1
|
Yardley JE, Govette A, Laesser CI, Lespagnol É, Logan JE, Sim JAP, Talbo MK, Prévost MS, Perry T, von Zezschwitz JD, Bally L, Brazeau AS, Heyman E, Jung ME, Peters TM, Zaharieva DP, Gillen JB. Sex influences health: reporting on female characteristics should be mandatory in exercise and physical activity-related diabetes research. Diabetologia 2024; 67:209-210. [PMID: 37794258 DOI: 10.1007/s00125-023-06022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
| | - Alexa Govette
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Céline I Laesser
- Department of Pediatrics, Division of Pediatric Endocrinology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Élodie Lespagnol
- Pluridisciplinary Sport Health and Society Research Unit (URePSSS), Lille University, Artois University, University of the Littoral Côte d'Opale, Lille, France
| | - Jessica E Logan
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jenna A P Sim
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Meryem K Talbo
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, QC, Canada
| | | | | | - Jasmin D von Zezschwitz
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
- Institute of Nutritional Medicine, University of Luebeck, Luebeck, Germany
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anne-Sophie Brazeau
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, QC, Canada
| | - Elsa Heyman
- Pluridisciplinary Sport Health and Society Research Unit (URePSSS), Lille University, Artois University, University of the Littoral Côte d'Opale, Lille, France
- University Institute of France (IUF), Paris, France
| | - Mary E Jung
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Tricia M Peters
- Division of Endocrinology, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
| | - Dessi P Zaharieva
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Jenna B Gillen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Helleputte S, Yardley JE, Scott SN, Stautemas J, Jansseune L, Marlier J, De Backer T, Lapauw B, Calders P. Effects of postprandial exercise on blood glucose levels in adults with type 1 diabetes: a review. Diabetologia 2023:10.1007/s00125-023-05910-x. [PMID: 37014379 DOI: 10.1007/s00125-023-05910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
People with type 1 diabetes experience challenges in managing blood glucose around exercise. Previous studies have examined glycaemic responses to different exercise modalities but paid little attention to participants' prandial state, although this is an important consideration and will enhance our understanding of the effects of exercise in order to improve blood glucose management around activity. This review summarises available data on the glycaemic effects of postprandial exercise (i.e. exercise within 2 h after a meal) in people with type 1 diabetes. Using a search strategy on electronic databases, literature was screened until November 2022 to identify clinical trials evaluating acute (during exercise), subacute (≤2 h after exercise) and late (>2 h to ≤24 h after exercise) effects of postprandial exercise in adults with type 1 diabetes. Studies were systematically organised and assessed by exercise modality: (1) walking exercise (WALK); (2) continuous exercise of moderate intensity (CONT MOD); (3) continuous exercise of high intensity (CONT HIGH); and (4) interval training (intermittent high-intensity exercise [IHE] or high-intensity interval training [HIIT]). Primary outcomes were blood glucose change and hypoglycaemia occurrence during and after exercise. All study details and results per outcome were listed in an evidence table. Twenty eligible articles were included: two included WALK sessions, eight included CONT MOD, seven included CONT HIGH, three included IHE and two included HIIT. All exercise modalities caused consistent acute glycaemic declines, with the largest effect size for CONT HIGH and the smallest for HIIT, depending on the duration and intensity of the exercise bout. Pre-exercise mealtime insulin reductions created higher starting blood glucose levels, thereby protecting against hypoglycaemia, in spite of similar declines in blood glucose during activity between the different insulin reduction strategies. Nocturnal hypoglycaemia occurred after higher intensity postprandial exercise, a risk that could be diminished by a post-exercise snack with concomitant bolus insulin reduction. Research on the optimal timing of postprandial exercise is inconclusive. In summary, individuals with type 1 diabetes exercising postprandially should substantially reduce insulin with the pre-exercise meal to avoid exercise-induced hypoglycaemia, with the magnitude of the reduction depending on the exercise duration and intensity. Importantly, pre-exercise blood glucose and timing of exercise should be considered to avoid hyperglycaemia around exercise. To protect against late-onset hypoglycaemia, a post-exercise meal with insulin adjustments might be advisable, especially for exercise in the evening or with a high-intensity component.
Collapse
Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Flanders, Belgium.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Sam N Scott
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Jan Stautemas
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laura Jansseune
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joke Marlier
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
McClure RD, Alcántara-Cordero FJ, Weseen E, Maldaner M, Hart S, Nitz C, Boulé NG, Yardley JE. Systematic Review and Meta-analysis of Blood Glucose Response to High-intensity Interval Exercise in Adults With Type 1 Diabetes. Can J Diabetes 2023; 47:171-179. [PMID: 36549943 DOI: 10.1016/j.jcjd.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Exercise-induced hyperglycemia is recognized in type 1 diabetes (T1D) clinical guidelines, but its association with high-intensity intermittent exercise (HIIE) in acute studies is inconsistent. In this meta-analysis, we examined the available evidence of blood glucose responses to HIIE in adults with T1D. The secondary, aim was to examine predictors of blood glucose responses to HIIE. We hypothesized that there would be no consistent effect on blood glucose from HIIE, unless examined in the context of participant prandial status. METHODS We conducted a literature search using key words related to T1D and HIIE. Studies were required to include at least 6 participants with T1D with a mean age >18 years, involve an HIIE intervention, and contain pre- and postexercise measures of blood glucose. Analyses of extracted data were performed using a general inverse variance statistical method with a random effects model and a weighted multiple regression. RESULTS Nineteen interventions from 15 reports were included in the analysis. A mean overall blood glucose decrease of -1.3 mmol/L (95% confidence interval [CI], -2.3 to -0.2 mmol/L) was found during exercise, albeit with high heterogeneity (I2=84%). When performed after an overnight fast, exercise increased blood glucose by +1.7 mmol/L (95% CI, 0.4 to 3.0 mmol/L), whereas postprandial exercise decreased blood glucose by -2.1 mmol/L (95% CI, -2.8 to -1.4 mmol/L), with a statistically significant difference between groups (p<0.0001). No associations with fitness (p=0.4), sex (p=0.4), age (p=0.9), exercise duration (p=0.9), or interval duration (p=0.2) were found. CONCLUSION The effect of HIIE on blood glucose is inconsistent, but partially explained by prandial status.
Collapse
Affiliation(s)
- Reid D McClure
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | | | - Emma Weseen
- Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Miranda Maldaner
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Sarah Hart
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Corbin Nitz
- Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada; Alberta Diabetes Institute, Edmonton, Alberta, Canada; Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
Yardley JE. Exercise and Diabetes: A Moving Target? Can J Diabetes 2023; 47:115-116. [PMID: 36858716 DOI: 10.1016/j.jcjd.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada.
| |
Collapse
|
5
|
Toor S, Yardley JE, Momeni Z. Type 1 Diabetes and the Menstrual Cycle: Where/How Does Exercise Fit in? Int J Environ Res Public Health 2023; 20:2772. [PMID: 36833469 PMCID: PMC9957258 DOI: 10.3390/ijerph20042772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Regular exercise is associated with substantial health benefits for individuals with type 1 diabetes (T1D). However, the fear of hypoglycemia (low blood glucose) due to activity-induced declines in blood glucose levels acts as a major barrier to partaking in exercise in this population. For females with T1D, hormonal fluctuations during the menstrual cycle and their effects on blood glucose levels can act as an additional barrier. The impact that these cyclic changes may have on blood glucose and insulin needs and the consequent risk of hypoglycemia during or after exercise are still unknown in this population. Therefore, in this narrative review, we gathered existing knowledge about the menstrual cycle in T1D and the effects of different cyclic phases on substrate metabolism and glucose response to exercise in females with T1D to increase knowledge and understanding around exercise in this underrepresented population. This increased knowledge in such an understudied area can help to better inform exercise guidelines for females with T1D. It can also play an important role in eliminating a significant barrier to exercise in this population, which has the potential to increase activity, improve mental health and quality of life, and decrease the risk of diabetes-related complications.
Collapse
Affiliation(s)
- Saru Toor
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Immunology and Infection Program, Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Jane E. Yardley
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Zeinab Momeni
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
6
|
Momeni Z, Boulé NG, Prado CM, Hinz HA, Yardley JE. The Effect of Starting Blood Glucose Levels on Serum Electrolyte Concentrations during and after Exercise in Type 1 Diabetes. Int J Environ Res Public Health 2023; 20:2109. [PMID: 36767477 PMCID: PMC9915529 DOI: 10.3390/ijerph20032109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Fear of hypoglycemia is a major exercise barrier for people with type 1 diabetes (PWT1D). Consequently, although guidelines recommend starting exercise with blood glucose (BG) concentration at 7-10 mmol/L, PWT1D often start higher, potentially affecting hydration and serum electrolyte concentrations. To test this, we examined serum and urine electrolyte concentrations during aerobic exercise (cycling 45 min at 60%VO2peak) in 12 PWT1D (10F/2M, mean ± SEM: age 29 ± 2.3 years, VO2peak 37.9 ± 2.2 mL·kg-1·min-1) with starting BG levels: 8-10 (MOD), and 12-14 (HI) mmol/L. Age, sex, and fitness-matched controls without diabetes (CON) completed one exercise session with BG in the normal physiological range. Serum glucose was significantly higher during exercise and recovery in HI versus MOD (p = 0.0002 and p < 0.0001, respectively) and in MOD versus CON (p < 0.0001). During exercise and recovery, MOD and HI were not significantly different in serum insulin (p = 0.59 and p = 0.63), sodium (p = 0.058 and p = 0.08), potassium (p = 0.17 and p = 0.16), calcium (p = 0.75 and 0.19), and magnesium p = 0.24 and p = 0.09). Our findings suggest that exercise of moderate intensity and duration with higher BG levels may not pose an immediate risk to hydration or serum electrolyte concentrations for PWT1D.
Collapse
Affiliation(s)
- Zeinab Momeni
- Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Normand G. Boulé
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
| | - Carla M. Prado
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Human Nutrition Research Unit, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Agricultural, Life and Environmental Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Heather A. Hinz
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
| | - Jane E. Yardley
- Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
| |
Collapse
|
7
|
Vlcek C, Greenberg D, Yardley JE, Klaprat N, MacIntosh A, Greenberg M, Brandt J, Gregoire N, Dostie S, Boutin D, Pow C, Archibald M, McGavock J. "How we do it": A qualitative study of strategies for adopting an exercise routine while living with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 13:1063859. [PMID: 36686448 PMCID: PMC9849595 DOI: 10.3389/fendo.2022.1063859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction For people living with type 1 diabetes (T1D) the challenge of increasing daily physical activity (PA) is compounded by the increased risks of hypoglycemia and glucose variability. Little information exists on the lived experience of overcoming these barriers and adopting and maintaining an active lifestyle while living with T1D. Research Design and Methods We conducted a patient-led qualitative study consisting of semi-structured interviews or focus groups with 22 individuals at least 16 years old living with T1D. We used existing patient co-researcher networks and snowball sampling to obtain a sample of individuals who reported being regularly physically active and had been diagnosed with T1D for at least one year. We used an interpretive description analysis to generate themes and strategies associated with maintaining an active lifestyle while living with T1D. We involved patient co-researchers in study design, data collection, and interpretation. Results 14 self-identified women and 8 self-identified men (ages 19-62, median age 32 years) completed the study, led by either a researcher, or a patient co-researcher and research assistant regarding their strategies for maintaining an active lifestyle. We identified five themes that facilitate regular sustained PA: (1) Structure and organization are important to adopt safe PA in daily life "I can't do spontaneous exercise. I actually need a couple hours of warning minimum"; (2) Trial and error to learn how their body responds to PA and food "Once you put the time and effort into learning, you will have greater success"; (3) Psychosocial aspects of PA "…because it's not just your body, it's your soul, it's your mind that exercise is for"; (4) Diabetes technology and (5) Education and peer support. Strategies to overcome barriers included (1) Technology; (2) Integrating psychosocial facilitators; (3) Insulin and carbohydrate adjustments; and (4) Planning for exercise. Conclusions Living an active lifestyle with T1D is facilitated by dedicated structure and organization of routines, accepting the need for trial and error to understand the personalized glycemic responses to PA and careful use of food to prevent hypoglycemia. These themes could inform clinical practice guidelines or future trials that include PA interventions.
Collapse
Affiliation(s)
- Cristine Vlcek
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jane E. Yardley
- Diabetes Action Canada, Toronto, ON, Canada
- Augustana Faculty, University of Alberta, Camrose, AB, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Edmonton, AB, Canada
| | - Nika Klaprat
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
| | | | | | | | | | | | - Conrad Pow
- Diabetes Action Canada, Toronto, ON, Canada
| | - Mandy Archibald
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
| |
Collapse
|
8
|
Sigal RJ, Yardley JE, Perkins BA, Riddell MC, Goldfield GS, Donovan L, Malcolm J, Hadjiyannakis S, Edwards AL, Gougeon R, Wells GA, Pacaud D, Woo V, Ford GT, Coyle D, Phillips P, Doucette S, Khandwala F, Kenny GP. The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomised Clinical Trial. J Clin Endocrinol Metab 2022; 108:e63-e75. [PMID: 36459469 DOI: 10.1210/clinem/dgac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To evaluate the incremental impact of resistance training on HbA1c, fitness, body composition and cardiometabolic risk factors in aerobically-active people with type 1 diabetes. RESEARCH DESIGN AND METHODS The Resistance Exercise in Already-active Diabetic Individuals (READI) trial (NCT00410436) was a four-centre randomized parallel-group trial. After a 5-week run-in period with diabetes management optimization, 131 aerobically-active individuals with type 1 diabetes were randomized to resistance exercise (n = 71, intervention - INT) or control (n = 60, CON) for 22 additional weeks. Both groups maintained their aerobic activities and were provided dietary counselling throughout. Exercise training was three times per week at community-based facilities. The primary outcome was HbA1c, and secondary outcomes included fitness (peak oxygen consumption, muscle strength), body composition (anthropometrics, dual-energy X-ray absorptiometry, computed tomography) and cardiometabolic risk markers (lipids, apolipoproteins). Assessors were blinded to group allocation. RESULTS There were no significant differences in HbA1c change between INT and CON. Declines in HbA1c [INT: 7.75 ± 0.10% (61.2 ± 1.1 mmol/mol) to 7.55 ± 0.10% (59 ± 1.1 mmol/mol); CON: 7.70 ± 0.11% (60.7 ± 1.2 mmol/mol) to 7.57 ± 0.11% (59.6 ± 1.3 mmol/mol); intergroup difference in change -0.07 [95% CI -0.31, 0.18]. Waist circumference decreased more in INT than CON after six months (p = 0.02). Muscular strength increased more in INT than in CON (p < 0.001). There were no intergroup differences in hypoglycemia or any other variables. CONCLUSIONS Adding resistance training did not impact glycemia, but it increased strength and reduced waist circumference, in aerobically active individuals with type 1 diabetes.
Collapse
Affiliation(s)
- Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jane E Yardley
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- University of Alberta, Augustana Faculty, Camrose, Canada
- Alberta Diabetes Institute, Edmonton, Canada
| | - Bruce A Perkins
- Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lois Donovan
- Departments of Medicine, Obstetrics and Gynecology, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Janine Malcolm
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Stasia Hadjiyannakis
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Alun L Edwards
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
| | - Réjeanne Gougeon
- Crabtree Nutrition Laboratories, Research Institute and Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Danièle Pacaud
- Alberta Children's Hospital, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vincent Woo
- Section of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Gordon T Ford
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Doug Coyle
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Penny Phillips
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Farah Khandwala
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| |
Collapse
|
9
|
Yardley JE. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia 2022; 65:1994-1999. [PMID: 35978179 DOI: 10.1007/s00125-022-05781-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
Recent guidelines suggest that adding anaerobic (high intensity or resistance) activity to an exercise session can prevent blood glucose declines that occur during aerobic exercise in individuals with type 1 diabetes. This theory evolved from earlier study data showing that sustained, anaerobic activity (high intensity cycling) increases blood glucose levels in these participants. However, studies involving protocols where anaerobic (high intensity interval) and aerobic exercise are combined have extremely variable glycaemic outcomes, as do resistance exercise studies. Scrutinising earlier studies will reveal that, in addition to high intensity activity (intervals or weight lifting), these protocols had another common feature: participants were performing exercise after an overnight fast. Based on these findings, and data from recent exercise studies, it can be argued that participant prandial state may be a more dominant factor than exercise intensity where glycaemic changes in individuals with type 1 diabetes are concerned. As such, a reassessment of study outcomes and an update to exercise recommendations for those with type 1 diabetes may be warranted.
Collapse
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
10
|
Wu Z, Yardley JE, Messier V, Legault L, Grou C, Rabasa-Lhoret R. Comparison of Nocturnal Glucose After Exercise Among Dual-Hormone, Single-Hormone Algorithm-Assisted Insulin Delivery System and Usual Care in Adults and Adolescents Living with Type 1 Diabetes: A Pooled Analysis. Diabetes Technol Ther 2022; 24:754-762. [PMID: 35653732 DOI: 10.1089/dia.2022.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Available studies comparing the efficacy of dual-hormone (DH)-algorithm-assisted insulin delivery (AID), single-hormone (SH)-AID and usual care on postexercise overnight glucose in people with type 1 diabetes (T1D) have had different outcomes. By pooling data from all available studies, we aim to draw stronger conclusions. Methods: Data were pooled from two three-arm, open-label, randomized, controlled, crossover studies. Forty-one adults [median (Q1, Q3) age: 34.0 years (29.5, 51.0), mean HbA1c: 7.5% ± 1.0%] and 17 adolescents with T1D [age: 14.0 (13.0, 16.0), HbA1c: 7.8% ± 0.8%] underwent DH-AID, SH-AID, and usual care. Each intervention involved evening aerobic exercise (60-min). The primary outcome, time in range% (TIR%) overnight (00:00-06:00) postexercise based on continuous glucose monitoring, was compared among treatments using linear mixed effect model or generalized linear mixed model. Results: Among adults, mean TIR% was 94.0% ± 11.9%, 83.1% ± 20.5%, and 65.1% ± 37.0% during DH-AID, SH-AID, and usual care intervention, respectively (P < 0.05 for all between-group comparisons). DH-AID was superior to SH-AID and usual care, and SH-AID was superior to usual care regarding hypoglycemia and hyperglycemia prevention, but not glycemic variability. Among adolescents, DH-AID and SH-AID reduced dysglycemia, but not glycemic variability, better than usual care. Glycemic outcomes were similar between DH-AID and SH-AID. Conclusion: AID systems allow improved postexercise nocturnal glycemic management than usual care for both adults and adolescents. DH-AID was better than SH-AID among adults, but not adolescents.
Collapse
Affiliation(s)
- Zekai Wu
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Laurent Legault
- McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Caroline Grou
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
| | - Rémi Rabasa-Lhoret
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
11
|
Prévost MS, Rabasa-Lhoret R, Talbo MK, Yardley JE, Curry EG, Brazeau AS. Gender Differences in Strategies to Prevent Physical Activity-Related Hypoglycemia in Patients With Type 1 Diabetes: A BETTER Study. Diabetes Care 2022; 45:e51-e53. [PMID: 35045175 DOI: 10.2337/dc21-1899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Melinda S Prévost
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Remi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, Quebec, Canada.,Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal, Quebec, Canada
| | - Meryem K Talbo
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Jane E Yardley
- Department of Physical Education, University of Alberta-Augustana Campus, Camrose, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Alberta Diabetes Institute, Edmonton, Alberta, Canada.,Women's and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Emily G Curry
- Institute of Parasitology, McGill University, Sainte Anne-de-Bellevue, Quebec, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada.,Montreal Diabetes Research Center, Montreal, Quebec, Canada
| |
Collapse
|
12
|
Brockman NK, Sigal RJ, Kenny GP, Riddell MC, Perkins BA, Yardley JE. Afternoon aerobic and resistance exercise have limited impact on 24-h CGM outcomes in adults with type 1 diabetes: A secondary analysis. Diabetes Res Clin Pract 2021; 177:108874. [PMID: 34052249 DOI: 10.1016/j.diabres.2021.108874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/04/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
AIMS This study examined post-exercise glycemic variability in individuals with type 1 diabetes after acute bouts of resistance (RE) and aerobic exercise (AE) compared to a no-exercise day (CON). We hypothesized that exercise days would have greater glucose variability (standard deviation - SD, coefficient of variation - CV), and less time in range (TIR), compared to CON. METHODS A secondary analysis was conducted on previously collected data. Twelve active participants with type 1 diabetes performed three testing sessions in random order with at least 48 h in between: AE (45-min treadmill run at 60%VO2max), RE (three sets of eight repetitions, seven weight-lifting exercises), and CON (45-min no-exercise control). Interstitial glucose levels were monitored by blinded continuous glucose monitoring (CGM). Glycemic variability was evaluated for 0-6 h, overnight (00:00-06:00) and 24 h after exercise. RESULTS Mean CGM glucose, TIR, and time above/below range were similar among conditions (P > 0.05). Lower SD (0.8 [0.5-1.1], 1.4 [0.9-2.4]mmol/L, p = 0.009) and CV (11.4 [8.6-15.3], 23.4 [13.7-31.6]%, p = 0.007) were found overnight after AE versus CON. Otherwise, AE and RE had limited impact on post-exercise glycemia. CONCLUSIONS Acute RE and AE bouts may have limited impact on post-exercise glycemic variability compared to rest in habitually active individuals with type 1 diabetes.
Collapse
Affiliation(s)
- Nicole K Brockman
- University of Alberta, Faculty of Medicine and Dentistry, 8440 112st NW, Edmonton, Alberta T6G 2R7, Canada.
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, 1820 Richmond Rd. SW, Calgary, AB, Canada.
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Montpetit Hall, 125 University (Room 224), Ottawa, ON K1N 6N5, Canada.
| | - Michael C Riddell
- School of Kinesiology and Health Science, 347 Bethune College, York University, ON, Canada.
| | - Bruce A Perkins
- Diabetes Clinical Research Unit, Leadership Sinai Centre for Diabetes, Sinai Health System, L5-210, 60 Murray Street, Mailbox 16, Toronto, ON M5T 3L9, Canada.
| | - Jane E Yardley
- University of Alberta, Augustana Faculty, 4901- 46th Avenue, Camrose, AB T4V 2R3, Canada; Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, L-052, Li Ka Shing Centre for Health Research Innovation, 112 Street, Edmonton, AB T6G 2T9, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada; Women and Children's Health Research Institute, ECHA 4-081, University of Alberta, 11405 87 Avenue NW, Edmonton, AB T6G 1C9, Canada.
| |
Collapse
|
13
|
Yardley JE, Sigal RJ. Glucose management for exercise using continuous glucose monitoring: should sex and prandial state be additional considerations? Diabetologia 2021; 64:932-934. [PMID: 33409571 DOI: 10.1007/s00125-020-05373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada.
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
| | - Ronald J Sigal
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
14
|
Eckstein ML, Farinha JB, McCarthy O, West DJ, Yardley JE, Bally L, Zueger T, Stettler C, Boff W, Reischak-Oliveira A, Riddell MC, Zaharieva DP, Pieber TR, Müller A, Birnbaumer P, Aziz F, Brugnara L, Haahr H, Zijlstra E, Heise T, Sourij H, Roden M, Hofmann P, Bracken RM, Pesta D, Moser O. Differences in Physiological Responses to Cardiopulmonary Exercise Testing in Adults With and Without Type 1 Diabetes: A Pooled Analysis. Diabetes Care 2021; 44:240-247. [PMID: 33184152 DOI: 10.2337/dc20-1496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate physiological responses to cardiopulmonary exercise (CPX) testing in adults with type 1 diabetes compared with age-, sex-, and BMI-matched control participants without type 1 diabetes. RESEARCH DESIGN AND METHODS We compared results from CPX tests on a cycle ergometer in individuals with type 1 diabetes and control participants without type 1 diabetes. Parameters were peak and threshold variables of VO2, heart rate, and power output. Differences between groups were investigated through restricted maximum likelihood modeling and post hoc tests. Differences between groups were explained by stepwise linear regressions (P < 0.05). RESULTS Among 303 individuals with type 1 diabetes (age 33 [interquartile range 22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m2, HbA1c 6.9% [6.2; 7.7%] [52 (44; 61) mmol/mol]), VO2peak (32.55 [26.49; 38.72] vs. 42.67 ± 10.44 mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191] beats/min), and peak power (216 [171; 253] vs. 245 [200; 300] W) were lower compared with 308 control participants without type 1 diabetes (all P < 0.001). Individuals with type 1 diabetes displayed an impaired degree and direction of the heart rate-to-performance curve compared with control participants without type 1 diabetes (0.07 [-0.75; 1.09] vs. 0.66 [-0.28; 1.45]; P < 0.001). None of the exercise physiological responses were associated with HbA1c in individuals with type 1 diabetes. CONCLUSIONS Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA1c. Intriguingly, the participants in our cohort were people with recent-onset type 1 diabetes; heart rate dynamics were altered during CPX testing.
Collapse
Affiliation(s)
- Max L Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Juliano Boufleur Farinha
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - Daniel J West
- Population Health Science Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, U.K
| | - Jane E Yardley
- Alberta Diabetes Institute, Edmonton, Alberta, Canada.,Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Zueger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Winston Boff
- Institute for Children with Diabetes, Conceição Hospital Group, Porto Alegre, Brazil
| | - Alvaro Reischak-Oliveira
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA
| | - Thomas R Pieber
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Müller
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Faisal Aziz
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Laura Brugnara
- CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders and IDIBAPS-August Pi i Sunyer Biomedical Research Institute/Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Hofmann
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria .,Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| |
Collapse
|
15
|
Persad KL, Pringnitz MA, Yardley JE. 82 - Effects of the Menstrual Cycle on Exercise Blood Glucose Responses to Exercise in Females With Type 1 Diabetes. Can J Diabetes 2020. [DOI: 10.1016/j.jcjd.2020.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
16
|
Yardley JE. Fasting May Alter Blood Glucose Responses to High-Intensity Interval Exercise in Adults With Type 1 Diabetes: A Randomized, Acute Crossover Study. Can J Diabetes 2020; 44:727-733. [PMID: 33160882 DOI: 10.1016/j.jcjd.2020.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In individuals with type 1 diabetes (T1D), changes in blood glucose (BG) during high-intensity interval exercise (HIIE) are smaller than those observed during aerobic exercise. Study outcomes, however, have been variable, with some demonstrating significant BG decreases and others showing BG increases. This study compared BG outcomes between fasting (AME) and postprandial (PME) HIIE in T1D to test the hypothesis that AME would produce a BG increase, yet PME would cause BG to decline. METHODS Twelve (6 men and 6 women) physically active individuals with T1D performed two 45-minute exercise sessions (AME at 7:00 AM, PME at 5:00 PM) in random order, separated by at least 48 hours. Sessions consisted of a 10-minute warmup (50%VO2peak), followed by 10-second sprints every 2 minutes for 24 minutes, and then an 11-minute cooldown. Capillary glucose was measured pre- and postexercise, and then 60 minutes postexercise. Interstitial glucose was recorded for 24 hours postexercise using continuous glucose monitoring. RESULTS AME caused capillary glucose to increase (from 7.6±1.4 to 9.2±2.9 mmol/L during exercise, and 9.9±2.8 mmol/L in recovery), whereas PME produced a decline in capillary glucose (from 9.9±3.1 to 9.5±3.4 mmol/L during exercise and 8.9±2.7 mmol/L during recovery; time × treatment interaction, p=0.014). PME was associated with a higher frequency of hyperglycemic events in the 6 hours and overnight (midnight to 6:00 AM) after exercise. CONCLUSIONS Fasting HIIE results in a different BG trajectory than postprandial exercise in T1D, and may be beneficial for hypoglycemia avoidance during exercise.
Collapse
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
17
|
Riddell MC, Scott SN, Fournier PA, Colberg SR, Gallen IW, Moser O, Stettler C, Yardley JE, Zaharieva DP, Adolfsson P, Bracken RM. The competitive athlete with type 1 diabetes. Diabetologia 2020; 63:1475-1490. [PMID: 32533229 PMCID: PMC7351823 DOI: 10.1007/s00125-020-05183-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
Regular exercise is important for health, fitness and longevity in people living with type 1 diabetes, and many individuals seek to train and compete while living with the condition. Muscle, liver and glycogen metabolism can be normal in athletes with diabetes with good overall glucose management, and exercise performance can be facilitated by modifications to insulin dose and nutrition. However, maintaining normal glucose levels during training, travel and competition can be a major challenge for athletes living with type 1 diabetes. Some athletes have low-to-moderate levels of carbohydrate intake during training and rest days but tend to benefit, from both a glucose and performance perspective, from high rates of carbohydrate feeding during long-distance events. This review highlights the unique metabolic responses to various types of exercise in athletes living with type 1 diabetes. Graphical abstract.
Collapse
Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- LMC Diabetes & Endocrinology, Toronto, ON, Canada.
| | - Sam N Scott
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Paul A Fournier
- School of Human Sciences, Division Sport Science, Exercise and Health, University of Western Australia, Crawley, WA, Australia
| | - Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA
| | - Ian W Gallen
- Royal Berkshire NHS Foundation Trust Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
- Women's and Children's Health Research Institute, Edmonton, AB, Canada
| | - Dessi P Zaharieva
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, A111 Engineering East, Fabian Way, Crymlyn Burrows, Swansea, SA1 8EN, UK.
| |
Collapse
|
18
|
|
19
|
Klaprat NMD, Askin N, MacIntosh A, Brunton N, Hay JL, Yardley JE, Marks SD, Sibley KM, Duhamel TA, McGavock JM. Filling gaps in type 1 diabetes and exercise research: a scoping review and priority-setting project. BMJ Open Diabetes Res Care 2020; 8:8/1/e001023. [PMID: 32139601 PMCID: PMC7059416 DOI: 10.1136/bmjdrc-2019-001023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/19/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Our team examined the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitated T1D stakeholders in determining the top 10 list of priorities for exercise research. Two methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership. Published (Medline, Embase, CINAHL and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum 4 weeks and available in English. We extracted information on PE and patient-reported outcomes (PROs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long list that a 12-person stakeholder steering committee used to identify the top 10 priority research questions. Of 9962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control. Recent exercise-based randomized trials in T1D have not included PE and PROs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.
Collapse
Affiliation(s)
- Nika M D Klaprat
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline L Hay
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Albrechtsen Research Centre, St Boniface Hospital Research, Winnipeg, Manitoba, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport and Recreation, University of Alberta-Augustana Campus, Camrose, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Seth D Marks
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Education Resource for Children and Adolescents, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Albrechtsen Research Centre, St Boniface Hospital Research, Winnipeg, Manitoba, Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
| |
Collapse
|
20
|
McCormick JJ, Notley SR, Yardley JE, Sigal RJ, Kenny GP. Blunted circulating irisin in adults with type 1 diabetes during aerobic exercise in a hot environment: a pilot study. Appl Physiol Nutr Metab 2020; 45:679-682. [PMID: 32053388 DOI: 10.1139/apnm-2019-0624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Irisin is a novel myokine associated with increased metabolism, which may be upregulated in type 1 diabetes (T1D) during exercise-heat stress. We therefore assessed serum irisin production in young adults with and without T1D during incremental exercise in dry-heat (35 °C). The change in irisin during exercise was lower in individuals with compared with without T1D (-1.79 (SEM 25.68) vs. 59.74 (SEM 79.63) pg/mL; p = 0.024), indicating that irisin expression during exercise-heat stress is blunted in T1D. Novelty We show that, when assessed in young adults with and without T1D during exercise-heat stress, serum irisin production is blunted in T1D.
Collapse
Affiliation(s)
- James J McCormick
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada.,Alberta Diabetes Institute, Edmonton, AB, Canada.,Faculty of Kinesiology, Sport and Recreation, University of Alberta, AB, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB T2T 5C7, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
21
|
Yardley JE. The Athlete with Type 1 Diabetes: Transition from Case Reports to General Therapy Recommendations. Open Access J Sports Med 2019; 10:199-207. [PMID: 31827338 PMCID: PMC6902845 DOI: 10.2147/oajsm.s149257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Fear of hypoglycemia is a common barrier to exercise and physical activity for individuals with type 1 diabetes. While some of the earliest studies in this area involved only one or two participants, the link between exercise, exogenous insulin, and hypoglycemia was already clear, with the only suggested management strategies being to decrease insulin dosage and/or consume carbohydrates before and after exercise. Over the past 50 years, a great deal of knowledge has been developed around the impact of different types and intensities of exercise on blood glucose levels in this population. Recent decades have also seen the development of technologies such as continuous glucose monitors, faster-acting insulins and commercially available insulin pumps to allow for the real-time observation of interstitial glucose levels, and more precise adjustments to insulin dosage before, during and after activity. As such, there are now evidence-based exercise and physical activity guidelines for individuals with type 1 diabetes. While the risk of hypoglycemia has not been completely eliminated, therapy recommendations have evolved considerably. This review discusses the evolution of the knowledge and the technology related to type 1 diabetes and exercise that have allowed this evolution to take place.
Collapse
Affiliation(s)
- Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Edmonton, Canada.,Augustana Faculty, University of Alberta, Camrose, Canada.,Women's and Children's Research Institute, Edmonton, Canada
| |
Collapse
|
22
|
Toghi-Eshghi SR, Yardley JE. Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study. J Clin Endocrinol Metab 2019; 104:5217-5224. [PMID: 31211392 DOI: 10.1210/jc.2018-02384] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/12/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the effect of morning exercise in the fasting condition vs afternoon exercise on blood glucose responses to resistance exercise (RE). RESEARCH DESIGN AND METHODS For this randomized crossover design, 12 participants with type 1 diabetes mellitus [nine females; aged 31 ± 8.9 years; diabetes duration, 19.1 ± 8.3 years; HbA1c, 7.4% ± 0.8% (57.4 ± 8.5 mmol/mol)] performed ∼40 minutes of RE (three sets of eight repetitions, seven exercises, at the individual's predetermined eight repetition maximum) at either 7 am (fasting) or 5 pm. Sessions were performed at least 48 hours apart. Venous blood samples were collected immediately preexercise, immediately postexercise, and 60 minutes postexercise. Interstitial glucose was monitored overnight postexercise by continuous glucose monitoring (CGM). RESULTS Data are presented as mean ± SD. Blood glucose rose during fasting morning exercise (9.5 ± 3.0 to 10.4 ± 3.0 mmol/L), whereas it declined with afternoon exercise (8.2 ± 2.5 to 7.4 ± 2.6 mmol/L; P = 0.031 for time-by-treatment interaction). Sixty minutes postexercise, blood glucose concentration was significantly higher after fasting morning exercise than after afternoon exercise (10.9 ± 3.2 vs 7.9 ± 2.9 mmol/L; P = 0.019). CGM data indicated more glucose variability (2.7 ± 1.1 vs 2.0 ± 0.7 mmol/L; P = 0.019) and more frequent hyperglycemia (12 events vs five events; P = 0.025) after morning RE than after afternoon RE. CONCLUSIONS Compared with afternoon RE, morning (fasting) RE was associated with distinctly different blood glucose responses and postexercise profiles.
Collapse
Affiliation(s)
- Saeed Reza Toghi-Eshghi
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| |
Collapse
|
23
|
Klaprat NM, Yardley JE, Duhamel TA, Mcgavock JM. 18 - Nothing About Us Without Us: Identifying Research Priorities for Exercise and Type 1 Diabetes. Can J Diabetes 2019. [DOI: 10.1016/j.jcjd.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Macintosh A, Hay JL, Zaharieva DP, Jamnik V, Riddell MC, Boulé NG, Mcgavock JM, Yardley JE. 106 - Vigorous Intensity Intervals and Moderate Intensity Exercise Have Similar Postexercise Impacts on Blood Glucose in Trained Young Adults With Type 1 Diabetes. Can J Diabetes 2019. [DOI: 10.1016/j.jcjd.2019.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Brockman NK, Sigal RJ, Kenny GP, Riddell MC, Perkins BA, Yardley JE. Sex-Related Differences in Blood Glucose Responses to Resistance Exercise in Adults With Type 1 Diabetes: A Secondary Data Analysis. Can J Diabetes 2019; 44:267-273.e1. [PMID: 31623995 DOI: 10.1016/j.jcjd.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 06/26/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In adults with type 1 diabetes, resistance exercise (RE) is associated with more stable blood glucose (BG) levels than aerobic exercise, both during and after exercise. In individuals without diabetes, growth hormone and epinephrine responses to RE differ between the sexes. These hormones are known to affect BG levels in individuals with type 1 diabetes. In this study, we explored whether sex-related differences may exist in BG responses to RE in individuals with type 1 diabetes. METHODS A secondary data analysis was conducted on pooled data from 2 studies with identical RE protocols for individuals with type 1 diabetes (13 males, age range 16 to 63 years; 10 females, age range 19 to 45 years). The RE session consisted of 7 resistance-based exercises performed at 5 pm. Plasma glucose samples were collected before, immediately after and 1 h after exercise. Interstitial glucose levels were recorded through blinded continuous glucose monitoring 24 h before, during and 24 h after exercise. RESULTS There was a significant sex-by-time interaction (p<0.001) in plasma glucose responses to RE. Plasma glucose decreased significantly in males from 8.6±2.5 to 6.3±2.1 mmol/L (p<0.001) during exercise, whereas females experienced no significant change (7.2±1.3 to 7.3±1.3 mmol/L, p=0.999). In the 6 h after RE, males developed significantly more hypoglycemia, as measured by continuous glucose monitoring (p=0.048). CONCLUSIONS Males may have a greater risk of hypoglycemia with an acute bout of RE than females. Further research is needed to examine this phenomenon more closely, as sex-specific recommendations for preventing hypoglycemia around RE may be necessary in type 1 diabetes.
Collapse
Affiliation(s)
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Diabetes Clinical Research Unit, Leadership Sinai Centre for Diabetes, Sinai Health System, Toronto, Ontario, Canada
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada; Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
26
|
Rees JL, Chang CR, François ME, Marcotte-Chénard A, Fontvieille A, Klaprat ND, Dyck RA, Funk DR, Snydmiller G, Bastell K, Godkin FE, Dubé MC, Riesco E, McGavock JM, Yardley JE, Sigal RJ, Gibala MJ, Weisnagel SJ, Prado CM, Jung M, Manders R, Lee T, Singer J, Boulé NG, Little JP. Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol 2019; 56:755-765. [PMID: 31093764 DOI: 10.1007/s00592-019-01358-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022]
Abstract
AIM To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol. METHODS Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring. RESULTS Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI - 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from - 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (- 1.56 mmol/L; 95% CI - 2.18, - 0.95, p < 0.001). CONCLUSION Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed. TRIAL REGISTRATION NCT02834689.
Collapse
Affiliation(s)
- Jordan L Rees
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Courtney R Chang
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Monique E François
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Alexis Marcotte-Chénard
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Adeline Fontvieille
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Nika D Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Rebecca A Dyck
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Deanna R Funk
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Gary Snydmiller
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Kent Bastell
- Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Florence E Godkin
- Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Marie-Christine Dubé
- Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Eléonor Riesco
- Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
- Research Center on Aging, CIUSSSE - CHUS, Sherbrooke, QC, J1H 4C4, Canada
| | - Jon M McGavock
- DREAM Research Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, R3E 3P4, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada
- Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - S John Weisnagel
- Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Mary Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ralph Manders
- Faculty of Health and Medical Sciences, University of Surrey, Guilford, GU2 7WG, UK
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada.
| | - Jonathan P Little
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada.
| |
Collapse
|
27
|
Notley SR, Poirier MP, Yardley JE, Sigal RJ, Kenny GP. Impaired whole-body heat loss in type 1 diabetes during exercise in the heat: a cause for concern? Diabetologia 2019; 62:1087-1089. [PMID: 30941449 DOI: 10.1007/s00125-019-4858-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/11/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, 125 University, Room 367, Montpetit Hall, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Martin P Poirier
- Human and Environmental Physiology Research Unit, School of Human Kinetics, 125 University, Room 367, Montpetit Hall, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, 125 University, Room 367, Montpetit Hall, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, 125 University, Room 367, Montpetit Hall, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| |
Collapse
|
28
|
Yardley JE, Rees JL, Funk DR, Toghi-Eshghi SR, Boulé NG, Senior PA. Effects of Moderate Cycling Exercise on Blood Glucose Regulation Following Successful Clinical Islet Transplantation. J Clin Endocrinol Metab 2019; 104:493-502. [PMID: 30403817 DOI: 10.1210/jc.2018-01498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/31/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Islet transplantation is effective in preventing hypoglycemia in patients with type 1 diabetes (T1D). However, it is unknown whether transplanted islets regulate plasma glucose concentrations appropriately during and after exercise in human islet transplant recipient (ITxs). OBJECTIVE To determine the effect of exercise on plasma glucose, insulin, and glucagon concentrations in ITxs compared with control subjects (CONs) without diabetes. INTERVENTION Participants completed two conditions in random order: 45 minutes of aerobic exercise (60% VO2peak) and 45 minutes of seated rest. Blood samples were drawn at baseline, immediately after exercise or rest, and every 15 minutes throughout a 60-minute recovery period. Postexercise (24 hours) interstitial glucose was monitored with continuous glucose monitoring (CGM). RESULTS Twenty-four participants (12 ITxs, 12 CONs) completed the protocol. Plasma glucose decreased more over time with exercise in ITxs compared with CONs [main effects of treatment (P = 0.019), time (P = 0.001), and group (P = 0.012)]. Plasma glucose was lower during exercise vs rest in ITxs but not CONs [treatment by group interaction (P = 0.028)]. Plasma glucose decreased more during exercise than during rest [treatment by time interaction (P = 0.001)]. One ITx and one CON experienced plasma glucose concentrations <3.5 mmol/L at the end of exercise, both of whom returned above that threshold within 15 minutes. Nocturnal CGM glucose <3.5 mmol/L was detected in two CONs but no ITxs. CONCLUSION Despite a greater plasma glucose decline during exercise in ITxs, hypoglycemia risk was similar during and after exercise in ITxs compared with CONs.
Collapse
Affiliation(s)
- Jane E Yardley
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan L Rees
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Deanna R Funk
- Augustana Faculty, University of Alberta, Camrose, Alberta, Canada
| | - Saeed Reza Toghi-Eshghi
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Normand G Boulé
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
29
|
Rempel M, Yardley JE, MacIntosh A, Hay JL, Bouchard D, Cornish S, Marks SD, Hai Y, Gordon JW, McGavock J. Vigorous Intervals and Hypoglycemia in Type 1 Diabetes: A Randomized Cross Over Trial. Sci Rep 2018; 8:15879. [PMID: 30367116 PMCID: PMC6203731 DOI: 10.1038/s41598-018-34342-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022] Open
Abstract
Adding vigorous-intensity intervals (VII) to moderate-intensity exercise prevents immediate declines in blood glucose in type 1 diabetes (T1D) however the intensity required to minimize post-exercise hypoglycemia is unknown. To examine this question, ten sedentary T1D individuals completed four treadmill exercise sessions: a control session of 45 minutes of walking at 45–55% of heart rate reserve (HRR) and three sessions consisting of 60 seconds (VII) at 70%, 80%, or 90% of HRR every 4 minutes during exercise at 45–55% of HRR. We used continuous glucose monitoring (CGM) to measure time ≤3.9 mmol/L, glucose variability, hypoglycemia frequency and area under the curve (AUC) for hypoglycemia and hyperglycemia for 12 hours post-exercise. We also examined growth hormone and cortisol responses during and following exercise. In the 12 hours post-exercise, the percentage of time ≤3.9 mmol/L, glucose variability, and AUC for hypoglycemia and hyperglycemia were similar across conditions. The frequency of hypoglycemic events was highest after the 90% intervals compared to the control arm (12 vs 3 events, p = 0.03). There was a trend towards elevated growth hormone with increasing exercise intensity but cortisol levels were similar across conditions. Adding VII to moderate intensity exercise may increase hypoglycemia risk at higher intensities.
Collapse
Affiliation(s)
- Meaghan Rempel
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jane E Yardley
- University of Alberta, Augustana Faculty, Camrose, Alberta, Canada.,University of Alberta, Faculty of Kinesiology, Sport and Recreation, Alberta, Canada
| | - Andrea MacIntosh
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline L Hay
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Danielle Bouchard
- Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada
| | - Stephen Cornish
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Seth D Marks
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Education and Resource for Children and Adolescents, Children's Hospital Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Yan Hai
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph W Gordon
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM), Winnipeg, Manitoba, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada. .,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada. .,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM), Winnipeg, Manitoba, Canada.
| |
Collapse
|
30
|
Houlder SK, Yardley JE. Continuous Glucose Monitoring and Exercise in Type 1 Diabetes: Past, Present and Future. Biosensors (Basel) 2018; 8:bios8030073. [PMID: 30081478 PMCID: PMC6165159 DOI: 10.3390/bios8030073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/29/2022]
Abstract
Prior to the widespread use of continuous glucose monitoring (CGM), knowledge of the effects of exercise in type 1 diabetes (T1D) was limited to the exercise period, with few studies having the budget or capacity to monitor participants overnight. Recently, CGM has become a staple of many exercise studies, allowing researchers to observe the otherwise elusive late post-exercise period. We performed a strategic search using PubMed and Academic Search Complete. Studies were included if they involved adults with T1D performing exercise or physical activity, had a sample size greater than 5, and involved the use of CGM. Upon completion of the search protocol, 26 articles were reviewed for inclusion. While outcomes have been variable, CGM use in exercise studies has allowed the assessment of post-exercise (especially nocturnal) trends for different exercise modalities in individuals with T1D. Sensor accuracy is currently considered adequate for exercise, which has been crucial to developing closed-loop and artificial pancreas systems. Until these systems are perfected, CGM continues to provide information about late post-exercise responses, to assist T1D patients in managing their glucose, and to be useful as a tool for teaching individuals with T1D about exercise.
Collapse
Affiliation(s)
- Shaelyn K Houlder
- Augustana Faculty, University of Alberta, 4901-46 Ave, Camrose, AB T4V 2R3, Canada.
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, 4901-46 Ave, Camrose, AB T4V 2R3, Canada.
- Alberta Diabetes Institute, 112 St. NW, Edmonton, AB T6G 2T9, Canada.
| |
Collapse
|
31
|
Brockman NK, Yardley JE. Sex-related differences in fuel utilization and hormonal response to exercise: implications for individuals with type 1 diabetes. Appl Physiol Nutr Metab 2018; 43:541-552. [PMID: 29420905 DOI: 10.1139/apnm-2017-0559] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sex-related differences in metabolic and neuroendocrine response to exercise in individuals without diabetes have been well established. Men and women differ in fuel selection during exercise, in which women rely to a greater extent on fat oxidation, whereas males rely mostly on carbohydrate oxidation for energy production. The difference in fuel selection appears to be mediated by sex-related differences in hormonal (including catecholamines, growth hormone, and estrogen) response to different types and intensities of exercise. In general, men exhibit an amplified counter-regulatory response to exercise, with elevated levels of catecholamines compared with women. However, women exhibit greater sensitivity to the lipolytic action of the catecholamines and deplete less of their glycogen stores than men during exercise, which suggests that women may experience a greater defense in blood glucose control after exercise than men. Conversely, little is known about sex-related differences in response to exercise in individuals with type 1 diabetes (T1D). A single study investigating sex-related differences in response to moderate aerobic exercise in individuals with T1D found sex-related differences in catecholamine response and fuel selection, but changes in blood glucose were not measured. To our knowledge, there are no studies investigating sex-related differences in blood glucose responses to different types and intensities of exercise in individuals with T1D. This review summarizes sex-related differences in exercise responses that could potentially impact blood glucose levels during exercise in individuals with T1D and highlights the need for further research.
Collapse
Affiliation(s)
- Nicole K Brockman
- a Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada
| | - Jane E Yardley
- a Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada.,b Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 8602-112 Street, Edmonton, AB T6G 2E1, Canada
| |
Collapse
|
32
|
Yardley JE, Brockman NK, Bracken RM. Could Age, Sex and Physical Fitness Affect Blood Glucose Responses to Exercise in Type 1 Diabetes? Front Endocrinol (Lausanne) 2018; 9:674. [PMID: 30524371 PMCID: PMC6262398 DOI: 10.3389/fendo.2018.00674] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
Closed-loop systems for patients with type 1 diabetes are progressing rapidly. Despite these advances, current systems may struggle in dealing with the acute stress of exercise. Algorithms to predict exercise-induced blood glucose changes in current systems are mostly derived from data involving relatively young, fit males. Little is known about the magnitude of confounding variables such as sex, age, and fitness level-underlying, uncontrollable factors that might influence blood glucose control during exercise. Sex-related differences in hormonal responses to physical exercise exist in studies involving individuals without diabetes, and result in altered fuel metabolism during exercise. Increasing age is associated with attenuated catecholamine responses and lower carbohydrate oxidation during activity. Furthermore, higher fitness levels can alter hormonal and fuel selection responses to exercise. Compounding the limited research on these factors in the metabolic response to exercise in type 1 diabetes is a limited understanding of how these variables affect blood glucose levels during different types, timing and intensities of activity in individuals with type 1 diabetes (T1D). Thus, there is currently insufficient information to model a closed-loop system that can predict them accurately and consistently prevent hypoglycemia. Further, studies involving both sexes, along with a range of ages and fitness levels, are needed to create a closed-loop system that will be more precise in regulating blood glucose during exercise in a wide variety of individuals with T1D.
Collapse
Affiliation(s)
- Jane E. Yardley
- Augustana Faculty, University of Alberta, Camrose, AB, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Jane E. Yardley
| | | | - Richard M. Bracken
- Diabetes Research Unit and School of Sport and Exercise Science, Swansea University, Swansea, United Kingdom
| |
Collapse
|
33
|
|
34
|
Rempel M, MacIntosh A, Hay J, Bouchard DR, Cornish S, Hai SM, Gordon J, McGavock J, Yardley JE. Vigorous Intensity Exercise and Hypoglycemia Risk in Untrained Individuals with Type 1 Diabetes. Can J Diabetes 2017. [DOI: 10.1016/j.jcjd.2017.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Abstract
Optimal blood glucose management still remains the biggest challenge in active individuals with diabetes, particularly in insulin users, but some newer strategies have been introduced to maintain blood glucose control. Recent studies emphasize the importance of exercise intensity on glycemic balance. In individuals with type 1 and type 2 diabetes, both resistance and high-intensity intermittent exercise have been shown to confer beneficial physiological adaptations in training studies, while also showing acute glycemic benefits from single sessions. At the same time, anyone training at higher intensities also should take into consideration potential impairments in thermoregulation in individuals with diabetes, which can increase the risk of heat stress during exercise in hot and/or humid conditions. Recent studies of medication effects on electrolyte balance and hydration give a more complete picture of potential exercise risks for athletes with diabetes. Use of the latest diabetes-related technologies also may benefit the athlete with diabetes.
Collapse
Affiliation(s)
- Jane E Yardley
- 1Department of Social Sciences, University of Alberta, Augustana Faculty, Camrose, AB, CANADA; and 2Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | | |
Collapse
|
36
|
Abstract
Islet transplantation (ITx) is effective in preventing severe hypoglycemia by restoring glucose-dependent insulin secretion in type 1 diabetes (T1D), but may not normalize glucose regulation. Studies suggest that physical activity plays a role in maintaining β-cell mass and function in individuals with type 2 diabetes and animal models of diabetes. This could indicate that physical activity plays a role in graft survival in ITx recipients. This review's objective is to assess current knowledge related to physical activity in ITx recipients. Responses to other challenges in blood glucose control (i.e., hypoglycemia) in human ITx recipients were examined to provide in-depth background information. To identify studies involving exercise in ITx recipients, a systematic search was performed using PubMed, Medline, and Embase, which revealed 277 English language publications. Publications were excluded if they did not involve ITx recipients; did not involve physical activity or hypoglycemia; or did not report on glucose, insulin, or counterregulatory hormones. During induced hypoglycemia, studies indicate normal suppression of insulin in ITx individuals compared with healthy non-T1D controls. Studies involving exercise in ITx animals have conflicting results, with time since transplantation and transplantation site (spleen, liver, kidney, peritoneal cavity) as possible confounders. No study examining blood glucose responses to physical activity in human ITx recipients was identified. A small number of induced-hypoglycemia studies in humans, and exercise studies in animals, would suggest that glucoregulation is greatly improved yet is still imperfect in this population and that ITx does not fully restore counterregulatory responses to challenges in blood glucose homeostasis.
Collapse
Affiliation(s)
- Deanna R Funk
- a Augustana Faculty, University of Alberta., 4901 - 46th Avenue Camrose, AB T4V 2R3, Canada
| | - Normand G Boulé
- b Faculty of Physical Education and Recreation, University of Alberta. 1-059D, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada
| | - Peter A Senior
- c Faculty of Medicine and Dentistry, Division of Endocrinology, University of Alberta. 2000 College Plaza 8215 112 Street, Edmonton AB T6G 2C8, Canada
| | - Jane E Yardley
- a Augustana Faculty, University of Alberta., 4901 - 46th Avenue Camrose, AB T4V 2R3, Canada
| |
Collapse
|
37
|
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39:2065-2079. [PMID: 27926890 PMCID: PMC6908414 DOI: 10.2337/dc16-1728] [Citation(s) in RCA: 1312] [Impact Index Per Article: 164.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sheri R Colberg
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jane E Yardley
- Department of Social Sciences, Augustana Campus, University of Alberta, Camrose, Alberta, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - David W Dunstan
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Paddy C Dempsey
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Edward S Horton
- Harvard Medical School and Joslin Diabetes Center, Boston, MA
| | | | - Deborah F Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
38
|
Yardley JE, Sigal RJ, Perkins BA, Riddell MC, Kenny GP. Resistance exercise in type 1 diabetes. Can J Diabetes 2015; 37:420-6. [PMID: 24321724 DOI: 10.1016/j.jcjd.2013.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 12/16/2022]
Abstract
It is relatively well known that moderate-intensity aerobic exercise increases the risk of hypoglycemia in individuals with type 1 diabetes. Conversely, brief high-intensity (anaerobic) activity can cause post-exercise hyperglycemia. Recent evidence has indicated that including small amounts of anaerobic activity, either in the form of short sprints or as resistance exercise (weight lifting), during aerobic exercise sessions may decrease the drop in blood glucose levels associated with moderate-intensity aerobic exercise. This review discusses the recent developments in the area of exercise and type 1 diabetes, with a particular focus on the effects of resistance exercise. Practical exercise recommendations, as well as suggestions for the future direction of research in this area, are also provided.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Ontario, Canada; Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | |
Collapse
|
39
|
Yardley JE, Kenny GP, Perkins BA, Riddell MC, Goldfield GS, Donovan L, Hadjiyannakis S, Wells GA, Phillips P, Sigal RJ. Resistance Exercise in Already-Active Diabetic Individuals (READI): study rationale, design and methods for a randomized controlled trial of resistance and aerobic exercise in type 1 diabetes. Contemp Clin Trials 2015; 41:129-38. [PMID: 25559915 DOI: 10.1016/j.cct.2014.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 02/08/2023]
Abstract
The Resistance Exercise in Already Active Diabetic Individuals (READI) trial aimed to examine whether adding a 6-month resistance training program would improve glycemic control (as reflected in reduced HbA₁c) in individuals with type 1 diabetes who were already engaged in aerobic exercise compared to aerobic training alone. After a 5-week run-in period including optimization of diabetes care and low-intensity exercise, 131 physically active adults with type 1 diabetes were randomized to two groups for 22weeks: resistance training three times weekly, or waiting-list control. Both groups maintained the same volume, duration and intensity of aerobic exercise throughout the study as they did at baseline. HbA₁c, body composition, frequency of hypoglycemia, lipids, blood pressure, apolipoproteins B and A-1 (ApoB and ApoA1), the ApoB-ApoA1 ratio, urinary albumin excretion, serum C-reactive protein, free fatty acids, total daily insulin dose, health-related quality of life, cardiorespiratory fitness and musculoskeletal fitness were recorded at baseline, 3 (for some variables), and 6 months. To our knowledge, READI is the only trial to date assessing the incremental health-related impact of adding resistance training for individuals with type 1 diabetes who are already aerobically active. Few exercise trials have been completed in this population, and even fewer have assessed resistance exercise. With recent improvements in the quality of diabetes care, the READI study will provide conclusive evidence to support or refute a major clinically relevant effect of exercise type in the recommendations for physical activity in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Jane E Yardley
- University of Alberta, Augustana Campus, Camrose, AB T4V 2R3, Canada; Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Bruce A Perkins
- Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Lois Donovan
- Department of Medicine, Cardiac Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB T2T 5C7, Canada; Department of Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB T2T 5C7, Canada
| | - Stasia Hadjiyannakis
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - George A Wells
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Penny Phillips
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Ronald J Sigal
- Department of Medicine, Cardiac Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB T2T 5C7, Canada; Department of Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB T2T 5C7, Canada.
| | | |
Collapse
|
40
|
Abstract
IN BRIEF Fear of hypoglycemia is one of the main barriers to physical activity for individuals with type 1 diabetes. Recent studies indicate that anaerobic forms of exercise (i.e., resistance exercise/weight lifting, sprints, and high-intensity intervals) can attenuate exercise-related declines in blood glucose both during and after exercise in young, healthy adults with type 1 diabetes. These responses might vary based on age, sex, and fitness level and in the general safety of relying on them to prevent hypoglycemia.
Collapse
Affiliation(s)
- Jane E. Yardley
- Department of Social Sciences, University of Alberta, Augustana Campus, Camrose, AB, Canada
- Manitoba Institute of Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ronald J. Sigal
- Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
41
|
Yardley JE, Zaharieva DP, Jarvis C, Riddell MC. The "ups" and "downs" of a bike race in people with type 1 diabetes: dramatic differences in strategies and blood glucose responses in the Paris-to-Ancaster Spring Classic. Can J Diabetes 2014; 39:105-10. [PMID: 25492557 DOI: 10.1016/j.jcjd.2014.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 08/05/2014] [Accepted: 09/09/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Recommendations for insulin adjustments and carbohydrate intake exist for individuals with type 1 diabetes who are undertaking moderate exercise. Very few guidelines exist for athletes with type 1 diabetes who are competing in events of higher intensity or longer duration. This observational study reports the strategies adopted by 6 habitually active men with type 1 diabetes (glycated hemoglobin = 8.3%±2.0%) undertaking a relatively intense endurance cycling event. METHODS Participants wore continuous glucose monitoring (CGM) sensors for 24 hours before competition, while racing and overnight postrace. They were asked to eat their regular meals and snacks and make their usual insulin adjustments before, during and after competition. All food intake and insulin adjustments were recorded in detail. RESULTS Participants used a variety of adjustments for exercise. Of 6 participants, 4 decreased their insulin dosages and all participants consumed carbohydrates during the race (mean = 87±57 g). In spite of these strategies, 3 of the 6 participants experienced mild to moderate hypoglycemia (not requiring assistance) during the event. Hyperglycemia was seen in all participants 3 hours postexercise. There were no incidents of nocturnal hypoglycemia. CONCLUSIONS Individuals with type 1 diabetes can compete in intensive long-distance athletic events using a variety of nutrition- and insulin-adjustment strategies. In addition to finely tuned insulin adjustments and increased carbohydrate intake, vigilance will always be required to maintain some semblance of glycemic control during events of extended duration.
Collapse
Affiliation(s)
- Jane E Yardley
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Augustana Campus, Camrose, Alberta, Canada.
| | - Dessi P Zaharieva
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | | | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Yardley JE, Hay J, Abou-Setta AM, Marks SD, McGavock J. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract 2014; 106:393-400. [PMID: 25451913 DOI: 10.1016/j.diabres.2014.09.038] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 12/11/2022]
Abstract
AIMS Conflicting evidence exists regarding the benefits of physical activity for long-term blood glucose control in adults with type 1 diabetes (T1D). The object of this systematic review was to determine the effects of physical activity on long-term blood glucose control in T1D adults. METHODS PubMed/Medline, Embase, CENTRAL, SPORTdiscus, Global Health and ICTRP were searched up to October 2013 for randomized trials of aerobic or resistance exercise training in T1D adults. Exercises had to be performed at least twice weekly for a minimum of two months. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included cardiorespiratory fitness and insulin dose. RESULTS Six randomized trials were identified (323 adults); sample sizes ranged from n=6 to n=148 participants receiving the intervention. Five trials had an unknown risk of bias; one trial was deemed to be at high risk of bias. Exercise frequency varied from twice weekly to daily, with intensities (50-90% VO2peak), and session durations (20-120 min) varying widely. Four trials reported HbA1c, which decreased with exercise training (mean difference [MD] -0.78% (-9 mmol/mol), 95% CI -1.14 (-13 mmol/mol) to -0.41 (-5 mmol/mol); p<0.0001; I(2) 0%) compared with controls. Exercise training improved cardiorespiratory fitness by 3.45 ml/kg/min (95% CI 0.59 to 6.31, p=0.02, I(2) 0%) compared with controls. One trial reported an effect on insulin dose (MD -0.4U/kg, 95% CI -0.53 to -0.27, p<0.00001) compared to controls. CONCLUSION There are currently insufficient well-designed studies to ascertain the true effect of exercise training on HbA1c in individuals with T1D, but current results are promising.
Collapse
Affiliation(s)
- Jane E Yardley
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada; University of Alberta, Augustana Campus, Camrose, AB, Canada
| | - Jacqueline Hay
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada; Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Seth D Marks
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan McGavock
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
43
|
Stapleton JM, Yardley JE, Boulay P, Sigal RJ, Kenny GP. Whole-body heat loss during exercise in the heat is not impaired in type 1 diabetes. Med Sci Sports Exerc 2014; 45:1656-64. [PMID: 23475170 DOI: 10.1249/mss.0b013e31829002f3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The objective of this study is to determine whether individuals with type 1 diabetes exhibit impairments in local and whole-body heat loss responses that could affect core temperature regulation during exercise in the heat compared with matched, nondiabetic individuals. METHODS Twelve otherwise healthy individuals with type 1 diabetes (HbA1c = 7.7% ± 0.3%) and 12 controls matched for age, sex, body surface area, and physical fitness cycled continuously for 60 min at a set rate of metabolic heat production (approximately 400 W) in a whole-body direct calorimeter (35°C and 20% relative humidity). Local sweat rate (ventilated capsule) was measured on the back and skin blood flow (laser Doppler velocimetry) on the forearm. Core (rectal and esophageal) and mean skin temperatures and heart rate were measured continuously. Whole-body heat exchange and change in body heat content were measured using simultaneous direct whole-body and indirect calorimetry. RESULTS The change (mean ± SE) in body heat content was similar between groups during exercise (diabetes, 409 ± 27 kJ; control, 386 ± 33 kJ; P = 0.584) and recovery (diabetes, -115 ± 16 kJ; control, -93 ± 24 kJ; P = 0.457). Local heat loss responses of sweating (P = 0.783) and skin blood flow (P = 0.078) as well as rectal temperature (diabetes, 37.87°C ± 0.10°C; control, 37.85°C; ± 0.13°C; P = 0.977) and heart rate (diabetes, 130 ± 9 beats·min, vs control, 126 ± 8 beats·min, P = 0.326) were comparable at the end of the exercise period. CONCLUSION During light-to-moderate-intensity exercise performed under conditions permitting full sweat evaporation, otherwise healthy type 1 diabetic individuals did not show impaired heat loss responses during heat exposure when compared with matched individuals without diabetes.
Collapse
|
44
|
Yardley JE, Kenny GP, Riddell MC, Perkins BA, Sigal RJ. The Frequency of Nocturnal Hypoglycemia is Not Increased with Exercise in Physically Active Individuals with Well Controlled Type 1 Diabetes. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.08.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Yardley JE, Sigal RJ, Riddell MC, Perkins BA, Kenny GP. Performing resistance exercise before versus after aerobic exercise influences growth hormone secretion in type 1 diabetes. Appl Physiol Nutr Metab 2013; 39:262-5. [PMID: 24476484 DOI: 10.1139/apnm-2013-0329] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We compared growth hormone (GH) and plasma glucose (PG) levels in type 1 diabetic individuals performing aerobic before resistance exercise (AR) to when resistance exercise was performed first (RA). In AR, GH secretion declined in late exercise while it rose throughout exercise in RA, resulting in higher GH in RA versus AR at exercise completion. Higher GH during RA may support PG by increasing hepatic glucose production and lipid mobilization.
Collapse
Affiliation(s)
- Jane E Yardley
- a Human and Environmental Physiology Research Unit, Montpetit Hall, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | | | | | | |
Collapse
|
46
|
Abstract
Chronic medical conditions such as type 2 diabetes may alter the body's normal response to heat. Evidence suggests that the local heat loss response of skin blood flow (SkBF) is affected by diabetes-related impairments in both endothelium-dependent and non-endothelium-dependent mechanisms, resulting in lower elevations in SkBF in response to a heat or pharmacological stimulus. Thermoregulatory sweating may also be diminished by type 2 diabetes, impairing the body's ability to transfer heat from its core to the environment. Diabetes-associated co-morbidities and the medications (particularly those affecting fluid balance) required to treat these conditions may exacerbate the risk of heat-related illness by decreasing SkBF and sweating further. Unfortunately, the majority of studies measure local heat loss responses in the hands and feet and lack measures of core temperature. Therefore, the impact of these impairments on whole-body heat loss remains unknown. This review addresses heat-related vulnerability in individuals with type 2 diabetes by examining the literature related to heat loss responses in this population. Type 2 diabetes, its associated co-morbidities, and the medications required in their treatment may cause dehydration, lower SkBF, and reduced sweating, which could consequently impair thermoregulation. This effect is most evident in individuals with poor blood glucose control. Although type 2 diabetes can be associated with impairments in SkBF and sweating, more physically active individuals requiring fewer medications and having good blood glucose control may be able to tolerate heat as well as those of similar age and body composition.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | |
Collapse
|
47
|
Yardley JE, Stapleton JM, Carter MR, Sigal RJ, Kenny GP. Is whole-body thermoregulatory function impaired in type 1 diabetes mellitus? Curr Diabetes Rev 2013; 9:126-36. [PMID: 23363333 DOI: 10.2174/1573399811309020004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/22/2022]
Abstract
UNLABELLED During periods of extreme heat individuals with diabetes have greater rates of heat-related morbidity and mortality compared to their non-diabetic counterparts. The reason for this discrepancy is currently unknown. Furthermore, there is a lack of information about whether or not individuals with type 1 diabetes are at a thermoregulatory disadvantage during strenuous physical activity especially when performed in the heat. PURPOSE This review discusses the current literature pertaining to thermoregulatory responses in individuals with type 1 diabetes. METHODS We included 14 reviews and 95 original research articles identified by searches of PubMed and Google Scholar and deemed relevant to our subject by three independent readers. RESULTS Individuals with poorly controlled type 1 diabetes may have impaired heat sensation, and a reduced capacity to dissipate heat due to lower skin blood flow and sweating responses and a greater tendency towards dehydration compared to individuals without diabetes. Impairments may be attenuated or absent in those with good blood glucose control. We found no published studies examining thermoregulatory responses to physical activity in the heat in individuals with type 1 diabetes. CONCLUSIONS Type 1 diabetes may cause impairments in heat loss resulting in a greater level of thermal strain. Advancement in our understanding about the effects of type 1 diabetes on the heat stress response, especially during different challenges to human heat balance associated with changes in both environmental heat load and metabolic heat production (physical activity), will help us to determine where the risk of heat-illness/injury actually exists.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ontario, Canada, K1N 6N5
| | | | | | | | | |
Collapse
|
48
|
Yardley JE, Kenny GP, Perkins BA, Riddell MC, Balaa N, Malcolm J, Boulay P, Khandwala F, Sigal RJ. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care 2013; 36:537-42. [PMID: 23172972 PMCID: PMC3579339 DOI: 10.2337/dc12-0963] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In type 1 diabetes, small studies have found that resistance exercise (weight lifting) reduces HbA(1c). In the current study, we examined the acute impacts of resistance exercise on glycemia during exercise and in the subsequent 24 h compared with aerobic exercise and no exercise. RESEARCH DESIGN AND METHODS Twelve physically active individuals with type 1 diabetes (HbA(1c) 7.1 ± 1.0%) performed 45 min of resistance exercise (three sets of seven exercises at eight repetitions maximum), 45 min of aerobic exercise (running at 60% of Vo(2max)), or no exercise on separate days. Plasma glucose was measured during and for 60 min after exercise. Interstitial glucose was measured by continuous glucose monitoring 24 h before, during, and 24 h after exercise. RESULTS Treatment-by-time interactions (P < 0.001) were found for changes in plasma glucose during and after exercise. Plasma glucose decreased from 8.4 ± 2.7 to 6.8 ± 2.3 mmol/L (P = 0.008) during resistance exercise and from 9.2 ± 3.4 to 5.8 ± 2.0 mmol/L (P = 0.001) during aerobic exercise. No significant changes were seen during the no-exercise control session. During recovery, glucose levels did not change significantly after resistance exercise but increased by 2.2 ± 0.6 mmol/L (P = 0.023) after aerobic exercise. Mean interstitial glucose from 4.5 to 6.0 h postexercise was significantly lower after resistance exercise versus aerobic exercise. CONCLUSIONS Resistance exercise causes less initial decline in blood glucose during the activity but is associated with more prolonged reductions in postexercise glycemia than aerobic exercise. This might account for HbA(1c) reductions found in studies of resistance exercise but not aerobic exercise in type 1 diabetes.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Yardley JE, Sigal RJ, Kenny GP, Riddell MC, Lovblom LE, Perkins BA. Point accuracy of interstitial continuous glucose monitoring during exercise in type 1 diabetes. Diabetes Technol Ther 2013; 15:46-9. [PMID: 23137050 DOI: 10.1089/dia.2012.0182] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies of aerobic exercise have found lower sensor accuracy during exercise. Whether or not resistance exercise would also be associated with lower sensor accuracy has not yet been examined. This study sought to investigate the accuracy of continuous glucose monitoring sensor values at rest, during aerobic exercise, and during resistance exercise. SUBJECTS AND METHODS Twelve individuals with type 1 diabetes performed 45 min of aerobic exercise, resistance exercise, or no exercise/rest followed by 60 min of recovery while monitored by continuous glucose monitoring systems. RESULTS Sensors underestimated plasma glucose to the greatest extent during rest (-1.29 ± 1.39 mmol/L, P<0.001) and resistance exercise (-0.71 ± 1.35 mmol/L, P<0.001) and least during aerobic exercise (-0.11 ± 1.71 mmol/L, P=0.416). CONCLUSIONS Optimal accuracy observed with aerobic exercise might arise from augmented blood flow better equilibrating plasma and interstitial fluid or from the combination of systematic sensor underestimation and sensor lag time.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
50
|
Yardley JE, Iscoe KE, Sigal RJ, Kenny GP, Perkins BA, Riddell MC. Insulin pump therapy is associated with less post-exercise hyperglycemia than multiple daily injections: an observational study of physically active type 1 diabetes patients. Diabetes Technol Ther 2013; 15:84-8. [PMID: 23216304 DOI: 10.1089/dia.2012.0168] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aerobic exercise typically decreases blood glucose levels in individuals with type 1 diabetes. It is currently unknown if glucose responses to exercise and recovery differ between patients on multiple daily insulin injections (MDI) and continuous subcutaneous insulin infusion (CSII). SUBJECTS AND METHODS Nineteen (16 male, three female) physically active individuals with type 1 diabetes took part in this observational study. Interstitial glucose levels (blinded) were compared during 45 min of standardized aerobic exercise (cycling or running at 60% peak aerobic capacity) and during 6 h of postexercise recovery between individuals using MDI (n=9) and CSII (n=10) therapy. RESULTS Both MDI and CSII groups had similar reductions in glucose levels during exercise, but responses in early and late recovery differed (group × time interaction, P<0.01). Participants using MDI had greater increases in glucose throughout recovery compared with individuals with CSII. Two-thirds of the MDI patients experienced late-onset post-exercise hyperglycemia (blood glucose >12 mmol/L) compared with only 1/10(th) of the CSII patients (P<0.01). CONCLUSIONS Among individuals performing regular moderate-to-heavy intensity aerobic exercise, use of CSII helped to limit post-exercise hyperglycemia compared with MDI therapy and is not associated with increased risk for post-exercise late-onset hypoglycemia.
Collapse
Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | |
Collapse
|