Ketogenic propensity is differentially related to lipid-induced hepatic and peripheral insulin resistance

AIM

Determine the ketogenic response (β-hydroxybutyrate, a surrogate of hepatic ketogenesis) to a controlled lipid overload in humans.

METHODS

In total, nineteen young, healthy adults (age: 28.4 ± 1.7 years; BMI: 22.7 ± 0.3 kg/m2 ) received either a 12 h overnight lipid infusion or saline in a randomized, crossover design. Plasma ketones and inflammatory markers were quantified by colorimetric and multiplex assays. Hepatic and peripheral insulin sensitivity was assessed by the hyperinsulinemic-euglycemic clamp. Skeletal muscle biopsies were obtained to quantify gene expression related to ketone body metabolism and inflammation.

RESULTS

By design, the lipid overload-induced hepatic (50%, p < 0.001) and peripheral insulin resistance (73%, p < 0.01) in healthy adults. Ketones increased with hyperlipidemia and were subsequently reduced with hyperinsulinemia during the clamp procedure (Saline: Basal = 0.22 mM, Insulin = 0.07 mM; Lipid: Basal = 0.78 mM, Insulin = 0.51 mM; 2-way ANOVA: Lipid p < 0.001, Insulin p < 0.001, Interaction p = 0.07). In the saline control condition, ketones did not correlate with hepatic or peripheral insulin sensitivity. Conversely, in the lipid condition, ketones were positively correlated with hepatic insulin sensitivity (r = 0.59, p < 0.01), but inversely related to peripheral insulin sensitivity (r = -0.64, p < 0.01). Hyperlipidemia increased plasma inflammatory markers, but did not impact skeletal muscle inflammatory gene expression. Gene expression related to ketone and fatty acid metabolism in skeletal muscle increased in response to hyperlipidemia.

CONCLUSION

This work provides important insight into the role of ketones in human health and suggests that ketone body metabolism is altered at the onset of lipid-induced insulin resistance.

0862 Adequate Sleep Duration Enhances Cardiovascular Benefits Of A Physical Activity Intervention In Older African Americans

Introduction

African Americans are at a greater risk for cardiovascular disease and inadequate sleep than are corresponding whites. Age-associated declines in sleep duration, cardiovascular health, and physical activity highlight the need to understand the relationship among these variables in this population. While physical activity is thought to be beneficial for promoting sleep quality, it remains unknown how habitual short sleep during a physical activity intervention influences the intervention response in this population.

Methods

Sedentary older African Americans (n=27; 65-85 years old; 74% female) participating in the intervention arm of a 12-week randomized controlled physical activity trial (NCT03474302) were categorized as short (n= 15) or adequate (n=12) sleepers, defined as sleeping &lt;6 hours/night or &gt;6 hours/night on average during the intervention. Participants wore validated activity monitors at baseline and 12 weeks, and commercially available sleep monitors were worn daily. Differences in cardiovascular outcomes at baseline and 12 weeks were assessed between sleep categories using sex-adjusted linear mixed models.

Results

The intervention increased accelerometer derived steps (p=0.04) with no between group differences (p=0.78). Moderate to vigorous activity (MVA) duration increased (p&lt;0.001), but change was greater in adequate sleepers (9 minutes; p&lt;0.05). Body weight did not significantly change (-0.71 kg; p=0.11) and changes were similar between groups (p=0.55). Total (p=0.046) and LDL cholesterol (p=0.04) decreased over time. Adequate sleepers experienced improvements in systolic blood pressure (-10 ± 4.5 mmHg; p=0.03), total cholesterol (-30 ± 11 mg/dL; p=0.01), and LDL cholesterol (-23 ± 9 mg/dL; p=0.01) from baseline while short sleepers did not (all p&gt;0.05). Significant differences or trends between adequate and poor sleepers were observed (-10.5 mmHg; p=0.096; -30 mg/dL p=0.044; -21 mg/dL; p=0.095, respectively).

Conclusion

Adequate sleep during a physical activity intervention may be important to elicit cardiovascular benefits. Thus, research evaluating sleep extension complementary to increased physical activity is warranted in short sleepers.

Support

BrightFocus (A20175472); National Institute of General Medical Sciences of the National Institutes of Health (U54-GM104940)

Rationale and study design for lifestyle intervention in preparation for pregnancy (LIPP): A randomized controlled trial

INTRODUCTION

Maternal obesity increases neonatal risk for obesity and metabolic syndrome later in life. Prior attempts to break this intergenerational obesity cycle by limiting excessive gestational weight gain have failed to reduce neonatal adiposity. Alternatively, pre-conception lifestyle interventions may improve the in utero metabolic milieu during early pregnancy leading to improved fetal outcomes. This randomized controlled trial (RCT) is evaluating whether a lifestyle intervention to reduce weight and improve maternal metabolism in preparation for pregnancy (LIPP) attenuates neonatal adiposity, compared to standard medical advice.

MATERIAL AND METHODS

Overweight/class 1 obese women after a previous pregnancy, ~12 weeks postpartum, preparing for a subsequent pregnancy, will be block randomized (1:1) to either LIPP or standard of care in a parallel design. Randomization is stratified by lactation status and overweight vs. class 1 obesity. The LIPP program consists of intensive short-term weight loss followed by weight maintenance until conception using supervised exercise and a low glycemic Mediterranean diet.

PRIMARY OUTCOMES

Group differences in neonatal adiposity at birth assessed by PEA POD and placental mitochondrial lipid metabolism.

SECONDARY OUTCOMES

Group differences in maternal pregravid and gestational body composition, insulin sensitivity, β-cell function, fasting metabolic and inflammatory biomarkers, and overall quality of life. Exploratory outcomes include umbilical cord blood insulin resistance, lipid profile and inflammation.

DISCUSSION

This RCT will determine the efficacy of maternal weight loss prior to pregnancy on reducing neonatal adiposity. Findings may change standard obstetrical care by providing Level 1 evidence on lifestyle interventions improving neonatal outcomes for women planning for pregnancy.

CLINICAL TRIAL REGISTRATION

NCT03146156.

Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

Worldwide prevalence of adult overweight and obesity is a growing public health issue. Adults with overweight/obesity often have chronic musculoskeletal pain. Using a mixed-methods review, we aimed to quantify the effectiveness and explore the appropriateness of weight loss interventions for this population. Electronic databases were searched for studies published between 01/01/90 and 01/07/16. The review included 14 randomized controlled trials that reported weight and pain outcomes and three qualitative studies that explored perceptions of adults with co-existing overweight/obesity and chronic musculoskeletal pain. The random-effects pooled mean weight loss was 4.9 kg (95%CI:2.9,6.8) greater for intervention vs control. The pooled mean reduction in pain was 7.3/100 units (95%CI:4.1,10.5) greater for intervention vs control. Study heterogeneity was substantial for weight loss (I²  = 95%, tau = ±3.5 kg) and pain change (I²  = 67%, tau = ±4.1%). Meta-regression slopes for the predictors of study quality, mean age and baseline mean weight on mean study weight reduction were shallow and not statistically significant (P > 0.05). The meta-regression slope between mean pain reduction and mean weight lost was shallow, and not statistically significant, -0.09 kg per unit pain score change (95%CI:-0.21,0.40, P = 0.54). Meta-synthesis of qualitative findings resulted in two synthesized findings; the importance of healthcare professionals understanding the effects of pain on ability to control weight and developing management/education programmes that address comorbidity.

Gastric bypass surgery is protective from high-fat diet-induced non-alcoholic fatty liver disease and hepatic endoplasmic reticulum stress

AIM

High-fat diets are known to contribute to the development of obesity and related co-morbidities including non-alcoholic fatty liver disease (NAFLD). The accumulation of hepatic lipid may increase endoplasmic reticulum (ER) stress and contribute to non-alcoholic steatohepatitis and metabolic disease. We hypothesized that bariatric surgery would counter the effects of a high-fat diet (HFD) on obesity-associated NAFLD.

METHODS

Sixteen of 24 male Sprague Dawley rats were randomized to Sham (N = 8) or Roux-en-Y gastric bypass (RYGB) surgery (N = 8) and compared to Lean controls (N = 8). Obese rats were maintained on a HFD throughout the study. Insulin resistance (HOMA-IR), and hepatic steatosis, triglyceride accumulation, ER stress and apoptosis were assessed at 90 days post-surgery.

RESULTS

Despite eating a HFD for 90 days post-surgery, the RYGB group lost weight (-20.7 ± 6%, P < 0.01) and improved insulin sensitivity (P < 0.05) compared to Sham. These results occurred with no change in food intake between groups. Hepatic steatosis and ER stress, specifically glucose-regulated protein-78 (Grp78, P < 0.001), X-box binding protein-1 (XBP-1) and spliced XBP-1 (P < 0.01), and fibroblast growth factor 21 (FGF21) gene expression, were normalized in the RYGB group compared to both Sham and Lean controls. Significant TUNEL staining in liver sections from the Obese Sham group, indicative of accelerated cell death, was absent in the RYGB and Lean control groups. Additionally, fasting plasma glucagon like peptide-1 was increased in RYGB compared to Sham (P < 0.02).

CONCLUSION

These data suggest that in obese rats, RYGB surgery protects the liver against HFD-induced fatty liver disease by attenuating ER stress and excess apoptosis.

How safe is metabolic/diabetes surgery?

Although recent studies have shown the impressive antidiabetic effects of laparoscopic Roux-en-Y gastric bypass (LRYGB), the safety profile of metabolic/diabetes surgery has been a matter of concern among patients and physicians. Data on patients with type 2 diabetes who underwent LRYGB or one of seven other procedures between January 2007 and December 2012 were retrieved from the American College of Surgeons National Surgical Quality Improvement Program database and compared. Of the 66 678 patients included, 16 509 underwent LRYGB. The composite complication rate of 3.4% after LRYGB was similar to those of laparoscopic cholecystectomy and hysterectomy. The mortality rate for LRYGB (0.3%) was similar to that of knee arthroplasty. Patients who underwent LRYGB had significantly better short-term outcomes in all examined variables than patients who underwent coronary bypass, infra-inguinal revascularization and laparoscopic colectomy. In conclusion, LRYGB can be considered a safe procedure in people with diabetes, with similar short-term morbidity to that of common procedures such as cholecystectomy and appendectomy and a mortality rate similar to that of knee arthroplasty. The mortality risk for LRYGB is one-tenth that of cardiovascular surgery and earlier intervention with metabolic surgery to treat diabetes may eliminate the need for some later higher-risk procedures to treat diabetes complications.

Exercise-induced lowering of chemerin is associated with reduced cardiometabolic risk and glucose-stimulated insulin secretion in older adults

OBJECTIVE

To determine the effect of exercise on chemerin in relation to changes in fat loss, insulin action, and dyslipidemia in older adults.

PARTICIPANTS

Thirty older (65.9±0.9yr) obese adults (BMI:34.5±0.7kg/m2).

SETTING

Single-center, Cleveland Clinic.

DESIGN

Prospective clinical trial.

INTERVENTION

Twelve-weeks of exercise training (60minutes/day, 5day/week at ~85% HRmax). Subjects were instructed to maintain habitual nutrient intake.

MEASUREMENTS

Plasma chemerin was analyzed using an enzyme-linked immunosorbent assay. Peripheral and hepatic insulin sensitivity was assessed using a euglycemic-hyperinsulinic clamp with glucose kinetics. First-phase and total glucose-stimulated insulin secretion (GSIS) was calculated from an oral glucose tolerance test. Fasting blood lipids (cholesterol, triglycerides), total/visceral fat (dual-x-ray absorptiometry and computerized tomography) and cardiorespiratory fitness (treadmill test) were also tested pre and post intervention.

RESULTS

Exercise increased fitness and reduced total/visceral fat, blood lipids, and first-phase GSIS (P<0.05). Training also increased peripheral insulin sensitivity and lowered basal/insulin-related hepatic glucose production (P<0.01). The intervention reduced chemerin (87.1±6.0 vs. 78.1±5.8ng/ml; P=0.02), and the reduction correlated with decreased visceral fat (r=0.50, P=0.009), total body fat (r=0.42, P=0.02), cholesterol (r=0.38, P=0.04), triglycerides (r=0.36, P=0.05), and first-phase and total GSIS (r=0.39, P=0.03 and r=0.43, P=0.02, respectively).

CONCLUSIONS

Lower chemerin appears to be an important hormone involved in cardiometabolic risk and GSIS reduction following exercise in older adults.

Metabolic adaptations of skeletal muscle to voluntary wheel running exercise in hypertensive heart failure rats

The Spontaneously Hypertensive Heart Failure (SHHF) rat mimics the human progression of hypertension from hypertrophy to heart failure. However, it is unknown whether SHHF animals can exercise at sufficient levels to observe beneficial biochemical adaptations in skeletal muscle. Thirty-seven female SHHF and Wistar-Furth (WF) rats were randomized to sedentary (SHHFsed and WFsed) and exercise groups (SHHFex and WFex). The exercise groups had access to running wheels from 6-22 months of age. Hindlimb muscles were obtained for metabolic measures that included mitochondrial enzyme function and expression, and glycogen utilization. The SHHFex rats ran a greater distance and duration as compared to the WFex rats (P<0.05), but the WFex rats ran at a faster speed (P<0.05). Skeletal muscle citrate synthase and beta-hydroxyacyl-CoA dehydrogenase enzyme activity was not altered in the SHHFex group, but was increased (P<0.05) in the WFex animals. Citrate synthase protein and gene expression were unchanged in SHHFex animals, but were increased in WFex rats (P<0.05). In the WFex animals muscle glycogen was significantly depleted after exercise (P<0.05), but not in the SHHFex group. We conclude that despite robust amounts of aerobic activity, voluntary wheel running exercise was not sufficiently intense to improve the oxidative capacity of skeletal muscle in adult SHHF animals, indicating an inability to compensate for declining heart function by improving peripheral oxidative adaptations in the skeletal muscle.

Management of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease in the United States. Non-alcoholic steatohepatitis (NASH), the most severe form of NAFLD, has an increased risk for progression to cirrhosis and associated comorbidities such as cardiovascular disease. Metabolic syndrome (MS) including insulin resistance and obesity is central to the development of NASH. Currently there is no definitive treatment for NASH and most of the available treatment options are targeted towards improving various parameters of MS. Treatment of NAFLD includes diet and lifestyle modification, pharmacological interventions and surgical therapies, or a combination of these interventions. This review focuses on the available current and potential future therapies for treating NASH.

Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes

CONTEXT

Hyperglycemia resolves quickly after bariatric surgery, but the underlying mechanism and the most effective type of surgery remains unclear.

OBJECTIVE

To examine glucose metabolism and beta-cell function in patients with type 2 diabetes mellitus (T2DM) after two types of bariatric intervention; Roux-en-Y gastric bypass (RYGB) and gastric restrictive (GR) surgery.

DESIGN

Prospective, nonrandomized, repeated-measures, 4-week, longitudinal clinical trial.

PATIENTS

In all, 16 T2DM patients (9 males and 7 females, 52+/-14 years, 47+/-9 kg m(-2), HbA1c 7.2+/-1.1%) undergoing either RYGB (N=9) or GR (N=7) surgery.

OUTCOME MEASURES

Glucose, insulin secretion, insulin sensitivity at baseline, and 1 and 4 weeks post-surgery, using hyperglycemic clamps and C-peptide modeling kinetics; glucose, insulin secretion and gut-peptide responses to mixed meal tolerance test (MMTT) at baseline and 4 weeks post-surgery.

RESULTS

At 1 week post-surgery, both groups experienced a similar weight loss and reduction in fasting glucose (P<0.01). However, insulin sensitivity increased only after RYGB, (P<0.05). At 4 weeks post-surgery, weight loss remained similar for both groups, but fasting glucose was normalized only after RYGB (95+/-3 mg 100 ml(-1)). Insulin sensitivity improved after RYGB (P<0.01) and did not change with GR, whereas the disposition index remained unchanged after RYGB and increased 30% after GR (P=0.10). The MMTT elicited a robust increase in insulin secretion, glucagon-like peptide-1 (GLP-1) levels and beta-cell sensitivity to glucose only after RYGB (P<0.05).

CONCLUSION

RYGB provides a more rapid improvement in glucose regulation compared with GR. This improvement is accompanied by enhanced insulin sensitivity and beta-cell responsiveness to glucose, in part because of an incretin effect.

Higher Bone Density is Associated with a Decreased Risk of Colon Adenomas in Women

Purpose: Bone mass has been proposed as a biomarker of the cumulative exposure to calcium, vitamin D and endogenous and exogenous estrogens. Postmenopausal women with higher levels of bone mass have a decreased risk of colon cancer. No prior studies, however, have examined the role between bone mass and the risk of colon adenomas, which are precursor lesions that, if not removed, may lead to colon cancer.

Methods: We evaluated the potential association between bone mass, as measured by bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), and colon adenomas in 167 patients who underwent colonoscopy screening at University Hospitals in Cleveland, Ohio.

Results: We found that women with a total body BMD exceeding 1.294 g/cm2 (third tertile) compared to those with a total body BMD less than 1.167 g/cm2 (first tertile) had a much lower risk of colon adenomas (OR = 0.10; 95% C.I.: 0.02-0.74; P = 0.02). Similarly, women with a total body BMD between 1.167 and 1.294 g/cm2 (second tertile) compared to those with a BMD less than 1.167 g/cm2 had a decreased risk for colon adenomas (OR = 0.15; 95% C.I.: 0.03-0.80; P = 0.03; p-trend = 0.01). Postmenopausal women with a total body BMD in the second and third highest tertiles combined compared to those in the first tertile also had a decreased risk of colon adenomas.

Conclusions: Our results show, for the first time, that bone mass, as measured by total body BMD, is inversely associated with colon adenomas in women, which suggests the mechanisms underlying the synergistic actions of calcium, vitamin D, estrogen exposure and other factors affecting BMD including exercise are key to preventing the development of colonic lesions, particularly among women.

Nonalcoholic fatty liver disease: biochemical and therapeutic considerations

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging chronic liver disease and is reported to affect up to 70-80% of overweight and obese individuals. NAFLD represents a spectrum of liver diseases that range from simple hepatic steatosis, to a more severe and treatment resistant stage that features steatosis plus inflammation, termed nonalcoholic steatohepatitis (NASH), which may in turn progress to hepatic fibrosis, cirrhosis, and sub-acute liver failure. Thus, NAFLD and its subsequent complications create a significant health burden, and currently there is no effective treatment strategy. The biochemical mechanisms that underlie NAFLD are unclear at this time, but there is evidence that insulin resistance is a major contributing factor. In addition, circulating concentrations of inflammatory cytokines (e.g., TNF-alpha, IL-6) as well as decreased antiinflammatory factors (e.g., adiponectin, IL-10) are not only implicated in the development of insulin resistance and type 2 diabetes, but are also related to NAFLD. Such inflammatory mechanisms are fundamental in the progression of NAFLD toward higher risk cirrhotic states. This review outlines the leading theories of pathogenesis of NAFLD and highlights the potential role of exercise in treating and preventing NAFLD. Regular exercise can reverse insulin resistance, suppress low-grade systemic inflammation, and attenuate inflammatory markers associated with NAFLD. Thus, exercise has the potential to become an effective treatment and prevention modality for NAFLD and NASH.

In vitro evidence that hyperglycemia stimulates tumor necrosis factor-alpha release in obese women with polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) are often insulin resistant and have chronic low-level inflammation. The purpose of this study was to determine the effects of hyperglycemia in vitro on tumor necrosis factor (TNF)-alpha release from mononuclear cells (MNC) in PCOS. Twelve reproductive-age women with PCOS (six lean, six obese) and 12 age-matched controls (six lean, six obese) were studied. Insulin sensitivity (IS(HOMA)) was estimated from fasting levels of glucose and insulin and percent truncal fat was determined by dual energy absorptiometry (DEXA). TNFalpha release was measured from MNC cultured under euglycemic and hyperglycemic conditions. IS(HOMA) was higher in obese women with PCOS than in lean women with PCOS (student's t-test; 73.7 +/- 14.8 vs 43.1 +/- 8.6, P < 0.05), but similar to that of obese controls. IS(HOMA) was positively correlated with percent truncal fat (r=0.57, P < 0.04). Obese women with PCOS exhibited an increase in the percent change in TNFalpha release from MNC in response to hyperglycemia compared with obese controls (10 mM, 649 +/- 208% vs 133 +/- 30%, P < 0.003; 15 mM, 799 +/- 347% vs 183 +/- 59%, P < 0.04). The TNFalpha response directly correlated with percent truncal fat (r=0.45, P < 0.03) and IS(HOMA) (r=0.40, P < 0.05) for the combined groups, and with plasma testosterone (r=0.60, P < 0.05) for women with PCOS. MNC of obese women with PCOS exhibit an increased TNFalpha response to in vitro physiologic hyperglycemia. MNC-derived TNFalpha release may contribute to insulin resistance and hyperandrogenism, particularly when the combination of PCOS and increased adiposity is present.

Insulin signalling, exercise and cellular integrity

Although the effects of exercise on insulin sensitivity are generally positive, eccentric exercise presents a paradox because it induces a transient state of insulin resistance that persists for up to 48 h after the exercise bout. Excessive eccentric contractions, such as prolonged downhill running, or marathon running, causes muscle damage and disruption of the integrity of the cell. Down-regulation of insulin receptor tyrosine phosphorylation and subsequent steps in the insulin signalling pathway, including insulin receptor substrate-1 (IRS-1)-associated phosphoinositide 3-kinase (PI3K), Akt kinase serine phosphorylation and activity and glucose transporter (GLUT-4) protein content, are evident in skeletal muscle after eccentric exercise. Furthermore, increased tumour necrosis factor alpha (TNF-alpha) secretion from monocytes is associated with the decrease in PI3K activity after this type of exercise. Recent studies have shown that TNF-alpha can increase IRS-1 serine/threonine phosphorylation, which impairs IRS-1 docking to the insulin receptor, and this inhibits insulin signalling. Thus a unifying hypothesis to explain insulin resistance after eccentric exercise may include inflammation arising from the disruption of muscle-cell integrity, leading to an acute-phase response that includes TNF-alpha, with the latter inhibiting insulin signalling and subsequent metabolic events. In contrast, exercise training increases insulin signalling and GLUT-4 expression, decreases TNF-alpha expression in skeletal muscle, and is associated with enhanced insulin sensitivity. These observations highlight the complexity of the cellular and molecular adaptations to exercise. Understanding these adaptations is essential in order to establish a sound theoretical basis for recommending exercise as a therapeutic intervention for insulin resistance and type 2 diabetes.

Human aging is associated with altered TNF-alpha production during hyperglycemia and hyperinsulinemia

Changes in tumor necrosis factor-alpha (TNF-alpha) may provide a mechanism to explain impaired glucose metabolism with advancing age. Hyperglycemic clamps (180 min, 10 mM) were performed on seven older [67 +/- 2 yr; body mass index (BMI) 24.7 +/- 1.0 kg/m(2)] and seven younger (22 +/- 1 yr; BMI 21.8 +/- 1.3 kg/m(2)) healthy sedentary males with normal glucose tolerance. TNF-alpha production at basal and at the end of 180 min of hyperglycemia and hyperinsulinemia was measured ex vivo from lipopolysaccharide-stimulated (1 ng/ml) peripheral blood mononuclear cells. Plasma glucose, insulin, and C-peptide levels were similar in both groups at basal and during the last 30 min of the hyperglycemic clamp. Glucose infusion rates were lower (P < 0.004) in the older group compared with the young, indicating decreased insulin action among the older subjects. Basal TNF-alpha secretion was similar in older and younger subjects. TNF-alpha was suppressed (P < 0.02) in the younger group (230 +/- 46 vs. 126 +/- 49 pg/ml; basal vs. clamp) but not in the older group (153 +/- 37 vs. 182 +/- 42 pg/ml), with significant group differences in response (P < 0.05). A significant correlation was observed between the level of suppression in TNF-alpha production and insulin action (Kendall's rank, tau = 0.40, P < 0.05). Furthermore, the TNF-alpha response during the clamp was related to fat mass (r = 0.88, P < 0.001) and abdominal fat (r = 0.81, P < 0.003). In conclusion, these findings suggest a possible mechanism by which TNF-alpha may modulate glucose metabolism in younger people. Aging and modest increases in adiposity prevent the "normal" suppression of TNF-alpha production after a sustained postprandial-like hyperglycemic-hyperinsulinemic stimulus, which may contribute in part to the decline in insulin sensitivity in older men.

Physiological and metabolic characteristics of elite tug of war athletes

OBJECTIVE

To determine the aerobic power (VO(2)MAX), body composition, strength, muscular power, flexibility, and biochemical profile of an elite international squad of tug of war athletes.

METHODS

Sixteen male competitors (mean (SEM) age 34 (2) years) were evaluated in a laboratory. For comparative purposes, data were analysed relative to normative data for our centre and to a group of 20 rugby forwards from the Irish international squad.

RESULTS

The tug of war participants were lighter (83.6 (3.0) v 104.4 (1.8) kg, p<0.0001) and had less lean body mass (69.4 (2.1) v 86.2 (1.2) kg) than the rugby players and had lower than normal body fat (16.7 (0.9)%); all values are mean (SEM). Aerobic power measured during a treadmill test was 55.8 (1.6) ml/kg/min for the tug of war participants compared with 51.1 (1.4) ml/kg/min for the rugby forwards (p<0.03). A composite measure of strength derived from (sum of dominant and non-dominant grip strength and back strength)/lean body mass yielded a strength/mass ratio that was 32% greater (p<0.0001) for the tug of war group than the rugby group. Dynamic leg power was lower for the tug of war group than the rugby forwards (4659.8 (151.6) v 6198.2 (105) W respectively; p<0.0001). Leg flexibility was 25.4 (2.0) cm for the tug of war group. Back flexibility was 28.6 (1.4) cm which was lower (p<0.02) than the rugby forwards 34.2 (1.5) cm. Whereas blood chemistry and haematology were normal, packed cell volume, haemoglobin concentration, and erythrocyte volume were lower in the tug of war group than in the rugby players (p<0.05). All three haematological measures correlated with muscle mass (packed cell volume, r(2) = 0.37, p<0.0001; haemoglobin concentration, r(2) = 0.13, p<0.05; erythrocyte volume, r(2) = 0.21, p<0.01).

CONCLUSIONS

The data indicate that international level tug of war participants have excellent strength and above average endurance relative to body size, but have relatively low explosive leg power and back flexibility. The data provide reference standards for the sport and may be useful for monitoring and evaluating current and future participants.

Euglycemic clamp study in clozapine-induced diabetic ketoacidosis

OBJECTIVE

To describe the fifth case of clozapine-induced diabetic ketoacidosis (DKA) with complete resolution of abnormal glucose metabolism after discontinuation of clozapine as assessed by oral glucose tolerance testing (OGTT) and the first to be serially studied with markers of pancreatic autoimmunity; to demonstrate insulin resistance using the euglycemic clamp study and reduced pancreatic insulin reserve using intravenous glucose tolerance testing (IVGTT) in clozapine-induced diabetes mellitus and DKA, when the OGTT was normal; and to systematically review the previously described cases of clozapine-induced diabetes mellitus and DKA.

CASE SUMMARY

A 33-year-old white man without past or family history of diabetes mellitus presented with DKA after eight months of clozapine therapy (50 mg twice daily). After treatment of DKA and discontinuation of clozapine, glucose tolerance and concurrent serum insulin concentrations reverted to normal as measured by two OGTT performed 60 and 320 days after resolution of DKA.

DISCUSSION

Antiislet-cell antibodies, antiglutamic acid decarboxylase antibodies, and human insulin antibody were negative on two separate occasions. Euglycemic clamp study demonstrated insulin resistance manifested by a glucose disposal rate of approximately 55% of mean normal values. IVGTT demonstrated a low rate of glucose disappearance (KG = 0.95) and diminished first-phase insulin response when OGTT was normal, indicating impairment in insulin sensitivity and reduction in beta cell function 323 days after discontinuance of clozapine. This adverse reaction is considered probable according to the Naranjo probability scale.

CONCLUSIONS

The occurrence of cases of DKA and new or worsening diabetes mellitus in patients using clozapine suggests a causal relationship. We hypothesize that the mechanism by which clozapine may produce glucose intolerance may require a preexisting latent defect in insulin secretion and insulin action. With the administration of clozapine, some of these patients may develop worsening insulin resistance and may fail to mount an appropriate compensatory beta cell insulin secretion for the degree of insulin resistance. As a consequence, hyperglycemia develops and its persistence results in glucose toxicity, further suppressing beta cell insulin secretion. Such combined defects in insulin secretion and sensitivity are known to be synergistic, leading to the development of abnormal glucose tolerance, which can be clinically manifested as a spectrum ranging from impaired glucose tolerance through severe hyperglycemia to DKA. Patients being started on clozapine should be carefully followed for the development or worsening of diabetes mellitus, regardless of the dose of the drug.

Effects of a moderate glycemic meal on exercise duration and substrate utilization

PURPOSE

To determine whether eating a breakfast cereal with a moderate glycemic index could alter substrate utilization and improve exercise duration.

METHODS

Six active women (age, 24 +/- 2 yr; weight, 62.2 +/- 2.6 kg; VO(2peak), 46.6 +/- 3.8 mL x kg(-1) x min(-1)) ate 75 g of available carbohydrate in the form of regular whole grain rolled oats (RO) mixed with 300 mL of water or water alone (CON). The trials were performed in random order and the meal or water was ingested 45 min before performing cycling exercise to exhaustion (60% of VO(2peak)). Blood samples were drawn for glucose, glucose kinetics, free fatty acids (FFA), glycerol, insulin, epinephrine (EPI), and norepinephrine (NE) determination. A muscle biopsy was obtained from the vastus lateralis muscle before the trial and immediately after exercise for glycogen determination. Glucose kinetics (Ra) were determined using a [6,6-(2)H] glucose tracer.

RESULTS

Compared with CON, plasma FFA and glycerol levels were suppressed (P < 0.05) during the first 120 min of exercise for the RO trial. Respiratory exchange ratios (RER) were also higher (P < 0.05) for the first 120 min of exercise for the RO trial. At exhaustion, glucose, insulin, FFA, glycerol, EPI, NE, RER, and muscle glycogen were not different between trials. Glucose Ra was greater (P < 0.05) during the RO trial compared with CON (2.36 +/- 0.22 and 1.92 +/- 0.27 mg x kg(-1) x min(-1), respectively). Exercise duration was 5% longer during RO, but the mean times were not significantly different (253.6 +/- 6 and 242.0 +/- 15 min, respectively).

CONCLUSIONS

Increased hepatic glucose output before fatigue provides some evidence of glucose sparing after the breakfast cereal trial. However, exercise duration was not significantly altered, possibly because of the sustained suppression of lipid metabolism and increased carbohydrate utilization throughout much of the exercise period.

Clinically useful estimates of insulin sensitivity during pregnancy: validation studies in women with normal glucose tolerance and gestational diabetes mellitus

OBJECTIVE

We examined whether selected indexes of insulin sensitivity derived from an oral glucose tolerance test (IS(OGTT)) or fasting glucose/insulin levels (IS(QUICKI) and IS(HOMA)) can be used to predict insulin sensitivity in women before and during pregnancy.

RESEARCH DESIGN AND METHODS

A 2-h euglycemic-hyperinsulinemic clamp (5 mmol/l glucose, 40 mU. m(-2). min(-1) insulin) and a 120-min oral glucose tolerance test (75 g load pregravid, 100 g pregnant) were repeated on 15 women (10 with normal glucose tolerance [NGT] and 5 with gestational diabetes mellitus [GDM]) pregravid and during both early (12-14 weeks) and late (34-36 weeks) pregnancy. An index of insulin sensitivity derived from the clamp (IS(CLAMP)) was obtained from glucose infusion rates adjusted for change in fat-free mass and endogenous glucose production measured using [6,6(-2)H(2)]glucose.

RESULTS

Univariate analysis using combined groups and periods of pregnancy resulted in significant correlations between IS(CLAMP) and IS(OGTT) (r(2) = 0.74, P < 0.0001), IS(QUICKI) (r(2) = 0.64, P < 0.0001), and IS(HOMA) (r(2) = 0.53, P < 0.0001). The IS(OGTT) provided a significantly better correlation (P < 0.0001) than either IS(QUICKI) or IS(HOMA.) Multivariate analysis showed a significant group effect (P < 0.0003) on the prediction model, and separate equations were developed for the NGT (r(2) = 0.64, P < 0.0001) and GDM (r(2) = 0.85, P < 0.0001) groups. When subdivided by period of pregnancy, the correlation between IS(CLAMP) and IS(OGTT) pregravid was r(2) = 0.63 (P = 0.0002), during early pregnancy was r(2) = 0.80 (P < 0.0001), and during late pregnancy was r(2) = 0.64 (P = 0.0002).

CONCLUSIONS

Estimates of insulin sensitivity from the IS(OGTT) during pregnancy were significantly better than from fasting glucose and insulin values. However, separate prediction equations are necessary for pregnant women with NGT and women with GDM.

Maternal factors that determine neonatal size and body fat

These data are a review of previously published data. Initially, body composition was estimated in 186 neonates. Fat- free mass (FFM), which constituted 86% of birth weight, accounted for 83% of the variance in birth weight; fat mass (FM), which constituted 14% of birth weight, accounted for 46% of the variance in birth weight. Male neonates were an average of 175 g heavier than females. FFM was greater among males compared with females (P = 0.0001). Using stepwise logistic regression, 29% of the variance in birth weight, 30% in FFM, and 17% in FM was accounted for. Independent variables included maternal height, pregravid weight, weight gain during pregnancy, education, parity, paternal height and weight, neonatal sex, and gestational age. Including maternal insulin sensitivity explained 48% of the variance in birth weight, 53% in FFM, and 46% in FM. There was a positive correlation between weight gain and birth weight in control subjects but a negative correlation in subjects with gestational diabetes mellitus. Lastly, the roles of insulin, insulin-like growth factors, and leptin were examined in relation to fetoplacental growth and body composition. The assessment of fetal/neonatal body composition may improve the understanding of the effect of differential factors on fetal growth. Factors associated with accretion of fetal adipose tissue in late gestation are less well understood compared with birth weight and FFM. Additional studies of maternal glucose and lipid metabolism are needed to better evaluate fetal growth.

Effects of moderate and high glycemic index meals on metabolism and exercise performance

The purpose of this study was to determine whether pre-exercise ingestion of meals with moderate and high glycemic indexes (GI) affects glucose availability during exercise and exercise performance time. Six male volunteers (22 +/- 1 years; 80.4 +/- 3.7 kg; VO(2peak), 54.3 +/- 1.2 ml. kg(-1). min(-1)) ingested 75 g of carbohydrate in the form of 2 different breakfast cereals, rolled oats (moderate GI, approximately 61; MOD-GI) or puffed rice (high GI, approximately 82; HI-GI), combined with 300 mL of water; or water alone (control). The trials were randomized, and the meals were ingested 45 minutes before the subjects performed cycling exercise (60% VO(2peak)) to exhaustion. Venous blood samples were drawn to measure glucose, free fatty acids (FFAs), glycerol, insulin (INS), epinephrine (EPI) and norepinephrine (NE) concentrations. A muscle biopsy specimen was obtained from the vastus lateralis before the meal and immediately after exercise for glycogen determination. Before exercise, both test meals elicited significant (P <.05) hyperglycemia and hyperinsulinemia compared with control. The glycemic response was higher (P <.05) at the start of exercise after the HI-GI meal than after the control. During exercise, plasma glucose levels were higher (P <.05) at 60 (5.2 +/- 0.1, 4.2 +/- 0.2, and 4.6 +/- 0.1 mmol. L(-1)) and 90 (4.8 +/- 0.1, 4.1 +/- 0.1, and 4.3 +/- 0.1 mmol. L(-1)) minutes after the MOD-GI meal than after either the HI-GI or control. Total carbohydrate oxidation was greater (P <.05) during the MOD-GI trial than in control and was directly correlated with exercise performance time (r =.95, P <.0001). Pre-exercise plasma FFA levels were suppressed (P <.05) 30 and 45 minutes after ingestion of the HI-GI meal and 45 minutes after the MOD-GI meal compared with control. At 30, 60, and 120 minutes of exercise, FFAs remained suppressed (P <.05) for both test meals compared with control. At exhaustion, plasma glucose, INS, FFA, glycerol, EPI, and NE levels and muscle glycogen use were not different for all trials. Exercise time was prolonged (P <.05) after the MOD-GI meal compared with control, but the HI-GI trial was not different from control (MOD-GI, 165 +/- 11; HI-GI, 141 +/- 8; control, 134 +/- 13 minutes). Thus, in contrast to the HI-GI meal or control, the MOD-GI breakfast cereal ingested 45 minutes before exercise enhanced performance time, maintained euglycemia for a longer period during exercise, and resulted in greater total carbohydrate oxidation during the exercise bout. We conclude that a MOD-GI meal provides a significant performance and metabolic advantage when consumed 45 minutes before exercise.

Insulin and exercise differentially regulate PI3-kinase and glycogen synthase in human skeletal muscle

The purpose of this study was to determine the separate and combined effects of exercise and insulin on the activation of phosphatidylinositol 3-kinase (PI3-kinase) and glycogen synthase in human skeletal muscle in vivo. Seven healthy men performed three trials in random order. The trials included 1) ingestion of 2 g/kg body wt carbohydrate in a 10% solution (CHO); 2) 75 min of semirecumbent cycling exercise at 75% of peak O(2) consumption; followed by 5 x 1-min maximal sprints (Ex); and 3) Ex, immediately followed by ingestion of the carbohydrate solution (ExCHO). Plasma glucose and insulin were increased (P < 0.05) at 15 and 30 (Post-15 and Post-30) min after the trial during CHO and ExCHO, although insulin was lower for ExCHO. Hyperinsulinemia during recovery in CHO and ExCHO led to an increase (P < 0.001) in PI3-kinase activity at Post-30 compared with basal, although the increase was lower (P < 0. 004) for ExCHO. Furthermore, PI3-kinase activity was suppressed (P < 0.02) immediately after exercise (Post-0) during Ex and ExCHO. Area under the insulin response curve for all trials was positively associated with PI3-kinase activity (r = 0.66, P < 0.001). Glycogen synthase activity did not increase during CHO but was increased (P < 0.05) at Post-0 and Post-30 during Ex and ExCHO. Ingestion of the drink increased (P < 0.05) carbohydrate oxidation during CHO and ExCHO, although the increase after ExCHO was lower (P < 0.05) than CHO. Carbohydrate oxidation was directly correlated with PI3-kinase activity for all trials (r = 0.63, P < 0.001). In conclusion, under resting conditions, ingestion of a carbohydrate solution led to activation of the PI3-kinase pathway and oxidation of the carbohydrate. However, when carbohydrate was ingested after intense exercise, the PI3-kinase response was attenuated and glycogen synthase activity was augmented, thus facilitating nonoxidative metabolism or storage of the carbohydrate. Activation of glycogen synthase was independent of PI3-kinase.

Muscle damage impairs insulin stimulation of IRS-1, PI 3-kinase, and Akt-kinase in human skeletal muscle

Physiological stress associated with muscle damage results in systemic insulin resistance. However, the mechanisms responsible for the insulin resistance are not known; therefore, the present study was conducted to elucidate the molecular mechanisms associated with insulin resistance after muscle damage. Muscle biopsies were obtained before (base) and at 1 h during a hyperinsulinemic-euglycemic clamp (40 mU x kg(-1) x min(-1)) in eight young (age 24+/-1 yr) healthy sedentary (maximal O(2) consumption, 49.7+/-2.4 ml x kg(-1) x min(-1)) males before and 24 h after eccentric exercise (ECC)-induced muscle damage. To determine the role of cytokines in ECC-induced insulin resistance, venous blood samples were obtained before (control) and 24 h after ECC to evaluate ex vivo endotoxin-induced mononuclear cell secretion of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-1beta. Glucose disposal was 19% lower after ECC (P<0.05). Insulin-stimulated insulin receptor substrate (IRS)-1 tyrosine phosphorylation was 45% lower after ECC (P<0.05). Insulin-stimulated phosphatidylinositol (PI) 3-kinase, Akt (protein kinase B) serine phosphorylation, and Akt activity were reduced 34, 65, and 20%, respectively, after ECC (P < 0.05). TNF-alpha, but not IL-6 or IL-1beta production, increased 2.4-fold 24 h after ECC (P<0.05). TNF-alpha production was positively correlated with reduced insulin action on PI 3-kinase (r = 0.77, P = 0.04). In summary, the physiological stress associated with muscle damage impairs insulin stimulation of IRS-1, PI 3-kinase, and Akt-kinase, presumably leading to decreased insulin-mediated glucose uptake. Although more research is needed on the potential role for TNF-alpha inhibition of insulin action, elevated TNF-alpha production after muscle damage may impair insulin signal transduction.

Regular exercise enhances insulin activation of IRS-1-associated PI3-kinase in human skeletal muscle

Insulin action in skeletal muscle is enhanced by regular exercise. Whether insulin signaling in human skeletal muscle is affected by habitual exercise is not well understood. Phosphatidylinositol 3-kinase (PI3-kinase) activation is an important step in the insulin-signaling pathway and appears to regulate glucose metabolism via GLUT-4 translocation in skeletal muscle. To examine the effects of regular exercise on PI3-kinase activation, 2-h hyperinsulinemic (40 mU. m(-2). min(-1))-euglycemic (5.0 mM) clamps were performed on eight healthy exercise-trained [24 +/- 1 yr, 71.8 +/- 2.0 kg, maximal O(2) uptake (VO(2 max)) of 56.1 +/- 2.5 ml. kg(-1). min(-1)] and eight healthy sedentary men and women (24 +/- 1 yr, 64.7 +/- 4.4 kg, VO(2 max) of 44.4 +/- 2.7 ml. kg(-1). min(-1)). A [6, 6-(2)H]glucose tracer was used to measure hepatic glucose output. A muscle biopsy was obtained from the vastus lateralis muscle at basal and at 2 h of hyperinsulinemia to measure insulin receptor substrate-1(IRS-1)-associated PI3-kinase activation. Insulin concentrations during hyperinsulinemia were similar for both groups (293 +/- 22 and 311 +/- 22 pM for trained and sedentary, respectively). Insulin-mediated glucose disposal rates (GDR) were greater (P < 0.05) in the exercise-trained compared with the sedentary control group (9.22 +/- 0.95 vs. 6.36 +/- 0.57 mg. kg fat-free mass(-1). min(-1)). Insulin-stimulated PI3-kinase activation was also greater (P < 0.004) in the trained compared with the sedentary group (3.8 +/- 0.5- vs. 1.8 +/- 0.2-fold increase from basal). Endurance capacity (VO(2 max)) was positively correlated with PI3-kinase activation (r = 0.53, P < 0.04). There was no correlation between PI3-kinase and muscle morphology. However, increases in GDR were positively related to PI3-kinase activation (r = 0.60, P < 0.02). We conclude that regular exercise leads to greater insulin-stimulated IRS-1-associated PI3-kinase activation in human skeletal muscle, thus facilitating enhanced insulin-mediated glucose uptake.

TNF-alpha impairs insulin signaling and insulin stimulation of glucose uptake in C2C12 muscle cells

Physiological stressors such as sepsis and tissue damage initiate an acute immune response and cause transient systemic insulin resistance. This study was conducted to determine whether tumor necrosis factor-alpha (TNF-alpha), a cytokine produced by immune cells during skeletal muscle damage, decreases insulin responsiveness at the cellular level. To examine the molecular mechanisms associated with TNF-alpha and insulin action, we measured insulin receptor substrate (IRS)-1- and IRS-2-mediated phosphatidylinositol 3-kinase (PI 3-kinase) activation, IRS-1-PI 3-kinase binding, IRS-1 tyrosine phosphorylation, and the phosphorylation of two mitogen-activated protein kinases (MAPK, known as p42(MAPK) and p44(MAPK)) in cultured C2C12 myotubes. Furthermore, we determined the effects of TNF-alpha on insulin-stimulated 2-deoxyglucose (2-DG) uptake. We observed that TNF-alpha impaired insulin stimulation of IRS-1- and IRS-2-mediated PI 3-kinase activation by 54 and 55% (P < 0.05), respectively. In addition, TNF-alpha decreased insulin-stimulated IRS-1 tyrosine phosphorylation by 40% (P < 0.05). Furthermore, TNF-alpha repressed insulin-induced p42(MAPK) and p44(MAPK) tyrosine phosphorylation by 81% (P < 0.01). TNF-alpha impairment of insulin signaling activation was accompanied by a decrease (P < 0.05) in 2-DG uptake in the muscle cells (60 +/- 4 vs. 44 +/- 6 pmol. min-1. mg-1). These data suggest that increases in TNF-alpha may cause insulin resistance in skeletal muscle by inhibiting IRS-1- and IRS-2-mediated PI 3-kinase activation as well as p42(MAPK) and p44(MAPK) tyrosine phosphorylation, leading to impaired insulin-stimulated glucose uptake.

Age-related differences in the pancreatic beta-cell response to hyperglycemia after eccentric exercise

Eccentric exercise (ECC) causes muscle damage, insulin resistance, and increased pancreatic beta-cell secretion in young individuals. However, the effects of age on the pancreatic beta-cell response to glucose after ECC are unknown. Hyperglycemic clamps (180 min, 10.0 mM) were performed on eight young (age 22 +/- 1 yr) and eight older (age 66 +/- 2 yr) healthy sedentary males without exercise (CONT) and 48 h after ECC. ECC increased (P < 0.02) muscle soreness ratings and plasma creatine kinase concentrations in both groups. Insulin and C-peptide secretions were similar between young and older subjects during CONT clamps. ECC increased (P < 0.05) first-phase (0-10 min) C-peptide area under the curve in young (4.2 +/- 0.4 vs. 3.7 +/- 0.6 nM . min; ECC vs. CONT, respectively) but not in older subjects (3.2 +/- 0.7 vs. 3.5 +/- 0.7 nM . min; ECC vs. CONT), with significant group differences (P < 0.02). Indeed, ECC repressed (P < 0.05) first-phase peak C-peptide concentrations in older subjects (0. 93 +/- 0.16 vs. 1.12 +/- 0.11 nM; ECC vs. CONT). Moreover, first-phase C-peptide-to-insulin molar ratios suggest age-related differences (P < 0.05) in insulin/C-peptide clearance after ECC. Furthermore, the observed C-peptide response after ECC was related to abdominal adiposity [r = -0.62, P < 0.02, and r = -0.66, P < 0. 006, for first and second (10-180 min) phases, respectively]. In conclusion, older individuals did not exhibit the compensatory increase in beta-cell secretion observed among young individuals after ECC. Thus, with increasing age, the pancreatic beta-cell may be less responsive to the physiological stress associated with ECC.

A moderate glycemic meal before endurance exercise can enhance performance

The purpose of this study was to determine whether presweetened breakfast cereals with various fiber contents and a moderate glycemic index optimize glucose availability and improve endurance exercise performance. Six recreationally active women ate 75 g of available carbohydrate in the form of breakfast cereals: sweetened whole-grain rolled oats (SRO, 7 g of dietary fiber) or sweetened whole-oat flour (SOF, 3 g of dietary fiber) and 300 ml of water or water alone (Con). The meals were provided 45 min before semirecumbent cycle ergometer exercise to exhaustion at 60% of peak O2 consumption (VO2peak). Diet and physical activity were controlled by having the subjects reside in the General Clinical Research Center for 2 days before each trial. Blood samples were drawn from an antecubital vein for glucose, free fatty acid (FFA), glycerol, insulin, epinephrine, and norepinephrine determination. Breath samples were obtained at 15-min intervals after meal ingestion and at 30-min intervals during exercise. Muscle glycogen concentration was determined from biopsies taken from the vastus lateralis muscle before the meal and immediately after exercise. Plasma FFA concentrations were lower (P < 0.05) during the SRO and SOF trials for the first 60 and 90 min of exercise, respectively, than during the Con trial. Respiratory exchange ratios were higher (P < 0.05) at 90 and 120 min of exercise for the SRO and SOF trials, respectively, than for the Con trial. At exhaustion, glucose, insulin, FFA, glycerol, epinephrine, and norepinephrine concentrations, respiratory exchange ratio, and muscle glycogen use in the vastus lateralis muscle were similar for all trials. Exercise time to exhaustion was 16% longer (P < 0.05) during the SRO than during the Con trial: 266.5 +/- 13 and 225.1 +/- 8 min, respectively. There was no difference in exercise time for the SOF (250.8 +/- 12) and Con trials. We conclude that eating a meal with a high dietary fiber content and moderate glycemic index 45 min before prolonged moderately intense exercise significantly enhances exercise capacity.

A single bout of concentric resistance exercise increases basal metabolic rate 48 hours after exercise in healthy 59-77-year-old men

BACKGROUND

It has been shown that basal metabolic rate (BMR) decreases with age. The extent to which some of the decrease can be reversed by exercise in older men and women is unclear. Resistance exercise has been shown to significantly increase muscle mass in older individuals, and because muscle is a highly active metabolic tissue there is potential to increase BMR as a secondary outcome to the training adaptation.

METHODS

Twelve healthy men aged 59-77 years performed single-leg knee extension exercise (right and left leg) and bench press lifts (16 sets, 10 reps/set with timed recovery between sets) at 75% of the individual's 3RM. Subjects only performed the concentric phase of the lift. BMR was measured on two separate occasions, once after a nonexercise control period and again 48 hrs after a bout of resistance exercise.

RESULTS

BMR was significantly increased (p < .006) 48 hrs after exercise (EX) compared to control (CON) (284.0 +/- 34.0 vs 274.9 +/- 34.0 kJ/hr, respectively). Calculated over a 24-hour period, the energy expenditure corresponded to 1570 +/- 193 and 1627 +/- 193 kcal/24 hr (p < .0002) for the CON and EX measures, respectively. VO2 (L/min) was higher (p < .0002) 48 hrs after the EX bout compared to 48 hrs post-CON (0.232 +/- 0.03 vs 0.225 +/- 0.03 L/min, respectively).

CONCLUSION

We conclude that in healthy 59-77-year-old men, an acute bout of resistance exercise causes a sustained increase in BMR that persists for up to 48 hours after exercise.

Relationship between glucose tolerance and glucose-stimulated insulin response in 65-year-olds

BACKGROUND

Decreased insulin secretion may contribute to the deterioration of glucose tolerance associated with aging.

METHODS

We studied the insulin response to a 3-hour hyperglycemic clamp (10 mM) of 19 young (24 +/- 1 y) subjects with normal glucose tolerance and 60 older (65 +/- 1 y) subjects with various levels of glucose tolerance.

RESULTS

The noninsulin dependent diabetic (NIDDM) group had a diminished first phase immunoreactive (IR)-insulin response compared to young and nondiabetic older groups (p < .05). The older groups had a lower rate of change in IR insulin concentration during the third hour of hyperglycemia compared to the young group (p < .05). This was not, however, a universal finding, because a decreased third hour response was not seen in a subgroup of older subjects whose glucose tolerance was similar to that of the young group. Another subgroup of older subjects with a decrease in glucose tolerance mild enough to be considered normal by the National Diabetes Group Criteria tended to have both an increase in the early insulin response and a decrease in the third hour response. More severe decreases in glucose tolerance were associated with blunting of the early response.

CONCLUSION

Aberrations in early and late phase glucose-stimulated insulin responses appear to be present in older subjects with even mildly decreased glucose tolerance. Some individuals, however, show no evidence of deterioration of glucose tolerance or insulin response to glucose with aging, at least up to age 70 years.

Endurance exercise training reduces glucose-stimulated insulin levels in 60- to 70-year-old men and women

BACKGROUND

Aging is frequently associated with development of insulin resistance and deterioration of glucose tolerance. Plasma glucose and insulin concentrations tend to be higher than in young people, even in those older individuals whose glucose tolerance is within the normal range. A sedentary life style could play a role in the development of insulin resistance and hyperinsulinemia with advancing age.

METHODS

We evaluated the effect of 9 mo of vigorous endurance exercise training (approximately 80% of maximal heart rate) on the glucose-stimulated insulin response and glucose disposal rate, using the hyperglycemic clamp procedure, in 12 people aged 65 +/- 1 yr (mean +/- SE) with normal glucose tolerance. The post-training hyperglycemic clamps were performed approximately 16 h after a usual exercise session.

RESULTS

VO2max increased approximately 23% in response to the exercise program. The plasma insulin concentration (I) during hyperglycemia (180 mg.dL-1) was significantly lower (mean 36 +/- 6 microU.mL-1 before vs 26 +/- 5 microU.mL-1 after; p < .05) after the exercise program. Insulin action was improved by the exercise, as the glucose disposal rate (M) during hyperglycemia was unchanged despite the blunted insulin response, resulting in an increase in the M/I ratio from 24 +/- 5 to 30 +/- 5 (p < .05), a value similar to the M/I ratio of 33 +/- 4 found in normally active young subjects.

CONCLUSION

These results provide evidence that regular exercise is effective in reducing hyperinsulinemia and improving insulin action in 65-yr-olds to levels typical of young people.

Insulin resistance in aging is related to abdominal obesity

Studies have shown that insulin resistance increases with age, independent of changes in total adiposity. However, there is growing evidence that the development of insulin resistance may be more closely related to abdominal adiposity. To evaluate the independent effects of aging and regional and total adiposity on insulin resistance, we performed hyperinsulinemic euglycemic clamps on 17 young (21-33 yr) and 67 older (60-72 yr) men and women. We assessed FFM and total and regional adiposity by hydrodensitometry and anthropometry. Insulin-stimulated GDRs at a plasma insulin concentration of approximately 450 pM averaged 45.6 +/- 3.3 mumol.kg FFM-1 x min-1 (mean +/- SE) in the young subjects, 45.6 +/- 10.0 mumol.kg FFM-1 x min-1 in 24 older subjects who were insulin sensitive, and 23.9 +/- 11.7 mumol.kg FFM-1 x min-1 in 43 older subjects who were insulin resistant. Few significant differences were apparent in skin-fold and circumference measurements between young and insulin-sensitive older subjects, but measurements at most central body sites were significantly larger in the insulin-resistant older subjects. Waist girth accounted for > 40% of the variance in insulin action, whereas age explained only 10-20% of the total variance and < 2% of the variance when the effects of waist circumference were statistically controlled. These results suggest that insulin resistance is more closely associated with abdominal adiposity than with age.

Plasma glucose kinetics during exercise in subjects with high and low lactate thresholds

The purpose of this study was to test the hypothesis that the rate of plasma glucose oxidation during exercise is inversely related to muscle respiratory capacity. To this end, 14 subjects were studied: in 7 of these subjects, the blood lactate threshold (LT) occurred at a relatively high intensity [i.e., at 65 +/- 2% of peak cycle ergometer oxygen uptake (VO2 peak)], whereas in the other 7 subjects, LT occurred at a relatively low intensity (i.e., at 45 +/- 2% of VO2 peak). VO2peak did not differ between the two groups, but citrate synthase activity in the vastus lateralis muscle was 53% higher (P < 0.05) in the high LT group. A primed continuous infusion of [U-13C]glucose was used to quantify rates of glucose appearance (Ra), disappearance (Rd), and oxidation (R(ox)) during 90 min of exercise at 55% VO2peak. Although both absolute and relative rates of oxygen uptake during exercise were similar in the two groups, mean Ra and Rd were 17% lower (P < 0.001) in the high LT group, and mean R(ox) was 25% lower (21.0 +/- 2.6 vs. 27.9 +/- 2.6 mumol.min-1.kg-1; P < 0.001). The percentage of total energy derived from glucose oxidation was inversely related to muscle citrate synthase activity (r = -0.85; P < 0.01). These data support the concept that skeletal muscle respiratory capacity has a major role in determining the metabolic response to submaximal exercise.

Eccentric exercise induces transient insulin resistance in healthy individuals

Euglycemic-hyperinsulinemic clamps were performed on six healthy untrained individuals to determine whether exercise that induces muscle damage also results in insulin resistance. Clamps were performed 48 h after bouts of predominantly 1) eccentric exercise [30 min, downhill running, -17% grade, 60 +/- 2% maximal O2 consumption (VO2max)], 2) concentric exercise (30 min, cycle ergometry, 60 +/- 2% VO2max), or 3) without prior exercise. During the clamps, euglycemia was maintained at 90 mg/dl while insulin was infused at 30 mU.m-2.min-1 for 120 min. Hepatic glucose output (HGO) was determined using [6,6-2H]glucose. Eccentric exercise caused marked muscle soreness and significantly elevated creatine kinase levels (273 +/- 73, 92 +/- 27, 87 +/- 25 IU/l for the eccentric, concentric, and control conditions, respectively) 48 h after exercise. Insulin-mediated glucose disposal rate was significantly impaired (P less than 0.05) during the clamp performed after eccentric exercise (3.47 +/- 0.51 mg.kg-1.min-1) compared with the clamps performed after concentric exercise (5.55 +/- 0.94 mg.kg-1.min-1) or control conditions (5.48 +/- 1.0 mg.kg-1.min-1). HGO was not significantly different among conditions (0.77 +/- 0.26, 0.65 +/- 0.27, and 0.66 +/- 0.64 mg.kg-1.min-1 for the eccentric, concentric, and control clamps, respectively). The insulin resistance observed after eccentric exercise could not be attributed to altered plasma cortisol, glucagon, or catecholamine concentrations. Likewise, no differences were observed in serum free fatty acids, glycerol, lactate, beta-hydroxybutyrate, or alanine. These results show that exercise that results in muscle damage, as reflected in muscle soreness and enzyme leakage, is followed by a period of insulin resistance.

Effects of treadmill exercise to exhaustion on the insulin response to hyperglycemia in untrained men

The effects of a single bout of exercise to exhaustion on pancreatic insulin secretion were determined in seven untrained men by use of a 3-h hyperglycemic clamp with plasma glucose maintained at 180 mg/100 ml. Clamps were performed either 12 h after an intermittent treadmill run at approximately 77% maximum O2 consumption or without prior exercise. Arterialized blood samples for glucose, insulin, and C-peptide determination were obtained from a heated hand vein. The peak insulin response during the early phase (0-10 min) of the postexercise clamp was higher (81 +/- 8 vs. 59 +/- 9 microU/ml; P less than 0.05) than in the nonexercise clamp. Incremental areas under the insulin (376 +/- 33 vs. 245 +/- 51 microU.ml-1.min) and C-peptide (17 +/- 2 vs. 12 +/- 1 ng.ml-1.min) curves were also greater (P less than 0.05) during the early phase of the postexercise clamp. No differences were observed in either insulin concentrations or whole body glucose disposal during the late phase (15-180 min). Area under the C-peptide curve was greater during the late phase of the postexercise clamp (650 +/- 53 vs. 536 +/- 76 ng.ml-1.min, P less than 0.05). The exercise bout induced muscle soreness and caused an elevation in plasma creatine kinase activity (142 +/- 32 vs. 305 +/- 31 IU/l; P less than 0.05) before the postexercise clamp. We conclude that in untrained men a bout of running to exhaustion increased pancreatic beta-cell insulin secretion during the early phase of the hyperglycemic clamp. Increased insulin secretion during the late phase of the clamp appeared to be compensated by increased insulin clearance.

Fat storage in athletes: metabolic and hormonal responses to swimming and running

Despite similar rates of energy expenditure during training, it has been suggested that swimmers store greater amounts of body fat than runners. To investigate these discrepancies, eight male swimmers (S) and runners (R) were monitored during 45 min of swimming or running (75% VO2max), respectively, and six triathletes were monitored during swimming (ST) and running (RT). Each group was also monitored during two hours of recovery. Venous blood samples were obtained before exercise, immediately after exercise (0 min) and at 15, 30, 60 and 120 min of recovery. These samples were analyzed for glucose, lactate, glycerol, free fatty acids (FFA), insulin, glucagon, norepinephrine (NE) and epinephrine (E). Expired gases and heart rates (HR) were obtained during exercise and also during recovery. The caloric cost of recovery was similar, but the RER results suggested increased fat oxidation during recovery for the S and the ST. Serum glucose was greater (P less than 0.05) immediately after exercise for R (6.71 +/- 0.29 mmol/l) and RT (6.40 +/- 0.26) compared to the S (4.97 +/- 0.19) and ST (4.87 +/- 0.18), and was significantly elevated for the initial 30 min of recovery. FFA were similar throughout the recovery period; however, blood glycerol was greater immediately after exercise (0 min) for R compared to S (NS) and was significantly elevated after exercise (0 min) for RT compared to ST. Differences in blood glucose or fat release were not explained by differences in NE or E; however, the glucacon-to-insulin ratio was significantly greater after exercise in the S and ST compared to the R and RT.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of increased training volume on the oxidative capacity, glycogen content and tension development of rat skeletal muscle

This study examined the effects of a short-term sudden increment in training load on the oxidative capacity, glycogen content and tension-generating ability of rat skeletal muscle. After training on a treadmill 5 dwk-1 for 9 wk (30 m.min-1 6 degrees, 60 min.d-1), rats were randomly divided into a normal training volume (NTV) group (N = 11) and an increased training volume (ITV) group (N = 8). The NTV group were sacrificed 24 h after the last bout of exercise, while the ITV group continued to train for further 6 successive days. Training duration for this latter group was increased to 120 min.d-1 for the first 2 d; 240 min.d-1 for the next 2 d; and 360 min.d-1 for the final 2 d; speed and grade were kept constant. Respiratory capacity (QO2) and citrate synthase activity were increased (P less than 0.05) in both the soleus and plantaris muscles, with no change in the white vastus lateralis muscle of the NTV group when compared to age- matched sedentary controls. Glycogen levels were unchanged in these muscles, but liver glycogen content was greater (231.9 +/- 10.1 vs 156.8 +/- 15.3 umol.g-1 w.w. for the NTV vs age-matched sedentary controls, respectively, P less than 0.05). Peak tetanic tension in the gastrocnemius was not changed by training, or the increased training load. Citrate synthase activity (umol.min-1.g-1) was significantly greater (P less than 0.05) in the plantaris (33.3 +/- 1.0 vs 27.0 +/- 1.7) and soleus muscles (40.5 +/- 2.7 vs 28.4 +/- 1.3) in the ITV vs NTV groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of exercise on glucose disposal: response to a maximal insulin stimulus

We used the euglycemic clamp to assess the effects of exercise on maximally insulin-stimulated glucose disposal. In 11 young men, a 60-min bout of exercise had no significant effect on the rate of glucose disposal during a euglycemic clamp performed approximately 30 min postexercise in which plasma insulin was raised to approximately 2,500 microU/ml (a maximal insulin stimulus). The maximal rate of glucose disposal attained during the clamp averaged 15.7 +/- 1.0 mg.kg lean body mass-1.min-1 after exercise vs. a control value of 15.4 mg.kg lean body mass-1.min-1. In a second experiment, eight men performed supine cycle exercise during the 3rd h of a 4-h euglycemic clamp with a plasma insulin concentration of approximately 2,500 microU/ml. Exercise during the hyperinsulinemic clamp resulted in a 70% increase in glucose disposal rate. There was no measurable increase in glucose 6-phosphate in the quadriceps muscle during the insulin infusion at rest. We conclude that prior exercise does not enhance maximally insulin-stimulated glucose disposal in young healthy men. Our results are compatible with the interpretations that glucose availability rather than glucose metabolism limits the rate of glucose disposal in response to a maximal insulin stimulus in resting subjects and that the increase in glucose uptake in response to superimposed exercise is primarily due to an increase in glucose availability.

Changes in selected blood measures during repeated days of intense training and carbohydrate control

Ten runners were studied to determine whether selected blood measures were useful indices of the metabolic stress associated with intense training and dietary carbohydrate (CHO) deficiency. The runners performed two diet/training regimens, involving 5 repeated days of intense training approximately 80 min/d, approximately 80% VO2max) and dietary CHO control (8.0 g.kg-1.d-1, EQ-CHO; 3.9 g.kg-1.d-1, LO-CHO). Resting blood samples were obtained after a 3-day control period, after 3 and 5 days of intense training, and after 3 days of rest. Resting uric acid levels were significantly higher (P less than 0.05) after 3 and 5 days of training during the LO-CHO vs EQ-CHO regimen (353 +/- 21 vs 309 +/- 24, and 345 +/- 26 vs 302 +/- 26 mol.l-1, respectively). Resting thyroxine (T4) levels were higher (P less than 0.05) after 5 days of training during the LO-CHO vs EQ-CHO regimen (102.2 +/- 6.2 vs 83.7 +/- 4.5 nmol.l-1, respectively). While creatine kinase levels were elevated after both regimens (P less than 0.05), there was no difference between regimens. Serum cortisol (C) levels were reduced by 10% for both regimens (P less than 0.05), possibly due to an expansion in plasma volume (7.6 and 7.3% for the LO-CHO and EQ-CHO regimens, respectively). Resting FFA levels were increased (P less than 0.05) during both regimens, but there was no difference between the regimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of reduced training on submaximal and maximal running responses

The purpose of this investigation was to examine the effects of a reduction in training volume (RT) (8 km/day, 5 days/wk, for 10 days) in five highly trained collegiate distance runners. The subjects were tested midseason (MS) (110 km/wk), after a 10-day taper (80 km/wk) and subsequent championship meet (post-championship, PC), and post RT. PC data represent the runners at their peak performance capacity. Maximal oxygen consumption, maximal heart rate (HR), and time to exhaustion during the max tests, as measured at PC and RT, were not altered. Other parameters were measured for all conditions. No changes were observed in body weight and percent body fat (p greater than 0.05). Submaximal treadmill runs (TR) at 265 and 298 m/min revealed no alterations in VO2 submax, ratings of perceived exertion (RPE), HR and 2-min post-run lactate levels (p greater than 0.05). The HR during a 6-min track run (265 m/min) significantly increased (p less than 0.001) by 10 bts/min with RT vs MS and PC, which may be a result of mechanical or psychological changes. After RT, 1-min recovery HR (HRr) for the track run and 1- and 2-min post-TR were significantly elevated by 16, 12, and 12 bts/min, respectively. It is not apparent what role HRr serves as an indicator of fitness level and performance capability during reduced training. These results suggest that the reduced training program used did not sufficiently diminish nor improve aerobic capacity in highly trained distance runners.

Carbohydrate balance in competitive runners during successive days of intense training

This study was designed to investigate the effect of intense training on muscle glycogen stores under conditions of controlled carbohydrate (CHO) intake. On two separate occasions, 10 highly trained distance runners increased their training load for 5 days (20 km/day, approximately 80% maximal O2 consumption) while eating a diet whose carbohydrate composition either equaled (EQ-CHO) or contained approximately 50% of the runner's estimated daily expenditure (LO-CHO). Total muscle glycogen levels were lower after the LO-CHO regimen. Photometric analysis of the glycogen content in individual fibers revealed that 27% type I and 17% type II fibers had optical densities less than 0.2 U after the LO-CHO regimen, whereas 7% type I and 0% type II were similarly depleted after the EQ-CHO diet. A linear relationship was observed between the histochemical and direct chemical analysis of muscle glycogen content. Treadmill O2 uptake measured at 185 and 238 m/min was higher during the LO-CHO than the EQ-CHO regimen. Ratings of perceived exertion were higher during the 238-m/min run for the LO-CHO regimen. After 3 days of rest, running economy and perception of effort returned to pretraining levels and muscle glycogen stores were approximately 85% of the pretraining values. Thus when CHO intake was only approximately 50% of the energy requirements there was a marked depletion of muscle glycogen stores, particularly in type I fibers, and a concomitant decrease in running economy and increased perception of fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of sodium bicarbonate on sprint performance: relationship to dosage

The purpose of this investigation was to determine the minimum oral dosage of bicarbonate needed to significantly elevate blood bicarbonate and the influence of induced alkalosis on performance in high-intensity, short-duration exercise. Nine endurance-trained cyclists performed four 2-min sprints on separate occasions using an isokinetic cycle ergometer (Fitron, Cybex, Inc.). One hour before each test, the cyclists consumed either a placebo (A), a solution of 0.10 g NaHCO3.kg-1 body weight (B), a solution of 0.15 g NaHCO3.kg-1 body weight (C), or a solution of 0.20 g NaHCO3.kg-1 body weight (D) in random order. Arterialized venous blood was taken before (PRE) and after (POST) ingestion, and 1, 3, 5, 10, and 15 min following the 2-min bike sprint. The results showed a significant increase in POST blood bicarbonate, and the elevation was incrementally related to the dosage. There was, however, no significant improvement in performance. Total work (mean +/- SE) for each treatment (N.m per 2 min) were: A, 47,267 (+/- 2,472); B, 47,004 (+/- 3,094); C, 46,312 (+/- 2,964); and D, 47,190 (+/- 2,621). The results of this study show that incremental doses of NaHCO3 of 0.20 g.kg-1 and below produce incremental elevations in blood bicarbonate but do not produce improvements in performance for a sprint bout lasting 2 min.

Physiological responses to successive days of intense training in competitive swimmers

To examine the physiological responses to successive days of intense training, 12 male collegiate swimmers doubled their training distance (4,266 +/- 264 to 8,970 +/- 161 m.d-1) while maintaining the intensity at approximately 95% VO2max for 10 d. Blood samples were obtained pre-exercise and immediately and 5 min after a sub-maximal (approximately 95% VO2max) front crawl swim (365.8 m) on days 0, 5, and 11. Swim performance was assessed from a maximal front crawl swim (365.8 m), two maximal front crawl sprints (22.9 m), and a semi-tethered swim power test. No significant changes were observed in performance. Pre-exercise serum cortisol (17.5 +/- 1.5, 19.5 +/- 1.6, and 20.6 +/- 1.2 micrograms.dl-1 for days 0, 5, and 11, respectively) and creatine kinase (56.2 +/- 7.7, 93.1 +/- 10.1, and 119.0 +/- 23.1 U.l-1 for days 0, 5, and 11, respectively) values were significantly elevated (P less than 0.05) on days 5 and 11 compared to day 0. Resting plasma catecholamine concentrations were higher but not significantly different (P greater than 0.05) at the end of the training period. Measurements of hemoglobin and hematocrit indicated a relative increase of 11.4 +/- 2.7% (P less than 0.05) in estimated plasma volume during the training period. Resting blood glucose values were unaffected by the training regimen while small but significant decreases in resting blood lactate values (1.01 +/- 0.06, 0.85 +/- 0.06, and 0.86 +/- 0.06 mmol.l-1 for days 0, 5, and 11, respectively) were observed on days 5 and 11. Resting heart rate and systolic blood pressure were not affected by the increased training load.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of repeated days of intensified training on muscle glycogen and swimming performance

Twelve, highly trained male swimmers were studied before, during, and after 10 successive days of increased training in an attempt to determine the physical effects of training over-load. Their average training distance was increased from 4,266 to 8,970 m.d-1, while swimming intensity was maintained at 94% (SE +/- 2%) of their maximal oxygen uptake, resulting in an average caloric cost during training of 2,293 kcal.d-1 (+/- 74). As a result of the intensified training regimen, the swimmers experienced local muscular fatigue and difficulty in completing the training sessions. Nevertheless, their swimming power, sprinting (s.22.86 m-1), endurance (s.365.8 m-1) performance, aerobic capacity, and muscle (m. deltoid) citrate synthase were unchanged as a consequence of the 10-d training regimen. Four of the 12 swimmers were, however, unable to tolerate the heavier training demands, and were forced to swim at significantly slower (P less than 0.05) speeds during the training sessions. These men were found to have significantly reduced muscle glycogen values, which was the result of their abnormally low carbohydrate intake. The findings of this research suggest that some swimmers may experience chronic muscular fatigue as a result of their failure to ingest sufficient carbohydrate to match the energy demands of heavy training.

Muscle fiber composition and respiratory capacity in triathletes

In an effort to describe the skeletal muscle characteristics of trained triathletes, biopsies were obtained from the gastrocnemius, vastus lateralis, and posterior deltoid muscles of 11 triathletes and 4 normally active controls. Each specimen was analyzed for muscle fiber composition, respiratory capacity (QO2), and citrate synthase activity. The mean (+/- SE) percentage of type I fibers for the triathletes was 59 (4.0), 63 (3.3), and 60 (2.8) in the gastrocnemius, vastus lateralis, and deltoid, respectively (P greater than 0.05). The mean (+/- SE) QO2 values in the gastrocnemius (4.4 +/- 0.3 ml O2.min-1.g-1) and the vastus lateralis (4.1 +/- 0.2) were not significantly different while the QO2 values of the deltoid (3.6 +/- 0.2) were significantly lower than the gastrocnemius (P less than 0.05). The mean citrate synthase activity of the deltoid (27.7 +/- 1.7 mumol.min-1.g-1) was significantly lower than both the vastus lateralis (36.0 +/- 3.2) and the gastrocnemius (45.8 +/- 2.1) (P less than 0.05). There was a high correlation between the percentage of type I fibers and the citrate synthase activity within the vastus lateralis (r = .760) and deltoid (r = .610) (P less than 0.05) but not the gastrocnemius (r = .200). No significant relationships were observed between skeletal muscle characteristics and VO2 max nor between skeletal muscle characteristics and performance. The results of this study demonstrate that: (1) these triathletes have a high percentage of type I fibers in all three muscle groups; (2) skeletal muscle characteristics were not highly related to laboratory or competitive performance;(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of reduced training on muscular strength and endurance in competitive swimmers

Following 5 months of competitive training (approximately 9,000 yards.d-1, 6 d.wk-1), three groups of eight male swimmers performed 4 wk of either reduced training (3,000 yard.session-1) or inactivity. Two groups reduced their training to either 3 sessions.wk-1 (RT3) or 1 session.wk-1 (RT1), whereas the third group (IA) did no training. Measurement of muscular strength (biokinetic swim bench) showed no decrement in any group over the 4 wk. In contrast, swim power (tethered swim) was significantly decreased (P less than 0.05) in all groups, reaching a mean change of -13.6% by week 4. Blood lactate measured after a standard 200-yard (183 m) front crawl swim increased by 1.8, 3.5, and 5.5 mM over the 4 wk in groups RT3, RT1 and IA, respectively. In group RT1, stroke rate measured during the 200-yard swim significantly increased (P less than 0.05) from 0.54 +/- 0.03 to 0.59 +/- 0.03 strokes.-1 while stroke distance significantly decreased (P less than 0.05) from 2.50 +/- 0.08 to 2.29 +/- 0.13 m.stroke-1 during the 4-wk period. Both stroke rate and stroke distance were maintained in group RT3 over the 4 wk of reduced training. Group IA was not tested for stroke mechanics. Whereas maximal oxygen uptake decreases significantly (P less than 0.05) over the 4 wk in group RT1 (4.75 to 4.62 l.min-1), no change in maximal oxygen uptake was observed in group RT3. These results suggest that aerobic capacity is maintained over 4 wk of moderately reduced training (3 sessions.wk-1) in well-trained swimmers. Muscular strength was not diminished over 4 wk of reduced training or inactivity, but the ability to generate power during swimming was significantly reduced in all groups.