONS Our study highlighted moderate levels of DPA and total EE as potential determinants of IS, but not BF, in T2D at the time of diagnosis. Intervention studies are needed to conclusively elucidate the effect of DPA on these features. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER NCT01526720.
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Affiliation(s)
- M Dauriz
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy.
| | - E Bacchi
- Department of Medicine, University of Verona, Verona, Italy
| | - L Boselli
- Department of Medicine, University of Verona, Verona, Italy
| | - L Santi
- Department of Medicine, University of Verona, Verona, Italy
| | - C Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - M Trombetta
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - R C Bonadonna
- Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Parma School of Medicine, Parma, Italy; Azienda Ospedaliera Universitaria, Parma, Italy
| | - E Bonora
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
| | - P Moghetti
- Department of Medicine, University of Verona, Verona, Italy; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital Trust of Verona, Verona, Italy
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Bellavere F, Cacciatori V, Bacchi E, Gemma ML, Raimondo D, Negri C, Thomaseth K, Muggeo M, Bonora E, Moghetti P. Effects of aerobic or resistance exercise training on cardiovascular autonomic function of subjects with type 2 diabetes: A pilot study. Nutr Metab Cardiovasc Dis 2018; 28:226-233. [PMID: 29402509 DOI: 10.1016/j.numecd.2017.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Both aerobic (AER) and resistance (RES) training improve metabolic control in patients with type 2 diabetes (T2DM). However, information on the effects of these training modalities on cardiovascular autonomic control is limited. Our aim was to compare the effects of AER and RES training on cardiovascular autonomic function in these subjects. METHODS AND RESULTS Cardiovascular autonomic control was assessed by Power Spectral Analysis (PSA) of Heart Rate Variability (HRV) and baroreceptors function indexes in 30 subjects with T2DM, randomly assigned to aerobic or resistance training for 4 months. In particular, PSA of HRV measured the Low Frequency (LF) and High Frequency (HF) bands of RR variations, expression of prevalent sympathetic and parasympathetic drive, respectively. Furthermore, we measured the correlation occurring between systolic blood pressure and heart rate during a standardized Valsalva maneuver using two indexes, b2 and b4, considered an expression of baroreceptor sensitivity and peripheral vasoactive adaptations during predominant sympathetic and parasympathetic drive, respectively. After training, the LF/HF ratio, which summarizes the sympatho-vagal balance in HRV control, was similarly decreased in the AER and RES groups. After AER, b2 and b4 significantly improved. After RES, changes of b2 were of borderline significance, whereas changes of b4 did not reach statistical significance. However, comparison of changes in baroreceptor sensitivity indexes between groups did not show statistically significant differences. CONCLUSION Both aerobic and resistance training improve several indices of the autonomic control of the cardiovascular system in patients with T2DM. Although these improvements seem to occur to a similar extent in both training modalities, some differences cannot be ruled out. CLINICAL TRIAL REGISTRATION NUMBER NCT01182948, clinicaltrials.gov.
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Affiliation(s)
- F Bellavere
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy.
| | - V Cacciatori
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - E Bacchi
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - M L Gemma
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - D Raimondo
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - C Negri
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - K Thomaseth
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Padua, Italy
| | - M Muggeo
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - P Moghetti
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy.
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Bacchi E, Cavedon V, Zancanaro C, Moghetti P, Milanese C. Comparison between dual-energy X-ray absorptiometry and skinfold thickness in assessing body fat in overweigh/obese adult patients with type-2 diabetes. Sci Rep 2017; 7:17424. [PMID: 29234125 PMCID: PMC5727309 DOI: 10.1038/s41598-017-17788-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/30/2017] [Indexed: 01/28/2023] Open
Abstract
Percentage of body fat (%BF) is estimated in clinical practice using anthropometric equations, but little is known about their reliability in overweight/obese patients with type-2 diabetes. The aim of this study was to compare, in overweight/obese adults with type-2 diabetes, %BF estimated with several commonly used anthropometric equations and %BF measured with dual-energy X-ray absorptiometry (DXA, Hologic). The %BF was measured with DXA in 40 patients aged 40-68 years with type-2 diabetes (mean HbA1c, 7.3 ± 0.9%). Body density was estimated in the same patients by means of four anthropometric equations and converted to %BF using the Siri and Brozek equations. Paired-sample t-test and the mean signed difference procedure were used to compare anthropometric equation-derived %BF and DXA measurements. The coefficient of determination was computed. Bland-Altman analysis was used to test the agreement between methods. Among the four anthropometric equations, the Durnin-Womersley equation only showed close agreement with DXA in both female and male patients; the other equations significantly underestimated or overestimated %BF. Two new predictive equations were developed using DXA as the reference to predict total body and trunk %BF. Further comparative studies are required to confirm and refine the accuracy of practical, non-invasive methods for monitoring %BF in this population.
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Affiliation(s)
- Elisabetta Bacchi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Valentina Cavedon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Zancanaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Rinaldo N, Bacchi E, Coratella G, Vitali F, Milanese C, Rossi A, Schena F, Lanza M. Effects of Combined Aerobic-Strength Training vs Fitness Education Program in COPD Patients. Int J Sports Med 2017; 38:1001-1008. [PMID: 28982202 DOI: 10.1055/s-0043-112339] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We compared the effects of a new physical activity education program approach (EDU), based on a periodically supervised protocol of different exercise modalities vs traditionally supervised combined strength-endurance training (CT) on health-related factors in patients with stable chronic obstructive pulmonary disease (COPD). Twenty-eight COPD patients without comorbidities were randomly assigned to receive either EDU or CT. CT was continuously supervised to combine strength-endurance training; EDU was taught to progressively increase the rate of autonomous physical activity, through different training modalities such as Nordic walking, group classes and circuit training. Body composition, walking capacity, muscle strength, flexibility and balance, total daily energy expenditure and quality of life were evaluated at baseline, after 28 weeks training period (3d/week) and after a 14-week follow-up. No adverse events occurred during the interventions. After training, CT and EDU similarly improved walking capacity, body composition and quality of life. However, after 14 weeks of follow-up, such improvements were not maintained. Only in CT, muscle strength and flexibility improved after training but returned to baseline after follow-up. EDU, similar to CT, can effectively and safely improve health-related parameters in COPD patients. EDU could be an attractive alternative to traditional supervised training for improving quality of life in COPD patients.
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Affiliation(s)
- Nicoletta Rinaldo
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
| | - Elisabetta Bacchi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Italy
| | - Giuseppe Coratella
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy.,Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Francesca Vitali
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
| | - Chiara Milanese
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
| | - Andrea Rossi
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Pulmonary Unit, Verona, Italy
| | - Federico Schena
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
| | - Massimo Lanza
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Italy
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Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is a common and heterogeneous endocrine disorder, affecting 8-12% of reproductive-aged women. Insulin resistance and body fat excess are common features in these subjects. Increased physical activity and diet modifications are the first recommended approach in the management of these women, at least in overweight/obese subjects. Evaluation of cardiorespiratory fitness (CRF) is important in assessing exercise performance and in monitoring the effects of physical exercise interventions. Several studies have shown that CRF may be impaired in metabolic and endocrine disorders. However, there are little data on this issue in PCOS women. The aim of this narrative review is to critically evaluate whether aerobic capacity is altered in PCOS women, focusing on maximal oxygen uptake. METHODS An updated search of the literature was performed, identifying papers with maximal oxygen consumption measurements in women with PCOS compared to healthy controls. RESULTS We have identified six studies on this specific topic: four of them showed an alteration of maximal oxygen consumption in PCOS women, whereas two did not. However, taken together these studies suggest that CRF may be strikingly impaired in both normal-weight and overweight/obese subjects with this condition. CONCLUSIONS Women with PCOS appear to be characterized by a reduced cardiopulmonary fitness. However, further research on this topic is needed. This information may hopefully help clinicians and exercise specialist in planning individualized exercise programs aimed at improving the metabolic and endocrine outcomes in these women.
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Affiliation(s)
- S Donà
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, P.le Stefani, 1, 37126, Verona, Italy
| | - E Bacchi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, P.le Stefani, 1, 37126, Verona, Italy
| | - P Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, P.le Stefani, 1, 37126, Verona, Italy.
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Abstract
Exercise has a powerful action on metabolism, and adaptation of the body to changes induced by exercise is fundamental to be able to provide the energy required for muscle contraction and physiological functions of vital tissues. Depending on the intensity and duration of exercise, different mechanisms are called on to make energy available, and under homeostatic control, this is guaranteed by rapid and coordinated changes in the secretion of several hormones. Molecular mechanisms controlling muscle function and fiber phenotype are related to the specific mode of muscle activation. We can distinguish between two fundamental types of physical activity, endurance exercise and strength exercise, although there is a continuum between these exercise modalities. Besides the acute changes induced by a single exercise session, regular exercise may induce chronic adaptations, improving exercise capacity and affecting energy metabolism. Notably, although acute metabolic effects of exercise are mostly due to insulin-independent effects, exercise training may improve muscle insulin sensitivity and is considered a key tool in the prevention and treatment of metabolic disorders. This chapter focuses on the biochemistry of energy supply to the exercising muscle, on molecular mechanisms involved and on the physiology of energy metabolism during exercise in healthy subjects and patients with insulin resistance and/or diabetes.
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Dona’ S, Bacchi E, Coratella G, Moretta R, Flamigni S, Livornese D, Tosi F, Negri C, Kaufman JM, Schena F, Moghetti P. PCOS and Muscle Strength. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486196.32497.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bacchi E, Negri C, Di Sarra D, Tosi F, Tarperi C, Moretta R, Schena F, Bonora E, Kaufman JM, Moghetti P. Serum testosterone predicts cardiorespiratory fitness impairment in normal-weight women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2015; 83:895-901. [PMID: 26173542 DOI: 10.1111/cen.12855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 05/25/2015] [Accepted: 07/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Limited literature has shown that maximal oxygen consumption (V'O2max), that is the maximal capacity of an individual to perform aerobic work, may be lowered in overweight/obese women with polycystic ovary syndrome (PCOS). However, it remains unclear whether this impairment is associated with PCOS per se or is entirely due to body fat excess. Our objective was to assess whether cardiorespiratory fitness is altered in normal-weight PCOS women and to investigate which factors are associated with this phenomenon. SUBJECTS Fifteen normal-weight PCOS women and 15 age- and BMI-matched healthy controls. Fourteen subjects in each group completed the protocol. MEASUREMENTS V'O2max and ventilatory thresholds (maximal incremental cycle ergometer test with breath-by-breath analysis of gas exchange), insulin sensitivity (hyperinsulinaemic euglycaemic clamp) and androgenaemia (serum total and free testosterone, measured by liquid chromatography mass spectrometry and equilibrium dialysis) were accurately assessed. RESULTS Maximal V'O2 and power were strikingly impaired in normal-weight PCOS individuals, as compared with healthy controls (29·4 ± 1·5 vs 35·8 ± 1·6 ml O2/kg/min, P = 0·008; 138 ± 6 vs 170 ± 10 W, P = 0·011, respectively). Similarly, oxygen consumption and power at both the first and second ventilatory thresholds were significantly lower in PCOS subjects than in healthy women. In multiple regression analysis, V'O2max was negatively predicted by serum-free testosterone levels, but not by body fat mass and glucose disposal rate (R(2) = 0·45 P = 0·013). CONCLUSIONS Cardiorespiratory fitness is impaired in normal-weight PCOS women. Androgen excess but not insulin sensitivity is associated with this alteration.
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Affiliation(s)
- Elisabetta Bacchi
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Carlo Negri
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Daniela Di Sarra
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Flavia Tosi
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Cantor Tarperi
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Rossella Moretta
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Enzo Bonora
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Jean-Marc Kaufman
- Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Paolo Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Pellegrini B, Peyré-Tartaruga LA, Zoppirolli C, Bortolan L, Bacchi E, Figard-Fabre H, Schena F. Exploring Muscle Activation during Nordic Walking: A Comparison between Conventional and Uphill Walking. PLoS One 2015; 10:e0138906. [PMID: 26418339 PMCID: PMC4587792 DOI: 10.1371/journal.pone.0138906] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/06/2015] [Indexed: 11/18/2022] Open
Abstract
Nordic Walking (NW) owes much of its popularity to the benefits of greater energy expenditure and upper body engagement than found in conventional walking (W). Muscle activation during NW is still understudied, however. The aim of the present study was to assess differences in muscle activation and physiological responses between NW and W in level and uphill walking conditions. Nine expert Nordic Walkers (mean age 36.8±11.9 years; BMI 24.2±1.8 kg/m2) performed 5-minute treadmill trials of W and NW at 4 km/h on inclines of 0% and 15%. The electromyographic activity of seven upper body and five leg muscles and oxygen consumption (VO2) were recorded and pole force during NW was measured. VO2 during NW was 22.3% higher at 0% and only 6.9% higher at 15% than during W, while upper body muscle activation was 2- to 15-fold higher under both conditions. Lower body muscle activation was similarly increased during NW and W in the uphill condition, whereas the increase in erector spinae muscle activity was lower during NW than W. The lack of a significant increase in pole force during uphill walking may explain the lower extra energy expenditure of NW, indicating less upper body muscle activation to lift the body against gravity. NW seemed to reduce lower back muscle contraction in the uphill condition, suggesting that walking with poles may reduce effort to control trunk oscillations and could contribute to work production during NW. Although the difference in extra energy expenditure between NW and W was smaller in the uphill walking condition, the increased upper body muscle involvement during exercising with NW may confer additional benefit compared to conventional walking also on uphill terrains. Furthermore, people with low back pain may gain benefit from pole use when walking uphill.
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Affiliation(s)
- Barbara Pellegrini
- CeRiSM (Research Centre of Mountain Sport and Health), University of Verona, Rovereto, Italy
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- * E-mail:
| | | | - Chiara Zoppirolli
- CeRiSM (Research Centre of Mountain Sport and Health), University of Verona, Rovereto, Italy
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Bortolan
- CeRiSM (Research Centre of Mountain Sport and Health), University of Verona, Rovereto, Italy
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Hélène Figard-Fabre
- CeRiSM (Research Centre of Mountain Sport and Health), University of Verona, Rovereto, Italy
- Departmental Office of Sports, General Council of High Pyrenees, Tarbes, France
| | - Federico Schena
- CeRiSM (Research Centre of Mountain Sport and Health), University of Verona, Rovereto, Italy
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Spigolon G, Bacchi E, Negri C, Moghetti P, Pogliaghi S. Glycemic Response To Acute Exercise In Type Ii Diabetes. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000466153.45977.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bacchi E, Negri C, Tarperi C, Baraldo A, Faccioli N, Milanese C, Zanolin ME, Lanza M, Cevese A, Bonora E, Schena F, Moghetti P. Relationships between cardiorespiratory fitness, metabolic control, and fat distribution in type 2 diabetes subjects. Acta Diabetol 2014; 51:369-75. [PMID: 24129948 DOI: 10.1007/s00592-013-0519-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
Factors contributing to the reduced cardiorespiratory fitness typical of sedentary subjects with type 2 diabetes are still largely unknown. In this study, we assessed the relationships between cardiorespiratory fitness and abdominal and skeletal muscle fat content in 39 untrained type 2 diabetes subjects, 27 males and 12 females (mean ± SD age 56.5 ± 7.3 year, BMI 29.4 ± 4.7 kg/m(2)). Peak oxygen uptake (VO2peak) and ventilatory threshold (VO2VT) were assessed by maximal cycle ergometer exercise test, insulin sensitivity by euglycemic-hyperinsulinemic clamp, and body composition by dual-energy X-ray absorptiometry. Magnetic resonance imaging was used to evaluate visceral, total subcutaneous (SAT), superficial (SSAT) and deep sub-depots of subcutaneous abdominal adipose tissue, and sagittal abdominal diameter (SAD), as well as femoral quadriceps skeletal muscle fat content. In univariate analysis, both VO2peak and VO2VT were inversely associated with BMI, total fat mass, SAT, SSAT, and sagittal abdominal diameter. VO2peak was also inversely associated with skeletal muscle fat content. A significant direct association was observed between VO2VT and insulin sensitivity. No associations between cardiorespiratory fitness parameters and metabolic profile data were found. In multivariable regression analysis, after adjusting for age and gender, VO2peak was independently predicted by higher HDL cholesterol, and lower SAD and skeletal muscle fat content (R (2) = 0.64, p < 0.001), whereas VO2VT was predicted only by sagittal abdominal diameter (R (2) = 0.48, p = 0.025). In conclusion, in untrained type 2 diabetes subjects, peak oxygen uptake is associated with sagittal abdominal diameter, skeletal muscle fat content, and HDL cholesterol levels. Future research should target these features in prospective intervention studies.
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Affiliation(s)
- Elisabetta Bacchi
- Unit of Endocrinology and Metabolism, Department of Medicine, University of Verona, P.le Stefani 1, 37126, Verona, Italy
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Bacchi E, Negri C, Targher G, Lanza M, Schena F, Moghetti P. Reply: To PMID 23504926. Hepatology 2014; 59:352. [PMID: 24516886 DOI: 10.1002/hep.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Elisabetta Bacchi
- Unit of Endocrinology, Diabetes and Metabolism; Department of Medicine; Verona Italy
| | - Carlo Negri
- Unit of Endocrinology, Diabetes and Metabolism; Department of Medicine; Verona Italy
| | - Giovanni Targher
- Unit of Endocrinology, Diabetes and Metabolism; Department of Medicine; Verona Italy
| | - Massimo Lanza
- Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - Federico Schena
- Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - Paolo Moghetti
- Unit of Endocrinology, Diabetes and Metabolism; Department of Medicine; Verona Italy
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Bacchi E, Negri C, Targher G, Faccioli N, Lanza M, Zoppini G, Zanolin E, Schena F, Bonora E, Moghetti P. Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 Randomized Trial). Hepatology 2013; 58:1287-95. [PMID: 23504926 DOI: 10.1002/hep.26393] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/09/2013] [Indexed: 02/06/2023]
Abstract
UNLABELLED Although lifestyle interventions are considered the first-line therapy for nonalcoholic fatty liver disease (NAFLD), which is extremely common in people with type 2 diabetes, no intervention studies have compared the effects of aerobic (AER) or resistance (RES) training on hepatic fat content in type 2 diabetic subjects with NAFLD. In this randomized controlled trial, we compared the 4-month effects of either AER or RES training on insulin sensitivity (by hyperinsulinemic euglycemic clamp), body composition (by dual-energy X-ray absorptiometry), as well as hepatic fat content and visceral (VAT), superficial (SSAT), and deep (DSAT) subcutaneous abdominal adipose tissue (all quantified by an in-opposed-phase magnetic resonance imaging technique) in 31 sedentary adults with type 2 diabetes and NAFLD. After training, hepatic fat content was markedly reduced (P < 0.001), to a similar extent, in both the AER and the RES training groups (mean relative reduction from baseline [95% confidence interval] -32.8% [-58.20 to -7.52] versus -25.9% [-50.92 to -0.94], respectively). Additionally, hepatic steatosis (defined as hepatic fat content >5.56%) disappeared in about one-quarter of the patients in each intervention group (23.1% in the AER group and 23.5% in the RES group). Insulin sensitivity during euglycemic clamp was increased, whereas total body fat mass, VAT, SSAT, and hemoglobin A1c were reduced comparably in both intervention groups. CONCLUSION This is the first randomized controlled study to demonstrate that resistance training and aerobic training are equally effective in reducing hepatic fat content among type 2 diabetic patients with NAFLD.
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Affiliation(s)
- Elisabetta Bacchi
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Bacchi E, Spiazzi G, Zendrini G, Bonin C, Moghetti P. Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers. J Endocrinol Invest 2013; 36:343-6. [PMID: 23027765 DOI: 10.3275/8645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have reported that low body weight and menstrual alterations are very frequent findings in elite dancers, suggesting they could be at risk for associated medical problems. However, it is still largely unknown whether these alterations are also common in the very large number of young amateur dancers. AIM The aim of this study was to assess whether there is an increased prevalence of menstrual dysfunction also in amateur dancers. MATERIAL/SUBJECTS AND METHODS Ninety-two professional ballet dancers, 93 non-professional ballet dancers, and 293 (160 sedentary, 133 physically active) control women, ranging in age 14-23 yr, were included in the study. In these subjects, a detailed questionnaire that included questions on weight, height, age at menarche, training profile and menstrual alterations was administered. RESULTS BMI was lower in both professional and non-professional dancers than in controls. Frequency of menstrual dysfunction was 51%, 34% and 21% in professional dancers, non-professional dancers and controls, respectively (p<0.0001). Amenorrhea was reported by 23% of professional dancers, vs 1-7% in the other groups (p<0.0001). Age at menarche occurred later in professional dancers than in the other groups. Logistic regression analyses showed that menstrual dysfunction was associated with the training profile in professional dancers, and with BMI in non-professional dancers. Age at menarche was associated with menstrual dysfunction in both groups. CONCLUSIONS This study shows that low body weight and menstrual dysfunction are frequent findings also in amateur ballet dancers.
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Affiliation(s)
- E Bacchi
- University and AOUI Verona, Verona, Italy
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Abstract
Type 2 diabetes is characterized by frequent ectopic fat accumulation in several tissues and organs. In particular, a number of studies showed that these subjects frequently have hepatic fat accumulation, which may play a role in the metabolic abnormalities typical of diabetes and has been also linked to increased risk for cardiovascular disease. In the last decade, the effect of exercise on ectopic fat content of type 2 diabetic patients has raised growing interest. However, there are only a few small randomized controlled trials on this topic. Results from these intervention studies indicate that exercise training, independent of dietary modifications, may reduce hepatic fat content and serum transaminases in these patients, suggesting that exercise per se may be an effective strategy to be combined with the traditional dietary interventions. As regards the different training modalities, there is recent evidence that both aerobic and resistance exercise may equally reduce hepatic fat accumulation in type 2 diabetic subjects. However, information regarding the effect of exercise on liver histology and fat accumulation in other ectopic sites is still very limited.
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Affiliation(s)
- Elisabetta Bacchi
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Paolo Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani 1, 37126 Verona, Italy
- *Paolo Moghetti:
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Bacchi E, Negri C, Trombetta M, Zanolin ME, Lanza M, Bonora E, Moghetti P. Differences in the acute effects of aerobic and resistance exercise in subjects with type 2 diabetes: results from the RAED2 Randomized Trial. PLoS One 2012; 7:e49937. [PMID: 23227155 PMCID: PMC3515569 DOI: 10.1371/journal.pone.0049937] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 10/15/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Both aerobic (AER) and resistance (RES) training, if maintained over a period of several months, reduce HbA1c levels in type 2 diabetes subjects. However, it is still unknown whether the short-term effects of these types of exercise on blood glucose are similar. Our objective was to assess whether there may be a difference in acute blood glucose changes after a single bout of AER or RES exercise. STUDY DESIGN Twenty-five patients participating in the RAED2 Study, a RCT comparing AER and RES training in diabetic subjects, were submitted to continuous glucose monitoring during a 60-min exercise session and over the following 47 h. These measurements were performed after 10.9+0.4 weeks of training. Glucose concentration areas under the curve (AUC) during exercise, the subsequent night, and the 24-h period following exercise, as well as the corresponding periods of the non-exercise day, were assessed. Moreover, the low (LBGI) and high (HBGI) blood glucose indices, which summarize the duration and extent of hypoglycaemia or hyperglycaemia, respectively, were measured. RESULTS AER and RES training similarly reduced HbA1c. Forty-eight hour glucose AUC was similar in both groups. However, a comparison of glucose AUC during the 60-min exercise period and the corresponding period of the non-exercise day showed that glucose levels were lower during exercise in the AER but not in the RES group (time-by-group interaction p = 0.04). Similar differences were observed in the nocturnal periods (time-by-group interaction p = 0.02). Accordingly, nocturnal LBGI was higher in the exercise day than in the non-exercise day in the AER (p = 0.012) but not in the RES group (p = 0.62). CONCLUSIONS Although AER and RES training have similar long-term metabolic effects in diabetic subjects, the acute effects of single bouts of these exercise types differ, with a potential increase in late-onset hypoglycaemia risk after AER exercise. TRIAL REGISTRATION ClinicalTrials.gov NCT01182948.
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Affiliation(s)
- Elisabetta Bacchi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Carlo Negri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maddalena Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Section of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Massimo Lanza
- Section of Motor Sciences, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Bacchi E, Negri C, Zanolin ME, Milanese C, Faccioli N, Trombetta M, Zoppini G, Cevese A, Bonadonna RC, Schena F, Bonora E, Lanza M, Moghetti P. Metabolic effects of aerobic training and resistance training in type 2 diabetic subjects: a randomized controlled trial (the RAED2 study). Diabetes Care 2012; 35:676-82. [PMID: 22344613 PMCID: PMC3308269 DOI: 10.2337/dc11-1655] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess differences between the effects of aerobic and resistance training on HbA(1c) (primary outcome) and several metabolic risk factors in subjects with type 2 diabetes, and to identify predictors of exercise-induced metabolic improvement. RESEARCH DESIGN AND METHODS Type 2 diabetic patients (n = 40) were randomly assigned to aerobic training or resistance training. Before and after 4 months of intervention, metabolic phenotypes (including HbA(1c), glucose clamp-measured insulin sensitivity, and oral glucose tolerance test-assessed β-cell function), body composition by dual-energy X-ray absorptiometry, visceral (VAT) and subcutaneous (SAT) adipose tissue by magnetic resonance imaging, cardiorespiratory fitness, and muscular strength were measured. RESULTS After training, increase in peak oxygen consumption (V(O(2peak))) was greater in the aerobic group (time-by-group interaction P = 0.045), whereas increase in strength was greater in the resistance group (time-by-group interaction P < 0.0001). HbA(1c) was similarly reduced in both groups (-0.40% [95% CI -0.61 to -0.18] vs. -0.35% [-0.59 to -0.10], respectively). Total and truncal fat, VAT, and SAT were also similarly reduced in both groups, whereas insulin sensitivity and lean limb mass were similarly increased. β-Cell function showed no significant changes. In multivariate analyses, improvement in HbA(1c) after training was independently predicted by baseline HbA(1c) and by changes in V(O(2peak)) and truncal fat. CONCLUSIONS Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients. Changes after training in V(O(2peak)) and truncal fat may be primary determinants of exercise-induced metabolic improvement.
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Negri C, Bacchi E, Morgante S, Soave D, Marques A, Menghini E, Muggeo M, Bonora E, Moghetti P. Supervised walking groups to increase physical activity in type 2 diabetic patients. Diabetes Care 2010; 33:2333-5. [PMID: 20980426 PMCID: PMC2963489 DOI: 10.2337/dc10-0877] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the impact of an exercise program organized into supervised walking groups in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS Fifty-nine diabetic subjects were randomized to a control group receiving standard lifestyle recommendations or an intervention group assigned to three supervised walking sessions per week and counseling. Changes in metabolic features, weight, 6-min walk test, prescription of antidiabetic medications, and overall physical activity were assessed. RESULTS Functional capacity and overall physical activity were higher in the intervention group, whereas metabolic changes were not different between groups after 4 months. However, in subjects who attended at least 50% of scheduled walking sessions, changes in A1C and fasting glucose were greater than in control subjects. Discontinuation or reduction of antidiabetic drugs occurred in 33% of these patients versus 5% of control subjects (P<0.05). CONCLUSIONS Supervised walking may be beneficial in diabetic subjects, but metabolic improvement requires adequate compliance.
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Affiliation(s)
- Carlo Negri
- Unit of Endocrinology and Metabolism, Azienda Ospedaliera Universitaria Integrata di Verona, Department of Medicine, University of Verona, Verona, Italy
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