Effect of moderate-intensity exercise versus activities of daily living on 24-hour blood glucose homeostasis in male patients with type 2 diabetes
Jan-Willem van Dijk, Maarten Venema, Willem van Mechelen, Coen D A Stehouwer, Fred Hartgens, Luc J C van Loon, Jan-Willem van Dijk, Maarten Venema, Willem van Mechelen, Coen D A Stehouwer, Fred Hartgens, Luc J C van Loon
Abstract
Objective: To investigate the impact of activities of daily living (ADL) versus moderate-intensity endurance-type exercise on 24-h glycemic control in patients with type 2 diabetes.
Research design and methods: Twenty males with type 2 diabetes participated in a randomized crossover study consisting of three experimental periods of 3 days each. Subjects were studied under sedentary control conditions, and under conditions in which prolonged sedentary time was reduced either by three 15-min bouts of ADL (postmeal strolling, ∼3 METs) or by a single 45-min bout of moderate-intensity endurance-type exercise (∼6 METs). Blood glucose concentrations were assessed by continuous glucose monitoring, and plasma insulin concentrations were determined in frequently sampled venous blood samples.
Results: Hyperglycemia (glucose >10 mmol/L) was experienced for 6 h 51 min ±1 h 4 min per day during the sedentary control condition and was significantly reduced by exercise (4 h 47 min ± 1 h 2 min; P < 0.001), but not by ADL (6 h 2 min ± 1 h 16 min; P = 0.67). The cumulative glucose incremental areas under the curve (AUCs) of breakfast, lunch, and dinner were, respectively, 35 ± 5% (P < 0.001) and 17 ± 6% (P < 0.05) lower during the exercise and ADL conditions compared with the sedentary condition. The insulin incremental AUCs were, respectively, 33 ± 4% (P < 0.001) and 17 ± 5% (P < 0.05) lower during the exercise and ADL conditions compared with the sedentary condition.
Conclusions: When matched for total duration, moderate-intensity endurance-type exercise represents a more effective strategy to improve daily blood glucose homeostasis than repeated bouts of ADL. Nevertheless, the introduction of repeated bouts of ADL during prolonged sedentary behavior forms a valuable strategy to improve postprandial glucose handling in patients with type 2 diabetes.
Trial registration: ClinicalTrials.gov NCT00945165.
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References
- Stratton IM. Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–412.
- Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality. The San Antonio Heart Study. Diabetes Care 1998;21:1167–1172
- Zoungas S, Chalmers J, Ninomiya T, et al. ADVANCE Collaborative Group Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia 2012;55:636–643
- Cavalot F, Petrelli A, Traversa M, et al. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 2006;91:813–819
- de Vegt F, Dekker JM, Ruhé HG, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia 1999;42:926–931
- Meigs JB, Nathan DM, D’Agostino RB, Sr, Wilson PW, Framingham Offspring Study Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study. Diabetes Care 2002;25:1845–1850
- Praet SF, Manders RJ, Meex RC, et al. Glycaemic instability is an underestimated problem in Type II diabetes. Clin Sci (Lond) 2006;111:119–126
- van Dijk JW, Manders RJ, Hartgens F, Stehouwer CD, Praet SF, van Loon LJ. Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients. Diabetes Res Clin Pract 2011;93:31–37
- Praet SF, van Loon LJ. Exercise: the brittle cornerstone of type 2 diabetes treatment. Diabetologia 2008;51:398–401
- Colberg SR, Sigal RJ, Fernhall B, et al. American College of Sports Medicine. American Diabetes Association Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010;33:e147–e167
- Goodyear LJ, Kahn BB. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med 1998;49:235–261
- Manders RJ, Van Dijk JW, van Loon LJ. Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc 2010;42:219–225
- Praet SF, Manders RJ, Lieverse AG, et al. Influence of acute exercise on hyperglycemia in insulin-treated type 2 diabetes. Med Sci Sports Exerc 2006;38:2037–2044
- van Dijk JW, Manders RJ, Tummers K, et al. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia 2012;55:1273–1282
- van Dijk JW, Tummers K, Stehouwer CD, Hartgens F, van Loon LJ. Exercise therapy in type 2 diabetes: is daily exercise required to optimize glycemic control? Diabetes Care 2012;35:948–954
- Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ. Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab 2012;14:575–577
- Mikus CR, Oberlin DJ, Libla J, Boyle LJ, Thyfault JP. Glycaemic control is improved by 7 days of aerobic exercise training in patients with type 2 diabetes. Diabetologia 2012;55:1417–1423
- MacDonald AL, Philp A, Harrison M, Bone AJ, Watt PW. Monitoring exercise-induced changes in glycemic control in type 2 diabetes. Med Sci Sports Exerc 2006;38:201–207
- Healy GN, Dunstan DW, Salmon J, et al. Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose. Diabetes Care 2007;30:1384–1389
- Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008;31:661–666
- Lunde MS, Hjellset VT, Høstmark AT. Slow post meal walking reduces the blood glucose response: an exploratory study in female Pakistani immigrants. J Immigr Minor Health 2012;14:816–822
- Nygaard H, Tomten SE, Høstmark AT. Slow postmeal walking reduces postprandial glycemia in middle-aged women. Appl Physiol Nutr Metab 2009;34:1087–1092
- Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care 2012;35:976–983
- American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl. 1):S62–S69
- Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 2011;43:1575–1581
- American Diabetes Association Standards of medical care in diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
- Nathan DM, Buse JB, Davidson MB, et al. American Diabetes Association. European Association for the Study of Diabetes Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2009;52:17–30
- Bode BW, Schwartz S, Stubbs HA, Block JE. Glycemic characteristics in continuously monitored patients with type 1 and type 2 diabetes: normative values. Diabetes Care 2005;28:2361–2366
- Grøntved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA 2011;305:2448–2455
- van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med 2012;172:494–500
- Sluik D, Buijsse B, Muckelbauer R, et al. Physical Activity and Mortality in Individuals With Diabetes Mellitus: a prospective study and meta-analysis. Arch Intern Med 2012;172:1285–1295
- Wannamethee SG, Shaper AG. Physical activity in the prevention of cardiovascular disease: an epidemiological perspective. Sports Med 2001;31:101–114
- van Wijck K, Lenaerts K, Grootjans J, et al. Physiology and pathophysiology of splanchnic hypoperfusion and intestinal injury during exercise: strategies for evaluation and prevention. Am J Physiol Gastrointest Liver Physiol 2012;303:G155–G168
- Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ, A1c-Derived Average Glucose Study Group Translating the A1C assay into estimated average glucose values. Diabetes Care 2008;31:1473–1478
- Dubé JJ, Allison KF, Rousson V, Goodpaster BH, Amati F. Exercise dose and insulin sensitivity: relevance for diabetes prevention. Med Sci Sports Exerc 2012;44:793–799
- Balducci S, Zanuso S, Cardelli P, et al. Italian Diabetes Exercise Study (IDES) Investigators Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS ONE 2012;7:e49297.
- Hansen D, Dendale P, Jonkers RA, et al. Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients. Diabetologia 2009;52:1789–1797
Source: PubMed