Warm-up exercise in human type 2 diabetes: is high-intensity exercise required?

Abstract Background African Americans have a disproportionate prevalence and incidence of type 2 diabetes compared to Caucasians. Recent evidence indicates low cardiorespiratory fitness (CRF) level, an independent risk factor for type 2 diabetes, is also more prevalent in African Americans than Caucasians. Numerous studies in Caucasian populations suggest vigorous exercise intensity may promote greater improvements in CRF and other type 2 diabetes risk factors (e.g. reduction of glucose/insulin levels, pulse wave velocity, body fat, etc.) than moderate intensity. However, current evidence comparing health benefits of different aerobic exercise intensities on type 2 diabetes risk factors in African Americans is negligible. This is clinically important as African Americans have a greater risk for type 2 diabetes and are less likely to meet public health recommendations for physical activity than Caucasians. The purpose of the High-Intensity exercise to Promote Accelerated improvements in CardiorEspiratory fitness (HI-PACE) study is to evaluate whether high-intensity aerobic exercise elicits greater improvements in CRF, insulin action, and arterial stiffness than moderate-intensity exercise in African Americans. Methods/Design A randomized controlled trial will be performed on overweight and obese (body mass index: 25-45 kg/m2) African Americans (35-65 years) (n=60). Participants will be randomized to moderate-intensity (MOD-INT) or high-intensity (HIGH-INT) aerobic exercise training, or a non-exercise control group (CON) for 24 weeks. Supervised exercise will be performed at a heart rate associated with 45-55% and 70-80% of VO2 max in the MOD-INT and the HIGH-INT groups, respectively, for an exercise dose of 600 MET-minutes/week (consistent with public health recommendations). The primary outcome is change in CRF. Secondary outcomes include change in insulin sensitivity (measured via an intravenous glucose tolerance test), skeletal muscle mitochondrial oxidative capacity (via near infrared spectroscopy), skeletal muscle measurements (i.e. citrate synthase, COX IV, GLUT-4, CPT-1, PGC1-α), arterial stiffness (via carotid-femoral pulse wave velocity), body fat, C-reactive protein, and psychological outcomes (quality of life/exercise enjoyment). Discussion The anticipated results of the HI-PACE study will provide vital information on the health effects of high-intensity exercise in African Americans. This study will advance health disparity research and has the potential to influence future public health guidelines for physical activity. Trial Registration ClinicalTrials.gov ID: NCT02892331. Registered on 8 September 2016, https://clinicaltrials.gov/ct2/show/NCT02892331

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High Intensity Exercise Training in Type 2 Diabetes

http://isrctn.org/> ◽

10.1186/isrctn78698481 ◽

2013 ◽

Author(s):

Michael Trenell

Keyword(s):

Type 2 Diabetes ◽

Exercise Training ◽

High Intensity ◽

High Intensity Exercise

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High-Intensity Exercise Training for the Prevention of Type 2 Diabetes Mellitus

The Physician and Sportsmedicine ◽

10.3810/psm.2014.02.2042 ◽

2014 ◽

Vol 42 (1) ◽

pp. 7-14 ◽

Cited By ~ 7

Author(s):

Corey A. Rynders ◽

Arthur Weltman

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Exercise Training ◽

High Intensity ◽

High Intensity Exercise

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Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA1c in obese type 2 diabetes patients

Diabetologia ◽

10.1007/s00125-009-1354-3 ◽

2009 ◽

Vol 52 (9) ◽

pp. 1789-1797 ◽

Cited By ~ 92

Author(s):

D. Hansen ◽

P. Dendale ◽

R. A. M. Jonkers ◽

M. Beelen ◽

R. J. F. Manders ◽

...

Keyword(s):

Type 2 Diabetes ◽

Exercise Training ◽

High Intensity ◽

High Intensity Exercise ◽

Moderate Intensity ◽

Moderate Intensity Exercise ◽

Diabetes Patients

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Effects of Moderate- Versus High-Intensity Exercise Training on Physical Fitness and Physical Function in People With Type 2 Diabetes: A Randomized Clinical Trial

Physical Therapy ◽

10.2522/ptj.20140097 ◽

2014 ◽

Vol 94 (12) ◽

pp. 1720-1730 ◽

Cited By ~ 12

Author(s):

J. David Taylor ◽

James P. Fletcher ◽

Ruth Ann Mathis ◽

W. Todd Cade

Keyword(s):

Type 2 Diabetes ◽

Exercise Training ◽

Physical Fitness ◽

Physical Function ◽

High Intensity ◽

High Intensity Exercise ◽

High Group ◽

Glucose Levels ◽

Intensity Training

Background Exercise training is effective for improving physical fitness and physical function in people with type 2 diabetes. However, limited research has been conducted on the optimal exercise training intensity for this population. Objective The primary study objective was to investigate the effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes. Design This was a randomized clinical trial. Setting The setting was a university campus. Participants Twenty-one people with type 2 diabetes were randomly allocated to receive either moderate-intensity training (MOD group) or high-intensity training (HIGH group). Intervention The MOD group performed resistance training at an intensity of 75% of the 8-repetition maximum (8-RM) and aerobic training at an intensity of 30% to 45% of the heart rate reserve (HRR). The HIGH group performed resistance training at an intensity of 100% of the 8-RM and aerobic training at an intensity of 50% to 65% of the HRR. Measurements Muscle strength (peak torque [newton-meters]), exercise capacity (graded exercise test duration [minutes]), and physical function (Patient-Specific Functional Scale questionnaire) were measured at baseline and 3 months later. Acute exercise-induced changes in glucose levels were assessed immediately before exercise, immediately after exercise, and 1 hour after exercise during the first exercise training session. Results Although both groups showed improvements in physical fitness and physical function, the between-group effect sizes were not statistically significant (exercise capacity estimated marginal mean [EMM] difference=2.1, 95% confidence interval [95% CI]=−0.2, 4.5; muscle strength EMM difference=20.8, 95% CI=−23.3, 65.0; and physical function EMM difference=0.1, 95% CI=−0.6, 0.9). Mean percent changes in glucose levels measured immediately before exercise and immediately after exercise, immediately after exercise and 1 hour after exercise, and immediately before exercise and 1 hour after exercise for the MOD group were −11.4%, −5.0%, and −15.8%, respectively; those for the HIGH group were −21.5%, 7.9%, and −15.3%, respectively. Limitations Sample size, lack of outcome assessor masking, and physical function measurement subjectivity were limitations. Conclusions Moderate- and high-intensity exercise training, as defined in this study, may lead to similar improvements in physical fitness and physical function in people with type 2 diabetes.

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High-intensity exercise to promote accelerated improvements in cardiorespiratory fitness (HI-PACE): Study protocol for a randomized controlled trial

10.21203/rs.2.380/v2 ◽

2019 ◽

Author(s):

Joshua E. McGee ◽

Savanna G. Barefoot ◽

Nicole R. Gniewek ◽

Patricia M. Brophy ◽

Angela Clark ◽

...

Keyword(s):

Public Health ◽

Type 2 Diabetes ◽

African Americans ◽

Aerobic Exercise ◽

Cardiorespiratory Fitness ◽

High Intensity ◽

Controlled Trial ◽

High Intensity Exercise ◽

Moderate Intensity

Abstract Background African Americans have a disproportionate prevalence and incidence of type 2 diabetes compared to Caucasians. Recent evidence indicates low cardiorespiratory fitness (CRF) level, an independent risk factor for type 2 diabetes, is also more prevalent in African Americans than Caucasians. Numerous studies in Caucasian populations suggest vigorous exercise intensity may promote greater improvements in CRF and other type 2 diabetes risk factors (e.g. reduction of glucose/insulin levels, pulse wave velocity, body fat, etc.) than moderate intensity. However, current evidence comparing health benefits of different aerobic exercise intensities on type 2 diabetes risk factors in African Americans is negligible. This is clinically important as African Americans have a greater risk for type 2 diabetes and are less likely to meet public health recommendations for physical activity than Caucasians. The purpose of the High-Intensity exercise to Promote Accelerated improvements in CardiorEspiratory fitness (HI-PACE) study is to evaluate whether high-intensity aerobic exercise elicits greater improvements in CRF, insulin action, and arterial stiffness than moderate-intensity exercise in African Americans. Methods/Design A randomized controlled trial will be performed on overweight and obese (body mass index: 25-45 kg/m2) African Americans (35-65 years) (n=60). Participants will be randomized to moderate-intensity (MOD-INT) or high-intensity (HIGH-INT) aerobic exercise training, or a non-exercise control group (CON) for 24 weeks. Supervised exercise will be performed at a heart rate associated with 45-55% and 70-80% of VO2 max in the MOD-INT and the HIGH-INT groups, respectively, for an exercise dose of 600 MET-minutes/week (consistent with public health recommendations). The primary outcome is change in CRF. Secondary outcomes include change in insulin sensitivity (measured via an intravenous glucose tolerance test), skeletal muscle mitochondrial oxidative capacity (via near infrared spectroscopy), skeletal muscle measurements (i.e. citrate synthase, COX IV, GLUT-4, CPT-1, PGC1-α), arterial stiffness (via carotid-femoral pulse wave velocity), body fat, C-reactive protein, and psychological outcomes (quality of life/exercise enjoyment). Discussion The anticipated results of the HI-PACE study will provide vital information on the health effects of high-intensity exercise in African Americans. This study will advance health disparity research and has the potential to influence future public health guidelines for physical activity.

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Exercise Intensities as Factors of Metabolic Outcomes in Type 2 Diabetes: A Systematic Review

Home Health Care Management & Practice ◽

10.1177/1084822318815446 ◽

2018 ◽

Vol 31 (3) ◽

pp. 193-203

Author(s):

Elizabeth Moxley ◽

Tory Bugaieski

Keyword(s):

Type 2 Diabetes ◽

High Intensity ◽

Fasting Glucose ◽

High Intensity Exercise ◽

Systemic Review ◽

Moderate Intensity ◽

Low Intensity ◽

Metabolic Outcomes ◽

Low Intensity Exercise

Exercise is effective to prevent and treat type 2 diabetes, although currently underutilized. This review analyzes the metabolic response to exercise performance at various intensities in individuals with type 2 diabetes. These findings provide insight into the development of safe and efficacious exercise prescriptions and education. We conducted a systemic review of the literature to examine the association of various exercise protocols with metabolic outcomes in type 2 diabetes. Between 1984 and 2018, 29 studies were categorized per exercise mode and intensity levels according to the American College of Sports Medicine standards. The most consistent improvement was found in HbA1c following moderate- to high-intensity exercise—post-exercise fasting glucose improved to a lesser extent. Low-intensity exercise improved HOMA-IR (homeostasis model assessment for insulin resistance) levels. Glucose and HbA1c improved most following interval compared with continuous exercise, irrespective of intensity. A comparison of high-intensity exercise with moderate-intensity exercise demonstrated few differences in HbA1c, fasting glucose, fasting insulin, and HOMA-IR. Irrespective of exercise intensity, HbA1c improvements were observed, suggesting a delayed progression to diabetes-related complications. Initial low-intensity exercise, with increased quantities when feasible, will contribute to metabolic improvements. The variability in methodology and measurement contributed to inconsistent outcomes; additional research with larger samples sizes is warranted.

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