Advances in exercise, physical activity and diabetes mellitus

Diet and exercise form a solid foundation for the prevention and treatment of diabetes mellitus. Regular physical activity increases insulin sensitivity, improves pharmacotherapy, lowers blood sugar concentrations, reduces body fat content, builds muscle and improves cardiovascular fitness and function. A number of recent studies have demonstrated the effectiveness of regular exercise in improving metabolic control and overall health in persons with diabetes, although the clinical management of physically active patients with type 1 diabetes (T1D) remains a challenge. This year, we highlight a number of papers, published between 1 July and 30 June 2011, that are valuable contributions to the field of exercise and diabetes management. Mackenzie R 1 , Maxwell N 2 , Castle P 3 , Birckley G 2 , Watt P 2 1 School of Life Sciences, Department of Human and Health Sciences, University of Westminster, London, UK, 2 Chelsea School Research Centre, University of Brighton, Eastbourne, UK, and 3 Department of Sport and Exercise Science, University of Bedfordshire, Bedford, UK Diabetes Metab Res Rev 2011; 27 : 94–101 Aims: Similar to muscular contractions, hypoxia has been suggested to stimulate glucose uptake into skeletal muscle independent of insulin signalling. However, hypoxia has also been shown to cause insulin resistance in rodents, due to a sympathoadrenal-induced epinephrine release, thereby reducing glucose disposal. The aim of the study was to examine the effects of acute hypoxia, with and without exercise, on insulin sensitivity (SI2*), glucose effectiveness (SG2*) and β-cell function in individuals with type 2 diabetes mellitus (T2D). Methods: Eight sedentary males with T2D, who were not on exogenous insulin and who were diagnosed within the last 5 years, were recruited for this study. Following an overnight fast and baseline blood sampling, subjects completed the following in a randomised order (each visit separated by 7–14 days): (1) normoxic rest; (2) hypoxic rest (inspired O2 = 14.6%); (3) normoxic exercise; and (4) hypoxic exercise (inspired O2 = 14.6%). The exercise performed was at a work load equivalent to 90% of normoxic lactate threshold. Arterialised venous blood samples were taken every 10 min during the tests. A 4-h intravenous glucose tolerance test was administered immediately following each test under normoxic conditions. Results: The tests demonstrated increased insulin sensitivity following hypoxic rest compared with normoxic rest [SI2*= 2.25 ± 0.50 vs. 1.39 ± 0.08 × 10–4μU/ml (mean ± SEM), respectively] (p < 0.05), greater insulin sensitivity following hypoxic exercise compared with normoxic exercise (p < 0.05), and a lower acute insulin response to glucose following hypoxic rest compared with normoxic rest (p = 0.014). Blood lactic acid tests showed no differences between groups. Arterialised blood glucose tests showed a significantly greater decrease in glycaemia during hypoxic exercise (–1.82 ± 0.64 mmol/l) compared with normoxic exercise (–0.91 ± 0.35 mmol/l) (p < 0.05). With respect to insulin levels, hypoxic rest showed no change, while hypoxic exercise caused insulin levels to decrease from baseline but with no difference compared with normoxic exercise. The ability of glucose to use the muscle-contraction-stimulated pathway, as measured by glucose effectiveness (SG2*), showed no differences between conditions. Conclusion: Hypoxic conditions improve glucose tolerance, via insulin-mediated and non-insulin-mediated mechanisms, in the hours following exposure. Hypoxic exercise enhances insulin sensitivity over normoxic exercise in patients with T2D. Comment: Based on this study, acute hypoxia during rest and particularly during exercise provides improvements in short-term insulin sensitivity and glycaemic control for patients with T2D. While this study is an interesting and innovative approach to the treatment of diabetes, its applications and uses are limited with respect to economic and clinical practicality. Applying acute hypoxia to patients with T2D is expensive and cumbersome as a treatment. Research into long-standing hypoxia with respect to insulin sensitivity and glycaemic control may in as for with However, as a treatment for sedentary on a is at this of hypoxic a study that at in a of hypoxia, that hypoxia was with glucose insulin sensitivity, independent of body and in a study with who 5 of hypoxia over 2 insulin sensitivity remains hypoxia is for insulin sensitivity for patients with T2D. for the Diabetes Exercise Diabetes , : Aims: fitness is to of in patients with T2D. The aim of this study was to the of an exercise exercise with exercise on physical activity levels, levels and improving cardiovascular in a T2D in Methods: sedentary patients with T2D were in diabetes and were randomised to the exercise = the = The study was and was every 3 for groups. The and resistance a for a of min of exercise was measured by levels, while were of cardiovascular levels were by the and levels were in metabolic = 1 is a min is levels were Results: with the the the levels during the (mean ± ± vs. ± hours The also improvements in levels difference to < to = and to = blood levels < levels to = to < body to < and levels to < as measured by the UK Diabetes to < and to = also in the Conclusion: This type of exercise and is in improving exercise fitness and cardiovascular while levels in patients with T2D. although may increases in this is to the cardiovascular in Comment: This study thereby reducing the of vs. that are to are for a with the study The study provides for the of with to lower and cardiovascular The in this may to the study not are the effects of with patients with diabetes on a regular in an exercise a that compared with exercise with was that the was with improvements in while with study that at T2D patients that at and with at and in in blood and levels regular of by a exercise as to during is of for patients with is not a we to individuals to sedentary a every 3 Department of University of School of Diabetes Metab 2011; : T2D has at an a study of patients with and with no to is to T2D patients for an approach for patients may individuals who from Aims: The aim of the study was to for patients with T2D for a approach of an exercise test and a the was for Methods: T2D = with no of cardiovascular with were The was performed the exercise The study also the T2D patients = who and to the A was during the test and blood was every 2 min during exercise and The was a with a 1 0.08 the at of the for the was performed the was was as of during the was as a of on Results: A of patients completed the with patients with a and a the no on a and the patients were to have via ± vs. ± years, = and of diabetes ± vs. ± years, < the of the and the the for of and a of diabetes, that a the was With respect to patients who with of the patients with a 10 of of Conclusion: The that the a and to for with a of T2D 10 Comment: this study that the is a for is in patients with T2D who have the the work and health a at for who the exercise, and not the to The of and a a with a and physical to of The a and is in of studies to the effectiveness of the for cardiovascular in an of for in in patients with with diabetes, the study the approach of for with a of as a approach a study with was that for persons in Based on this the use of to may with its for the the approach to the to and with at a of School of and Health Science, Health Research Centre, and Diabetes Diabetes 2011; : activity for individuals with is with a of that to of are by physical order to a individuals with the and of activity to insulin and are no on to glucose levels are within the but glucose a to the of for individuals during and exercise, but of are during exercise. Aims: This study the use of a to with into the glucose and the at glucose is during exercise. Methods: a in and with in this field study. A baseline glucose was taken each and the and glucose was measured with for of physical The performed and and from to activity the the the a of on the measured glycaemia and the < activity levels 5 of Results: the were of and was of a insulin on a the in the were with an use of glucose levels were mmol/l) and were of of of the of glucose levels during exercise and the was Conclusion: The use of with a that of to the of and in physically active with This study also glycaemic to and body of were to while a glucose response the glucose was The is to glucose levels in the the was a for 30 min and min of a test and of a control the are to Comment: exercise have shown that patients with a in glucose during and physical exercise the this study also to of glucose and the for glucose a for in order to of glucose that from to A June study on glucose on that the from to the of by with no of study not use a to a but the in the the may of for to the Based on this may that to individuals with with in exercise and glycaemia who exercise of of with response to exercise and glucose 1 , 1 , 1 , 2 , 3 , , 5 , 5 1 of and University of 2 for and Health 3 Department of and Science, University of of of University of and 5 of and Sciences, University of Diabetes 2011; : is with regular physical activity for the management of T2D. However, the studies on that with not an muscle and have been shown to and the has been an has also been shown to improve exercise tolerance in with Aims: This study (1) to examine the of on acute metabolic and to exercise; (2) to examine the of exercise on and (3) to examine the between and acute exercise on response to a Methods: T2D and were in this study. The were between the of 30 and not blood and and activity levels, and within the last 3 with no to over the of the study. The study a with each to (1) and no exercise; (2) and exercise; (3) and no exercise; and (4) and exercise. and conditions were in the last 2 of each were for baseline glucose levels during a by an exercise the at rest for the test exercise blood samples were taken during and to 2 the exercise metabolic as and were measured and blood samples were Results: were on the exercise compared with the ± vs. ± = and ± vs. ± = exercise. increased and lactate levels during exercise (p and the (p = but not response to the was by but the was exercise was (p = 0.05). the and exercise levels were the lactate were in the compared with the (p 0.05). Conclusion: and exercise increased and no effects on the glycaemic response to the study exercise to with the of increased and increased lactate during exercise. Comment: A study at the short-term treatment with also that the of treatment with acute exercise not insulin sensitivity in insulin the of the may the effects of exercise While in this study was that increased a study with a in with The of that study are that reduces (p < The that the of in glucose on the exercise not the use of exercise as a treatment While has no glycaemic with exercise, this study that may to the of exercise and to glycaemic N Diabetes 2011; : Aims: The aim of this study was to the diabetes management of with and to with the physical activity performed by individuals with Methods: A of and and with in this study. were to an that of insulin insulin exercise and The were from on the of with and the with with The of on exercise and A to the was on the Diabetes Exercise and from to Results: of of to to while not the and not the With to clinical for with following of the of the of the of exercise was into and showed that the of blood glucose increased with of exercise (p = of blood glucose to the following of the of exercise, this was ± the was ± of exercise, the increased to ± of the that not decrease insulin on exercise the who = by at However, not a between of insulin and the of blood who to exercise blood glucose was of exercise compared with who However, were not (p = While of the for blood glucose and exercise, glucose during exercise. of who completed the that exercise blood glucose is of the from this study was that of exercise increases the of blood glucose in individuals with This was that during exercise glucose to glucose in patients with who not lower insulin from this study that reducing insulin levels on of exercise to decrease the of during the to insulin levels, the also of during and exercise to the of While the of this study are with the were not from who not lower insulin of that the to blood glucose during exercise, and of to with blood glucose The that exercise with blood glucose are in the and are no exercise with a of with blood glucose may by the that with in order to Comment: While physical activity insulin sensitivity and metabolic also is a for the insulin in response to exercise. However, who on exogenous insulin and as a of not insulin to exercise. The of may last for due to increased insulin sensitivity that to muscle and levels However, glucose control is for as the of during physical activity to to exercise may the provides for in order to glycaemia during and exercise However, the of this study that are not of that are but not are to with who are in glucose control during Department of and University of School of : Aims: resistance that is diagnosed during is as diabetes mellitus The aim of this study was to the of a resistance exercise with an on insulin and glycaemic control in patients diagnosed with The that the number of who insulin during was Methods: A randomised control of with was The were into an exercise that an during and a control that was not in an exercise the by a glucose tolerance the patients were to blood glucose with the of a glucose of to from a patients were on to each resistance exercise, of an to exercise the muscle groups. patients were to the each on for were by and with the each to that to the exercise The the as with glycaemic was and insulin was of glucose were the of the were and was the Results: The patients in an of ± (mean ± each was with a for insulin as treatment for as of patients insulin during compared with of patients (p = the the of in the blood glucose as suggested by the was (p = for patients in the the ± in the compared with ± in the difference in glucose levels was between the groups. were no of and not to with of the the as were no differences in body at and the number of between the groups. greater in and in the at of in patients in each The of this study that with an may an for with as significantly the number of patients who insulin and glycaemic control compared with studies with a number of subjects to of the effects of on with and the effectiveness of on metabolic control to the effects of exercise. Comment: blood glucose control is in order to the of during and from have shown that of during in a of and have been to of the of insulin resistance in with that exercise may a and for glucose in glycaemic While studies have shown the effectiveness of exercise in is the of on this The of this study showed glucose control in who performed each during as in the significantly within the glucose the to insulin as of in the insulin compared with of in the (p = studies on this may as a and to insulin for improving metabolic control in with and may in a in from the , 2 , 2 , 2 , 2 , 1 1 and 2 Diabetes 2011; : Aims: This study the of muscle in with diabetes compared with The the effectiveness of in Methods: A of subjects were in this study. were into of subjects The subjects in the The of The last subjects with T2D from to each subjects were into of 10 subjects who 10 subjects 10 10 in and the last 10 subjects in each were to no was exercise, the subjects for min during baseline of blood and by the subjects a of the were The subjects min of The exercise of a and a were to the with the of each exercise that were to rest and during the hours the exercise of and blood were were to of muscle the The control for 2 at min and The were also to for 2 each a to The was by each immediately to and at min and min treatment also a with the and blood were taken and blood were at Results: While the and no to exercise, the T2D showed the study The on the for the diabetes exercise (mean ± ± was (p < for the ± and ± groups. of muscle was was for immediately was and to 2 exercise. in subjects by by in the subjects with diabetes and by in the by in in the subjects with T2D and in the The are in physical were as as at reducing but the within 2 the was blood in the exercise was ± the < of the control this not during the study. The that the in blood as increased by ± the was blood in the was ± and this not during the for the control The the in blood the as the increased by ± the diabetes the blood of ± was lower (p < that of the and with the blood in subjects with diabetes increased the in the as in a of ± caused the in blood by and Blood 2 was but to by the was individuals with diabetes, exercise and are due to a of this study, subjects with T2D muscle the exercise and the in between 1 and 2 compared with the groups. are to muscle this study that in the in blood and in muscle compared with and Comment: is a that from physical activity in who not exercise in who physical of from muscle to the of the between and exercise, and the not following exercise. patients with T2D have function that of blood in on the may that in with The of this study that with T2D significantly levels of muscle and exercise compared with resistance exercise is for patients with diabetes to lower levels and improve This also provides to this blood and in of subjects with exercise is an of T2D, is that individuals with diabetes in form of physical for the muscle are as were in this study, patients to exercise and glycaemic control as a , A , , 1 1 Health 2 and 3 of of Aims: The aim of this study was to the of resistance exercise on patients with T2D. The that an exercise to improve glycaemic control improve Methods: = and = of (mean ± with T2D were recruited to in the study. in the for a of in as of subjects as were to the = that resistance exercise the control = in the each under for a of exercise in the control every and performed during baseline and at and to the load in form and the of The measured The was the of 30 and is to in from to are 10 to and to 30 The test was the Health is to of and physical and and each from to with of The of the was for each the and the have been in and have been shown to of and were taken and at of health was Results: the insulin and glycaemic were also for to were no between the of and and and were not between the at the a of ± and the control a of ± the for subjects in the to ± compared with a of ± for the control (p < The at in the was ± and ± in the control the health of the subjects also as the increased to ± This was the of ± in the control at (p < The and that with T2D and of subjects levels of to of clinical This study demonstrated that in not improves glycaemic as has been shown but also improves health in individuals with The that of the in health in the may to increased due to the exercise Comment: with diabetes are as to have clinical as without the This study a of as have significantly of diabetes and diabetes in in are to diagnosed and for A randomised control performed in that resistance exercise significantly glycaemic control and insulin sensitivity in patients with T2D have that regular exercise as as for While studies have the of exercise on and the of exercise on diabetes this study the of resistance exercise on with T2D. The that in to improving glycaemic exercise was at reducing the of and health in This study provides into an and the of The that on improving the health of patients in to glycaemic Exercise to an to and improve of G Department of Diabetes and Diabetes of Aims: The aim of this study was to the and effectiveness of a of a glucose and a physical activity in with This to the use of this innovative in a clinical The of the was to the of the by the to between physical activity and blood and also to to improve the of insulin a in of a that physical activity that is into a a the and of physical This has been in as the of were for for for and for Methods: A of (mean ± with in this study. the into a to physical subjects also a to in with The patients the for a of 3 at on the and at on the last of the between physical activity and blood glucose was Results: patients the for the of the without the study the of physical activity was ± (mean ± activity of ± ± ± ± and physical activity ± without physical activity for ± were ± activity measured by and blood glucose from the were for each was a between physical activity and blood glucose levels in of with between and 10 of the were no the in to physical was no between the of insulin insulin and the between blood glucose and physical The of this study that may a between physical activity and blood glucose as of the patients demonstrated between the The that of exercise and blood glucose a of the of insulin sensitivity in While studies with and for the may to to improve insulin during physical activity for and of the subjects the during the that this into diabetes Comment: have to the between physical activity and insulin sensitivity, with an between the studies the of physical activity on on However, the and to and type of physical for greater and for exercise. While the of this study are the innovative of the and a a for exercise increases the of in individuals with insulin to physical activity may to This may in insulin sensitivity during exercise and may and with to and control blood glucose levels during of physical Research of Department of University of 2011; : Aims: due to is a for to in and the The of T2D increases the of in patients with have been in the the of on improving This study short-term exercise reduces in with T2D who were as a Methods: the of males and who been diagnosed with T2D for at 5 were recruited for this study, that of were an exercise was measured via the and exercise were into an a The of to exercise at of on the on a and for a for 3 of exercise and following the last subjects were a of was administered and each was in a for 30 The test was the and a 30 in blood body and to were also measured on subjects and Results: subjects in were to during the test vs. = the exercise in the and in the and the difference in significantly between (p = between was not significantly at baseline vs. = but tolerance was significantly in the the = ± = ± = on was during The not in in body to blood 3 of tolerance was in with T2D. improvements without in physical body blood glucose to that the effects of exercise on tolerance are independent of of exercise. studies no improvements to tolerance exercise at a The study that who also a in tolerance exercise. is to in in of the increased that in lower studies have shown that exercise reduces in and with T2D, as as reducing of a in Comment: due to are a for with in this are in the The with T2D and the of this to this is to that a exercise have effects on tolerance, that exercise as a of 1 , 2 , 1 , 1 , 2 1 Department of and 2 Department of School of Health Diabetes 2011; : Aims: has been on the treatment of diabetes exercise. The aim of this study was to test the of a exercise on improving and in with T2D. Methods: with were into an exercise ± a control ± The exercise of 10 min of min of and 10 min of a for were with and an were in a with to to improve Health were also to a for the on diabetes and the of and exercise in and during and were measured with a was by the test and the and were measured by the test and the and was measured a 10 The test was to Results: was no difference in of the tests for and between control and exercise at the exercise showed improvements in body with in test in and and 10 and < 0.05). were no improvements in of the tests for patients in the control Conclusion: Diabetes is the cause of from the lower and for to on the in control and muscle that are taken into This study has shown that of are to improve and as as in with T2D, to and patients independent Comment: This is solid that the of an exercise to the of this by to improve and in T2D The performed by the were that at into a while a This is the study to the effects of exercise on improving and has shown valuable to studies performed on to to improve the of of patients with this , , , 1 , 1 , 1 Department of University Centre, The 2 University Centre, The 3 Research for Sport and Exercise Science, UK, Department of University Centre, The and 5 for of University Centre, The Metab 2011; : Aims: at a patients with are to have function increases in of are to of and cardiovascular This study the of an exercise on function and in with Methods: with of diabetes ± were in an exercise for with for min a was by a while the was at function and measured a were on and the fitness and were measured during a test a Results: increased the exercise while at not of the was significantly but no in baseline was was no difference in to and This study has shown that exercise for was in physical fitness and improving function in with is a to and cardiovascular is to physical in but have shown that of exercise The of in to a of not to to a exercise with not to cause of blood Comment: This study the of exercise for a with and the for exercise for in order to cardiovascular from in with this is not without for but the to the muscular and The no of

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