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Arevalo JA, Leija RG, Osmond AD, Curl CC, Duong JJ, Huie MJ, Masharani U, Brooks GA. Delayed and diminished postprandial lactate shuttling in healthy older men and women. Am J Physiol Endocrinol Metab 2024; 327:E430-E440. [PMID: 39110417 PMCID: PMC11482286 DOI: 10.1152/ajpendo.00183.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 09/19/2024]
Abstract
Lactate, a product of glycolysis, is formed under aerobic conditions. Extensive work has shown lactate flux in young and exercising humans; however, the effect of age is not known. We tested the hypothesis that postprandial lactate shuttling (PLS) would be diminished in older adults. We used [3-13C]lactate and [6,6-2H]glucose tracers, an oral glucose tolerance test (OGTT), and arterialized blood sampling to determine postprandial lactate rates of appearance (Ra), disappearance (Rd), and oxidation (Rox) in 15 young (28.1 ± 1.4 yr) and 13 older (70.6 ± 2.4 yr) healthy men and women. In young participants, fasting blood [lactate] (≈0.5 mM) rose after the glucose challenge, peaked at 15 min, dipped to a nadir at 30 min, and rose again peaking at 60 min (≈1.0 mM). Initial responses in lactate Ra of older participants were delayed and diminished until 90 min rising by 0.83 mg·kg-1·min-1. Lactate Rox was higher throughout the entire trial in young participants by a difference of ∼0.5 mg·kg-1·min-1. Initial peaks in lactate Ra and concentration in all volunteers demonstrated the presence of an enteric PLS following an OGTT. Notably, in the systemic, but not enteric, PLS phase, lactate Ra correlated highly with glucose Rd (r2 = 0.92). Correspondence of second peaks in lactate Ra and concentration and glucose Rd shows dependence of lactate Ra on glucose Rd. Although results show both enteric and systemic PLS phases in young and older study cohorts, metabolic responses were delayed and diminished in healthy older individuals.NEW & NOTEWORTHY We used isotope tracers, an oral glucose tolerance test, and arterialized blood sampling to determine postprandial lactate flux rates in healthy young and older men and women. Lactate rates of appearance and oxidation and the lactate-pyruvate exchange were delayed and diminished in both enteric and systemic postprandial lactate shuttle phases in older participants.
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Affiliation(s)
- Jose A. Arevalo
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Robert G. Leija
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Adam D. Osmond
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Casey C. Curl
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Justin J. Duong
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Melvin J. Huie
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
| | - Umesh Masharani
- Department of Medicine, University of California, San Francisco, United States
| | - George A. Brooks
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, United States
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Govette A, Gillen JB. At-home bodyweight interval exercise in the fed versus fasted state lowers postprandial glycemia and appetite perceptions in females. Appl Physiol Nutr Metab 2024; 49:1217-1227. [PMID: 38776559 DOI: 10.1139/apnm-2023-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Limited research has characterized the metabolic health benefits of bodyweight interval exercise (BWE) performed outside of a laboratory setting. Metabolic responses to exercise can also be influenced by meal timing around exercise, but the interactive effects of BWE and nutrition are unknown. This study investigated the effects of BWE performed in the fasted or fed state on postprandial glycemia, post-exercise fat oxidation and appetite perceptions. Twelve females (23 ± 2 years; 22 ± 2 kg/m2) underwent two virtually-monitored trials that involved completing BWE (10 × 1 min, 1 min recovery) 5 min before (FastEX) or beginning BWE 10 min after (FedEX) a standardized breakfast. Heart rate and rating of perceived exertion (RPE) were measured during exercise and capillary glucose concentrations were measured for 2 h postprandial. Following exercise, appetite perceptions were assessed and Lumen expired carbon dioxide percentage (L%CO2) was measured as an index of fat oxidation. Heart rate (85 ± 5%) and RPE (14 ± 2) did not differ between conditions (p > 0.05). Postprandial glucose mean (6.1 ± 0.6 vs. 6.8 ± 0.8 mmol/L, p = 0.03), peak (7.4 ± 1.2 vs. 8.5 ± 1.5 mmol/L, p = 0.01), and area under the curve (AUC) (758 ± 72 vs. 973 ± 82 mmol/L × 2 h, p = 0.004) were lower in FedEX versus FastEX. Appetite perceptions were lower in FedEX versus FastEX (-87.63 ± 58.51 vs. -42.06 ± 34.96 mm, p = 0.029). Post-exercise L%CO2 was transiently decreased 30 min post-exercise in both conditions (4.03 ± 0.38 vs. 4.29 ± 0.34%, p = 0.0023), reflective of increased fat oxidation following BWE. These findings demonstrate that BWE performed in the fed compared to the fasted state lowered postprandial glycemia and appetite perceptions in females.
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Affiliation(s)
- Alexa Govette
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Jenna B Gillen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
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McMillan DW, Kressler J, Jacobs KA, Nash MS. Substrate metabolism during recovery from circuit resistance exercise in persons with spinal cord injury. Eur J Appl Physiol 2021; 121:1631-1640. [PMID: 33655367 DOI: 10.1007/s00421-021-04629-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Whole body energy expenditure and lipid oxidation (Lox) are upregulated during and after exercise. Persons with spinal cord injury (SCI) generally have a blunted ability to utilize fat during exercise, but it is unknown if their substrate partitioning is affected during recovery from exercise. PURPOSE To determine the effect of a single session of upper body circuit resistance exercise (CRE) on energy expenditure and Lox during exercise recovery in persons with and without SCI. METHODS Twenty four persons (3 groups; 7 male and 1 female per group) without paralysis (neurologically intact; N) or with chronic (≥ 1 yr) paraplegia (P) or tetraplegia (T) participated. Energy expenditure and substrate partitioning were assessed via indirect calorimetry before, during, and three times after (up to 120 min after) a single session of CRE, or time-matched seated control (CON). RESULTS During CRE, all groups experienced a similar relative increase in oxygen consumption (49 ± 13, 55 ± 11, and 48 ± 15% VO2peak for N, P, and T, respectively). The Post0-120 energy expenditure was greater following CRE vs. CON (P < 0.01) and independent of injury characteristics (10.6, 22.6, and 14.3% higher than CON for N, P, and T; P = 0.21). The absolute increase in Lox above CON during recovery was similar for N, P, and T (5.74 ± 2.81, 6.62 ± 3.10, and 4.50 ± 3.91 g, respectively; P = 0.45). CONCLUSIONS Energy expenditure and lipid utilization was increased similarly following circuit exercise in persons without and with spinal cord injury in a manner independent of level of injury.
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Affiliation(s)
- David W McMillan
- The Miami Project To Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| | - Jochen Kressler
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Kevin A Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Miami, FL, USA
| | - Mark S Nash
- The Miami Project To Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Griffiths A, Deighton K, Shannon OM, Boos C, Rowe J, Matu J, King R, O'Hara JP. Appetite and energy intake responses to breakfast consumption and carbohydrate supplementation in hypoxia. Appetite 2020; 147:104564. [PMID: 31870935 DOI: 10.1016/j.appet.2019.104564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/17/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of experiment one was to determine the appetite, acylated ghrelin and energy intake response to breakfast consumption and omission in hypoxia and normoxia. Experiment two aimed to determine the appetite, acylated ghrelin and energy intake response to carbohydrate supplementation after both breakfast consumption and omission in hypoxia. METHODS In experiment one, twelve participants rested and exercised once after breakfast consumption and once after omission in normobaric hypoxia (4300 m: FiO2 ~11.7%) and normoxia. In experiment two, eleven participants rested and exercised in normobaric hypoxia (4300 m: FiO2 ~11.7%), twice after consuming a high carbohydrate breakfast and twice after breakfast omission. Participants consumed both a carbohydrate (1.2g·min-1 glucose) and a placebo beverage after breakfast consumption and omission. Measures of appetite perceptions and acylated ghrelin were taken at regular intervals throughout both experiments and an ad-libitum meal was provided post-exercise to quantify energy intake. RESULTS Breakfast consumption had no significant effect on post exercise energy intake or acylated ghrelin concentrations, despite reductions in appetite perceptions. As such, breakfast consumption increased total trial energy intake compared with breakfast omission in hypoxia (7136 ± 2047 kJ vs. 5412 ± 1652 kJ; p = 0.02) and normoxia (9276 ± 3058 vs. 6654 ± 2091 kJ; p < 0.01). Carbohydrate supplementation had no effect on appetite perceptions or acylated ghrelin concentrations after breakfast consumption or omission. As such, carbohydrate supplementation increased total energy intake after breakfast consumption (10222 ± 2831 kJ vs. 7695 ± 1970 kJ p < 0.01) and omission (8058 ± 2574 kJ vs. 6174 ± 2222 kJ p = 0.02). CONCLUSION Both breakfast consumption and carbohydrate supplementation provide beneficial dietary interventions for increasing energy intake in hypoxic conditions.
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Affiliation(s)
- Alex Griffiths
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
| | - Kevin Deighton
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
| | - Oliver M Shannon
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK; Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Leech Building, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Chris Boos
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK; Department of Cardiology, Poole Hospital NHS Trust, Poole, BH15 2JB, UK.
| | - Joshua Rowe
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
| | - Jamie Matu
- School of Clinical and Applied Science, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Roderick King
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
| | - John P O'Hara
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
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Kelly LP, Basset FA. Acute Normobaric Hypoxia Increases Post-exercise Lipid Oxidation in Healthy Males. Front Physiol 2017; 8:293. [PMID: 28567018 PMCID: PMC5434119 DOI: 10.3389/fphys.2017.00293] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/24/2017] [Indexed: 11/18/2022] Open
Abstract
The primary objective of the current study was to determine the effect of moderate normobaric hypoxia exposure during constant load cycling on post-exercise energy metabolism recorded in normoxia. Indirect calorimetry was used to examine whole body substrate oxidation before, during, 40–60 min post, and 22 h after performing 60 min of cycling exercise at two different fractions of inspired oxygen (FIO2): (i) FIO2 = 0.2091 (normoxia) and (ii) FIO2 = 0.15 (hypoxia). Seven active healthy male participants (26 ± 4 years of age) completed both experimental trials in randomized order with a 7-day washout period to avoid carryover effects between conditions. Resting energy expenditure was initially elevated following cycling exercise in normoxia and hypoxia (Δ 0.14 ± 0.05, kcal min−1, p = 0.037; Δ 0.19 ± 0.03 kcal min−1, p < 0.001, respectively), but returned to baseline levels the next morning in both conditions. Although, the same absolute workload was used in both environmental conditions (157 ± 10 W), a shift in resting substrate oxidation occurred after exercise performed in hypoxia while post-exercise measurements were similar to baseline after cycling exercise in normoxia. The additional metabolic stress of hypoxia exposure was sufficient to increase the rate of lipid oxidation (Δ 42 ± 11 mg min−1, p = 0.019) and tended to suppress carbohydrate oxidation (Δ −55 ± 26 mg min−1, p = 0.076) 40–60 min post-exercise. This shift in substrate oxidation persisted the next morning, where lipid oxidation remained elevated (Δ 9 ± 3 mg min−1, p = 0.0357) and carbohydrate oxidation was suppressed (Δ −22 ± 6 mg min−1, p = 0.019). In conclusion, prior exercise performed under moderate normobaric hypoxia alters post-exercise energy metabolism. This is an important consideration when evaluating the metabolic consequences of hypoxia exposure during prolonged exercise, and future studies should evaluate its role in the beneficial effects of intermittent hypoxia training observed in persons with obesity and insulin resistance.
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Affiliation(s)
- Liam P Kelly
- Faculty of Medicine, Memorial University of NewfoundlandSt. John's, NL, Canada.,School of Human Kinetics and Recreation, Memorial University of NewfoundlandSt. John's, NL, Canada
| | - Fabien A Basset
- School of Human Kinetics and Recreation, Memorial University of NewfoundlandSt. John's, NL, Canada
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Kato H, Nakano S, Inoue Y, Takeda T, Miura K, Nakamura T, Suzuki K, Bannai M. Greater Amino Acid Intake Is Required to Maximize Whole-Body Protein Synthesis Immediately after Endurance Exercise Than at Rest in Endurance-Trained Rats, as Determined by an Indicator Amino Acid Oxidation Method. J Nutr 2016; 146:1546-51. [PMID: 27358420 DOI: 10.3945/jn.115.226373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 05/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The indicator amino acid oxidation (IAAO) method has contributed to establishing protein and amino acid (AA) requirements by determining the optimal protein and AA intake that maximizes whole-body protein synthesis. However, it has not been used with endurance-trained subjects. OBJECTIVE This study aimed to determine the optimal AA intake immediately after endurance exercise and at rest in endurance-trained rats by using the IAAO method. METHODS Four-week-old male Fischer rats were divided into a sedentary (SED) group and a trained (TR) group, which underwent treadmill training 5 d/wk for 6 wk at 26 m/min for 60 min/d. On the metabolic trial day, half of the TR group was provided with test diets after daily treadmill running (TR-PostEx). The other half of the TR group (TR-Rest) and all of the SED group were provided with test diets while at rest. The test diets contained different amounts of AAs (3.3-37.3 g ⋅ kg(-1) ⋅ d(-1)). Phenylalanine in the test diet was replaced with L-[1-(13)C]phenylalanine. The phenylalanine oxidation rate (PheOx) was determined with (13)CO2 enrichment in breath, CO2 excretion rate, and enrichment of phenylalanine in blood during the feeding period. The optimal AA intake was determined with biphasic mixed linear regression crossover analysis for PheOx, which identified a breakpoint at the minimal PheOx in response to graded amounts of AA intake. RESULTS The optimal AA intake in the TR-PostEx group (26.8 g ⋅ kg(-1) ⋅ d(-1); 95% CI: 21.5, 32.1 g ⋅ kg(-1) ⋅ d(-1)) was significantly higher than in the SED (15.1 g ⋅ kg(-1) ⋅ d(-1); 95% CI: 11.1, 19.1 g ⋅ kg(-1) ⋅ d(-1)) and TR-Rest (13.3 g ⋅ kg(-1) ⋅ d(-1); 95% CI: 10.9, 15.7 g ⋅ kg(-1) ⋅ d(-1)) groups, which did not differ. CONCLUSIONS Greater AA intake is required to maximize whole-body protein synthesis immediately after endurance exercise than at rest, but not at rest in endurance-trained rats.
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Affiliation(s)
- Hiroyuki Kato
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Sayako Nakano
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Yoshiko Inoue
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Tomoko Takeda
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Kyoko Miura
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Taro Nakamura
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Katsuya Suzuki
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
| | - Makoto Bannai
- Frontier Research Laboratories, Institute for Innovation, Ajinomoto Co., Inc., Kawasaki, Kanagawa, Japan
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Beaulieu K, Olver TD, Abbott KC, Lemon PWR. Energy intake over 2 days is unaffected by acute sprint interval exercise despite increased appetite and energy expenditure. Appl Physiol Nutr Metab 2016; 40:79-86. [PMID: 25494974 DOI: 10.1139/apnm-2014-0229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A cumulative effect of reduced energy intake, increased oxygen consumption, and/or increased lipid oxidation could explain the fat loss associated with sprint interval exercise training (SIT). This study assessed the effects of acute sprint interval exercise (SIE) on energy intake, subjective appetite, appetite-related peptides, oxygen consumption, and respiratory exchange ratio over 2 days. Eight men (25 ± 3 years, 79.6 ± 9.7 kg, body fat 13% ± 6%; mean ± SD) completed 2 experimental treatments: SIE and recovery (SIEx) and nonexercise control. Each 34-h treatment consisted of 2 consecutive 10-h test days. Between 0800-1800 h, participants remained in the laboratory for 8 breath-by-breath gas collections, 3 buffet-type meals, 14 appetite ratings, and 4 blood samples for appetite-related peptides. Treatment comparisons were made using 2-way repeated measures ANOVA or t tests. An immediate, albeit short-lived (<1 h), postexercise suppression of appetite and increase in peptide YY (PYY) were observed (P < 0.001). However, overall hunger and motivation to eat were greater during SIEx (P < 0.02) without affecting energy intake. Total 34-h oxygen consumption was greater during SIEx (P = 0.04), elicited by the 1491-kJ (22%) greater energy expenditure over the first 24 h (P = 0.01). Despite its effects on oxygen consumption, appetite, and PYY, acute SIE did not affect energy intake. Consequently, if these dietary responses to SIE are sustained with regular SIT, augmentations in oxygen consumption and/or a substrate shift toward increased fat use postexercise are most likely responsible for the observed body fat loss with this type of exercise training.
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Affiliation(s)
- Kristine Beaulieu
- a Exercise Nutrition Research Laboratory, School of Kinesiology, The University of Western Ontario, London, ON N6A 5B9, Canada
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Glenn TC, Martin NA, Horning MA, McArthur DL, Hovda DA, Vespa P, Brooks GA. Lactate: brain fuel in human traumatic brain injury: a comparison with normal healthy control subjects. J Neurotrauma 2015; 32:820-32. [PMID: 25594628 PMCID: PMC4530406 DOI: 10.1089/neu.2014.3483] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We evaluated the hypothesis that lactate shuttling helps support the nutritive needs of injured brains. To that end, we utilized dual isotope tracer [6,6-(2)H2]glucose, that is, D2-glucose, and [3-(13)C]lactate techniques involving arm vein tracer infusion along with simultaneous cerebral (arterial [art] and jugular bulb [JB]) blood sampling. Traumatic brain injury (TBI) patients with nonpenetrating brain injuries (n=12) were entered into the study following consent of patients' legal representatives. Written and informed consent was obtained from control volunteers (n=6). Patients were studied 5.7±2.2 (mean±SD) days post-injury; during periods when arterial glucose concentration tended to be higher in TBI patients. As in previous investigations, the cerebral metabolic rate for glucose (CMRgluc, i.e., net glucose uptake) was significantly suppressed following TBI (p<0.001). However, lactate fractional extraction, an index of cerebral lactate uptake related to systemic lactate supply, approximated 11% in both healthy control subjects and TBI patients. Further, neither the CMR for lactate (CMRlac, i.e., net lactate release), nor the tracer-measured cerebral lactate uptake differed between healthy controls and TBI patients. The percentages of lactate tracer taken up and released as (13)CO2 into the JB accounted for 92% and 91% for control and TBI conditions, respectively, suggesting that most cerebral lactate uptake was oxidized following TBI. Comparisons of isotopic enrichments of lactate oxidation from infused [3-(13)C]lactate tracer and (13)C-glucose produced during hepatic and renal gluconeogenesis (GNG) showed that 75-80% of (13)CO2 released into the JB was from lactate and that the remainder was from the oxidation of glucose secondarily labeled from lactate. Hence, either directly as lactate uptake, or indirectly via GNG, peripheral lactate production accounted for ∼70% of carbohydrate (direct lactate uptake+uptake of glucose from lactate) consumed by the injured brain. Undiminished cerebral lactate fractional extraction and uptake suggest that arterial lactate supplementation may be used to compensate for decreased CMRgluc following TBI.
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Affiliation(s)
- Thomas C. Glenn
- UCLA Cerebral Blood Flow Laboratory, Los Angeles, California
- Department of Neurosurgery, UCLA Center for Health Sciences, Los Angeles, California
| | - Neil A. Martin
- UCLA Cerebral Blood Flow Laboratory, Los Angeles, California
- Department of Neurosurgery, UCLA Center for Health Sciences, Los Angeles, California
| | - Michael A. Horning
- Department of Integrative Biology, University of California, Berkeley, California
| | | | - David A. Hovda
- UCLA Cerebral Blood Flow Laboratory, Los Angeles, California
| | - Paul Vespa
- UCLA Cerebral Blood Flow Laboratory, Los Angeles, California
| | - George A. Brooks
- Department of Integrative Biology, University of California, Berkeley, California
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Henderson GC. Sexual dimorphism in the effects of exercise on metabolism of lipids to support resting metabolism. Front Endocrinol (Lausanne) 2014; 5:162. [PMID: 25339941 PMCID: PMC4188128 DOI: 10.3389/fendo.2014.00162] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022] Open
Abstract
Exercise training is generally a healthful activity and an effective intervention for reducing the risk of numerous chronic diseases including cardiovascular disease and diabetes. This is likely both a result of prevention of weight gain over time and direct effects of exercise on metabolism of lipids and the other macronutrient classes. Importantly, a single bout of exercise can alter lipid metabolism and metabolic rate for hours and even into the day following exercise, so individuals who regularly exercise, even if not performed every single day, overall could experience a substantial change in their resting metabolism that would reduce risk for metabolic diseases. However, resting metabolism does not respond similarly in all individuals to exercise participation, and indeed gender or sex is a major determinant of the response of resting lipid metabolism to prior exercise. In order to fully appreciate the metabolic effects and health benefits of exercise, the differences between men and women must be considered. In this article, the differences in the effects of exercise on resting metabolic rate, fuel selection after exercise, as well as the shuttling of triglyceride and fatty acids between tissues are discussed. Furthermore, concepts related to sex differences in the precision of homeostatic control and sex differences in the integration of metabolism between various organs are considered.
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Affiliation(s)
- Gregory C. Henderson
- Department of Exercise Science, Rutgers Center for Lipid Research, Rutgers University, New Brunswick, NJ, USA
- *Correspondence: Gregory C. Henderson, Department of Exercise Science, Rutgers Center for Lipid Research, Rutgers University, 70 Lipman Drive, Loree Building, New Brunswick, NJ 08901, USA e-mail:
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Henderson GC, Alderman BL. Determinants of resting lipid oxidation in response to a prior bout of endurance exercise. J Appl Physiol (1985) 2013; 116:95-103. [PMID: 24235102 DOI: 10.1152/japplphysiol.00956.2013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A single bout of exercise can alter subsequent resting metabolism for many hours and into the next day. However, differences between men and women, effects of nutritional state, and relative effects of resting metabolic rate (RMR) and respiratory exchange ratio (RER) in controlling the increase in lipid oxidation (Lox) after exercise are not yet clear. Effects of aerobic capacity (Vo2 peak) and exercise bout parameters (intensity and volume) also remain to be clearly elucidated as does the time course of changes after exercise. We performed a meta-analysis to assess these potential moderators of the impact of endurance exercise [effect sizes (ESs)] on subsequent Lox at rest (ES = 0.91; 95% CI: 0.69-1.12), on the day of exercise (ES = 1.22; 95% CI: 0.89-1.55), and on the following day (ES = 0.60; 95% CI: 0.35-0.85). ES for the exercise-related increase in resting Lox was significantly greater in men than women in the postabsorptive state but similar in the postprandial state. The ES for depression of RER after exercise was similar between men and women, while the ES for RMR in the postabsorptive state tended to be higher in men than women. Finally, Vo2 peak and exercise energy expenditure (EEE), but not intensity, were predictive of postexercise Lox. The findings indicate importance of EEE and fitness for ability to achieve robust enhancement of Lox after exercise. The results additionally indicate a gender difference in postexercise Lox that is dependent on nutritional state, as the ES for Lox was lower in women only in the postabsorptive state.
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Affiliation(s)
- Gregory C Henderson
- Department of Exercise Science and Sport Studies, Rutgers University, New Brunswick, New Jersey
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Abstract
Human muscles, limbs and supporting ventilatory, cardiovascular, and metabolic systems are well adapted for walking, and there is reasonable transfer of efficiency of movement to bicycling. Our efficiency and economy of movement of bipedal walking (≈30%) are far superior to those of apes. This overall body efficiency during walking and bicycling represents the multiplicative interaction of a phosphorylative coupling efficiency of ≈60%, and a mechanical coupling efficiency of ≈50%. These coupling efficiencies compare well with those of other species adapted for locomotion. We are capable runners, but our speed and power are inferior to carnivorous and omnivorous terrestrial mammalian quadrupeds because of biomechanical and physiological constraints. But, because of our metabolic plasticity (i.e., the ability to switch among carbohydrate (CHO)- and lipid-derived energy sources) our endurance capacity is very good by comparison to most mammals, but inferior to highly adapted species such as wolves and migratory birds. Our ancestral ability for hunting and gathering depends on strategy and capabilities in the areas of thermoregulation, and metabolic plasticity. Clearly, our competitive advantage of survival in the biosphere depends in intelligence and behavior. Today, those abilities that served early hunter-gatherers make for interesting athletic competitions due to wide variations in human phenotypes. In contemporary society, the stresses of regular physical exercise serve to minimize morbidities and mortality associated with physical inactivity, overnutrition, and aging.
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Affiliation(s)
- George A Brooks
- Department of Integrative Biology, University of California, Berkeley, California, USA.
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12
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Emhoff CAW, Messonnier LA, Horning MA, Fattor JA, Carlson TJ, Brooks GA. Direct and indirect lactate oxidation in trained and untrained men. J Appl Physiol (1985) 2013; 115:829-38. [PMID: 23788576 DOI: 10.1152/japplphysiol.00538.2013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lactate has been shown to be an important oxidative fuel. We aimed to quantify the total lactate oxidation rate (Rox) and its direct vs. indirect (glucose that is gluconeogenically derived from lactate and subsequently oxidized) components (mg·kg(-1)·min(-1)) during rest and exercise in humans. We also investigated the effects of endurance training, exercise intensity, and blood lactate concentration ([lactate]b) on direct and indirect lactate oxidation. Six untrained (UT) and six trained (T) men completed 60 min of constant load exercise at power outputs corresponding to their lactate threshold (LT). T subjects completed two additional 60-min sessions of constant load exercise at 10% below the LT workload (LT-10%), one of which included a lactate clamp (LC; LT-10%+LC). Rox was higher at LT in T [22.7 ± 2.9, 75% peak oxygen consumption (Vo2peak)] compared with UT (13.4 ± 2.5, 68% Vo2peak, P < 0.05). Increasing [lactate]b (LT-10%+LC, 67% Vo2peak) significantly increased lactate Rox (27.9 ± 3.0) compared with its corresponding LT-10% control (15.9 ± 2.2, P < 0.05). Direct and indirect Rox increased significantly from rest to exercise, and their relative partitioning remained constant in all trials but differed between T and UT: direct oxidation comprised 75% of total lactate oxidation in UT and 90% in T, suggesting the presence of training-induced adaptations. Partitioning of total carbohydrate (CHO) use showed that subjects derived one-third of CHO energy from blood lactate, and exogenous lactate infusion increased lactate oxidation significantly, causing a glycogen-sparing effect in exercising muscle.
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Affiliation(s)
- Chi-An W Emhoff
- Department of Integrative Biology, University of California, Berkeley, California
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Davitt PM, Arent SM, Tuazon MA, Golem DL, Henderson GC. Postprandial triglyceride and free fatty acid metabolism in obese women after either endurance or resistance exercise. J Appl Physiol (1985) 2013; 114:1743-54. [PMID: 23580597 DOI: 10.1152/japplphysiol.00095.2013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We investigated the effects of two exercise modalities on postprandial triglyceride (TG) and free fatty acid (FFA) metabolism. Sedentary, obese women were studied on three occasions in randomized order: endurance exercise for 60 min at 60-65% aerobic capacity (E), ~60 min high-intensity resistance exercise (R), and a sedentary control trial (C). After exercise, a liquid-mixed meal containing [U-(13)C]palmitate was consumed, and subjects were studied over 7 h. Isotopic enrichment (IE) of plasma TG, plasma FFA, and breath carbon dioxide compared with meal IE indicated the contribution of dietary fat to each pool. Total and endogenously derived plasma TG content was reduced significantly in both E and R compared with C (P < 0.05), with no effect of exercise on circulating exogenous (meal-derived) TG content. Exogenous plasma FFA content was increased significantly following both E and R compared with C (P < 0.05), whereas total and endogenous FFA concentrations were elevated only in E (P < 0.05) compared with C. Fatty acid (FA) oxidation rates were increased significantly after E and R compared with C (P < 0.05), with no difference between exercise modalities. The present results indicate that E and R may be equally effective in reducing postprandial plasma TG concentration and enhancing lipid oxidation when the exercise sessions are matched for duration rather than for energy expenditure. Importantly, tracer results indicated that the reduction in postprandial lipemia after E and R exercise bouts is not achieved by enhanced clearance of dietary fat but rather, is achieved by reduced abundance of endogenous FA in plasma TG.
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Affiliation(s)
- Patrick M Davitt
- Department of Exercise Science and Sport Studies, Rutgers University, New Brunswick, New Jersey 08901, USA
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Chenevière X, Borrani F, Droz D, Gojanovic B, Malatesta D. Effects of 2 different prior endurance exercises on whole-body fat oxidation kinetics: light vs. heavy exercise. Appl Physiol Nutr Metab 2012; 37:955-64. [DOI: 10.1139/h2012-076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to compare the effects of 2 different prior endurance exercises on subsequent whole-body fat oxidation kinetics. Fifteen men performed 2 identical submaximal incremental tests (Incr2) on a cycle ergometer after (i) a ∼40-min submaximal incremental test (Incr1) followed by a 90-min continuous exercise performed at 50% of maximal aerobic power-output and a 1-h rest period (Heavy); and (ii) Incr1 followed by a 2.5-h rest period (Light). Fat oxidation was measured using indirect calorimetry and plotted as a function of exercise intensity during Incr1 and Incr2. A sinusoidal equation, including 3 independent variables (dilatation, symmetry and translation), was used to characterize the fat oxidation kinetics and to determine the intensity (Fatmax) that elicited the maximal fat oxidation (MFO) during Incr. After the Heavy and Light trials, Fatmax, MFO, and fat oxidation rates were significantly greater during Incr2 than Incr1 (p < 0.001). However, Δ (i.e., Incr2–Incr1) Fatmax, MFO, and fat oxidation rates were greater in the Heavy compared with the Light trial (p < 0.05). The fat oxidation kinetics during Incr2Heavy showed a greater dilatation and rightward asymmetry than Incr1Heavy, whereas only a greater dilatation was observed in Incr2Light (p < 0.05). This study showed that although to a lesser extent in the Light trial, both prior exercise sessions led to an increase in Fatmax, MFO, and absolute fat oxidation rates during Incr2, inducing significant changes in the shape of the fat oxidation kinetics.
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Affiliation(s)
- Xavier Chenevière
- Institute of Sport Sciences (ISSUL), Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Bâtiment de Vidy, 1015 Lausanne, Switzerland
| | - Fabio Borrani
- Institute of Sport Sciences (ISSUL), Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Bâtiment de Vidy, 1015 Lausanne, Switzerland
- Department of Sport and Exercise Science, University of Auckland, Auckland 1142, New Zealand
| | - David Droz
- Institute of Sport Sciences (ISSUL), Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Bâtiment de Vidy, 1015 Lausanne, Switzerland
| | - Boris Gojanovic
- Department of Locomotion, CHUV, Avenue Pierre Decker 4, 1011 Lausanne, Switzerland
| | - Davide Malatesta
- Institute of Sport Sciences (ISSUL), Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Bâtiment de Vidy, 1015 Lausanne, Switzerland
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Johnson ML, Zarins Z, Fattor JA, Horning MA, Messonnier L, Lehman SL, Brooks GA. Twelve weeks of endurance training increases FFA mobilization and reesterification in postmenopausal women. J Appl Physiol (1985) 2010; 109:1573-81. [PMID: 20651217 DOI: 10.1152/japplphysiol.00116.2010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We examined the effects of exercise intensity and training on rates of lipolysis, plasma free fatty acid (FFA) appearance (R(a)), disappearance (R(d)), reesterification (R(s)), and oxidation (R(oxP)) in postmenopausal (PM) women. Ten sedentary but healthy women (55 ± 0.6 yr) completed 12 wk of supervised endurance exercise training on a cycle ergometer [5 days/wk, 1 h/day, 65% peak oxygen consumption (Vo(2peak))]. Flux rates were determined by continuous infusion of [1-(13)C]palmitate and [1,1,2,3,3-(2)H(5)]glycerol during 90 min of rest and 60 min of cycle ergometer exercise during one pretraining exercise trial [65% Vo(2peak) (PRE)] and two posttraining exercise trials [at power outputs that elicited 65% pretraining Vo(2peak) (absolute training; ABT) and 65% posttraining Vo(2peak) (relative training; RLT)]. Initial body weights (68.2 ± 4.5 kg) were maintained over the course of study. Training increased Vo(2peak) by 16.3 ± 3.9% (P < 0.05) (Zarins ZA, Wallis GA, Faghihnia N, Johnson ML, Fattor JA, Horning MA and Brooks GA. Metabolism 58: 9: 1338-1346, 2009). Glycerol R(a) and R(d) were elevated in the RLT trial (P < 0.05), but not the ABT trial after training. Rates of plasma FFA R(a), R(d), and R(oxP) were elevated during the ABT compared with PRE trial (P < 0.05). FFA R(s) accounted for most (50-70%) of R(d) during exercise; training reduced FFA R(s) during ABT, but not RLT compared with PRE. We conclude that, despite the large age-related decrease in metabolic scope in PM women, endurance training increases the capacities for FFA mobilization and oxidation during exercises of a given power output. However, after menopause, total lipid oxidation capacity remains low, with reesterification accounting for most of FFA R(d).
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Affiliation(s)
- M L Johnson
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, Berkeley, CA 94720-3140, USA.
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Henderson GC, Nadeau D, Horton ES, Nair KS. Effects of adiposity and 30 days of caloric restriction upon protein metabolism in moderately vs. severely obese women. Obesity (Silver Spring) 2010; 18:1135-42. [PMID: 20134416 PMCID: PMC2877146 DOI: 10.1038/oby.2009.505] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Protein metabolism adapts during caloric restriction (CR) to minimize protein loss, and it is unclear whether greater fat stores favorably affect this response. We sought to determine whether protein metabolism is related to degree of obesity and whether the response to CR is impacted by pre-CR adiposity level. Whole body protein metabolism was studied in 12 obese women over a wide range of BMI (30-53 kg/m(2)) as inpatients using [1-(13)C]leucine as a tracer following 5 days of a weight-maintaining diet and then after 30 days of CR (1,400 kcal deficit with maintained protein intake). When expressed as total rates, per body weight (BW) or per fat-free mass (FFM), leucine rate of appearance (Ra), and nonoxidative leucine disposal (NOLD) were significantly higher in the individuals with a greater degree of obesity (P < 0.05). Leucine oxidation (Rox) was also higher in more highly obese women when expressed as a total rate (P < 0.05) but not if expressed per BW or FFM. CR reduced BW, FFM, and fat mass (P < 0.001), and declines were relatively similar between individuals. CR reduced Ra (P < 0.001), NOLD (P < 0.01), and Rox (P < 0.05), and the relative decline was not affected by differences in fat mass. CR-induced declines were significant even when Ra and NOLD were normalized to BW or FFM. We conclude that fat mass, like FFM, is a key determinant of protein turnover. However, during CR, higher fat mass does not favorably alter the response of protein metabolism and does not mitigate the loss of FFM.
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Plasma triglyceride concentrations are rapidly reduced following individual bouts of endurance exercise in women. Eur J Appl Physiol 2010; 109:721-30. [PMID: 20217117 PMCID: PMC2883923 DOI: 10.1007/s00421-010-1409-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2010] [Indexed: 12/05/2022]
Abstract
It is known that chronic endurance training leads to improvements in the lipoprotein profile, but less is known about changes that occur during postexercise recovery acutely. We analyzed triglyceride (TG), cholesterol classes and apolipoproteins in samples collected before, during and after individual moderate- and hard-intensity exercise sessions in men and women that were isoenergetic between intensities. Young healthy men (n = 9) and young healthy women (n = 9) were studied under three different conditions with diet unchanged between trials: (1) before, during and 3 h after 90 min of exercise at 45% VO2peak (E45); (2) before, during and 3 h after 60 min of exercise at 65% VO2peak (E65), and (3) in a time-matched sedentary control trial (C). At baseline, high-density lipoprotein cholesterol (HDL-C) was higher in women than men (P < 0.05). In men and in women, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), HDL-C, apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), and LDL peak particle size were unaltered by exercise either during exertion or after 3 h of recovery. In women, but not in men, average plasma TG was significantly reduced below C at 3 h postexercise by approximately 15% in E45 and 25% in E65 (P < 0.05) with no significant difference between exercise intensities. In summary, plasma TG concentration rapidly declines following exercise in women, but not in men. These results demonstrate an important mechanism by which each individual exercise session may incrementally reduce the risk for cardiovascular disease (CVD) in women.
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Henderson GC, Fattor JA, Horning MA, Faghihnia N, Johnson ML, Luke-Zeitoun M, Brooks GA. Glucoregulation is more precise in women than in men during postexercise recovery. Am J Clin Nutr 2008; 87:1686-94. [PMID: 18541557 DOI: 10.1093/ajcn/87.6.1686] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The regulation of glycemia is challenged in healthy men and women after exercise bouts of substantial energy expenditure. OBJECTIVE We determined rates of glucose appearance (Ra), disappearance (Rd), and metabolic clearance (MCR) before, during, and after isoenergetic moderate and hard-intensity exercise. DESIGN Ten men and 8 women received primed-continuous infusion of [6,6-(2)H(2)]glucose tracer to measure glucose kinetics. Participants were studied under 3 different conditions with diet unchanged between trials: 1) before, during, and 3 h after 90 min of exercise at 45% of peak oxygen consumption (VO(2)peak; E45); 2) before, during, and 3 h after 60 min of exercise at 65% VO(2)peak (E65), and 3) in a time-matched sedentary control trial. RESULTS In men and women, Ra, Rd, and MCR increased above the control trial during exercise and were higher in E65 than in E45 (P < 0.05). Average Ra, Rd, and MCR remained elevated above the control over 3 h of postexercise recovery in men after exercise in E45 and E65 (P < 0.05), and blood glucose concentrations were depressed below the control during recovery (P < 0.05). Glucose concentrations were not depressed in women during 3 h of postexercise recovery, and in contrast with that in men, average Ra and Rd did not remain significantly elevated during postexercise recovery in women, although MCR did remain elevated in E65 (P < 0.05). CONCLUSIONS After exercise bouts, women are better able to maintain glucose concentrations at sedentary control levels, thus not requiring the counter-regulation of glucose production that is seen in men and requiring less accentuation of lipid metabolism.
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Affiliation(s)
- Gregory C Henderson
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, CA 94720-3140, USA
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Henderson GC, Fattor JA, Horning MA, Faghihnia N, Johnson ML, Mau TL, Luke-Zeitoun M, Brooks GA. Lipolysis and fatty acid metabolism in men and women during the postexercise recovery period. J Physiol 2007; 584:963-81. [PMID: 17855762 PMCID: PMC2277001 DOI: 10.1113/jphysiol.2007.137331] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We sought to determine whether lipolysis, fatty acid (FA) mobilization, and plasma FA oxidation would remain elevated for hours following isoenergetic exercise bouts of different intensities. Ten men and eight women received a primed-continuous infusion of [1,1,2,3,3-(2)H(5)]glycerol and continuous infusion of [1-(13)C]palmitate to measure glycerol and plasma FA kinetics. On Day 1 (D1), participants were studied under one of three different conditions, assigned in random order: (1) before, during and 3 h after 90 min of exercise at 45% V(O2)peak (E45), (2) before, during and 3 h after 60 min of exercise at 65% V(O2)peak (E65), and (3) in a time-matched sedentary control trial (C). For each condition, participants were studied by indirect calorimetry the following morning as well (D2). Rate of appearance (Ra) of glycerol (Ra(GL)) increased above C during exercise in men and women (P < 0.05), was higher in E45 than E65 in men (P < 0.05), and was not different between exercise intensities in women. During 3 h of postexercise recovery, Ra(GL) remained significantly elevated in men (P < 0.05), but not women. FA Ra (Ra(FA)) increased during exercise in men and women and was higher in E45 than E65 (P < 0.05), and remained elevated during 3 h of postexercise recovery in both sexes (P < 0.05), but with a greater relative increase in men than women (P < 0.05). Plasma FA oxidation (Rox) increased during exercise with no difference between intensities, and it remained elevated during 3 h of postexercise recovery in both sexes (P < 0.05). Total lipid oxidation (Lox) was elevated in both sexes (P < 0.05), but more in men during 3 h of postexercise recovery on D1 (P < 0.05) and remained elevated on D2 in men (P < 0.05), but not in women. There were no differences between E45 and E65 for postexercise energy substrate turnover or oxidation in men and women as energy expenditure of exercise (EEE) was matched between bouts. We conclude that the impact of exercise upon lipid metabolism persists into recovery, but that women depend more on lipid during exercise whereas, during recovery, lipid metabolism is accentuated to a greater extent in men.
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Affiliation(s)
- Gregory C Henderson
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California, Berkeley, CA 94720-3140, USA
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