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Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot Study

Authors:

Abstract

Objective: The purpose of the present study was to examine the impact of 12 weeks of elliptical high intensity interval training (HIIT) on metabolic risk factors and body composition in pre- and type 2 diabetes patients. Methods: Sixteen pre- (n = 8) and type 2 diabetes (n = 8) participants completed this study. Fasting blood glucose, HbA1c, anthropometric measurements, body composition (DXA), blood pressure, resting heart rate, VO2 max, dietary factors as well as total and physical activity energy expenditure were measured. The HIIT program on the elliptical was performed three times a week for 12 weeks. Results: After the intervention, we observed a significant improvement for fasting blood glucose, waist and hip circumference, appendicular fat mass, leg lean body mass and appendicular lean body mass, systolic blood pressure, resting heart rate and VO2 max (p < 0.05). In addition, we noted a lower tendency for leg fat mass (P = 0.06) and diastolic blood pressure (p = 0.05) as well as a higher tendency for total energy expenditure (p = 0.06) after the intervention. Conclusion: The present study indicates that elliptical HIIT seems to improve metabolic risk factors and body composition in pre- and type 2 diabetes patients.
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Note: This article will be published in a forthcoming issue of
the Journal of Physical Activity & Health. This article appears
here in its accepted, peer-reviewed form, as it was provided by
the submitting author. It has not been copy edited, proofed, or
formatted by the publisher.
Section: Original Research
Article Title: Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in
Pre- and Type 2 Diabetes Patients: A Pilot Study
Authors: Annie Fex1, Jean-Philippe Leduc-Gaudet1, Marie-Eve Filion1, Antony D. Karelis1,2,
and Mylène Aubertin-Leheudre1,2
Affiliations: 1Department of Kinanthropology, Université du Québec à Montréal, Montreal,
Canada. 2Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal,
Canada
Running Head: Interval training and metabolic complications
Journal: Journal of Physical Activity & Health
Acceptance Date: August 7, 2014
©2014 Human Kinetics, Inc.
DOI: http://dx.doi.org/10.1123/jpah.2014-0123
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Original Research
Effect of elliptical high intensity interval training on metabolic risk factor in pre- and type 2
diabetes patients: A pilot study
Running title: Interval training and metabolic complications
Annie Fex, MSc1, Jean-Philippe Leduc-Gaudet1, Marie-Eve Filion, MSc1, Antony D. Karelis, PhD1,2, and
Mylène Aubertin-Leheudre, PhD1,2
1Department of Kinanthropology, Université du Québec à Montréal, Montreal, Canada, H3C 3P8
2Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, Canada, H3W 1W4
Running title: Interval training and metabolic complications
Correspondent author: Mylène Aubertin-Leheudre, PhD
Department of Kinanthropology
Université du Québec à Montréal
8888, succ centre-ville
Montreal, Quebec, Canada
H3C 3P8
Tel: +001-514-987-3000 #5018
Fax: +001-514-987-6616
Email: aubertin-leheudre.mylene@uqam.ca
Number of words in abstract: 199
Number of words in text: 3052
Number of tables: 3
Submission date: March 20th, 2014
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
ABSTRACT
Objective: The purpose of the present study was to examine the impact of 12 weeks of elliptical
high intensity interval training (HIIT) on metabolic risk factors and body composition in pre- and
type 2 diabetes patients. Methods: Sixteen pre- (n = 8) and type 2 diabetes (n = 8) participants
completed this study. Fasting blood glucose, HbA1c, anthropometric measurements, body
composition (DXA), blood pressure, resting heart rate, VO2 max, dietary factors as well as total
and physical activity energy expenditure were measured. The HIIT program on the elliptical was
performed three times a week for 12 weeks. Results: After the intervention, we observed a
significant improvement for fasting blood glucose, waist and hip circumference, appendicular fat
mass, leg lean body mass and appendicular lean body mass, systolic blood pressure, resting heart
rate and VO2 max (p < 0.05). In addition, we noted a lower tendency for leg fat mass (P = 0.06)
and diastolic blood pressure (p = 0.05) as well as a higher tendency for total energy expenditure
(p = 0.06) after the intervention. Conclusion: The present study indicates that elliptical HIIT
seems to improve metabolic risk factors and body composition in pre- and type 2 diabetes
patients.
Keywords: HbA1c, fasting blood glucose, body composition, VO2 max
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
INTRODUCTION
Many studies have reported that traditional exercise training programs such as aerobic
(e.g. walking, cycling) or resistance training (e.g. weight lifting) are associated with an
improvement in blood glucose, HbA1c and insulin sensitivity levels in type 2 diabetes patients 1,
2. These exercise training programs have also shown to decrease the risk of type 2 diabetes 3.
However, one’s lifestyle (e.g. employment, family and leisure) may interfere with the amount of
time devoted to physical activity. In addition, with age, there is a higher risk of individuals being
more sedentary and having less time dedicated to physical activity programs 4. Accordingly, 61
% of individuals who are 65 years old and over are sedentary 4. Therefore, it is important to
provide new time-efficient physical activity programs to at risk populations.
High intensity interval training (HIIT), which consists of alternating repetitive short bouts
of high intensity exercise with less active or passive recovery periods, seems to meet this
requirement by engaging patients in a potentially more efficient intervention. Studies have
shown that HIIT is more effective than continuous moderate exercise in reducing metabolic
complications (e.g. blood pressure, lipid profile, visceral fat, insulin sensitivity) and increasing
cardiorespiratory fitness levels in different at risk populations such as patients with
cardiovascular diseases, individuals with the metabolic syndrome and overweight adolescents 5-7.
Interestingly, a review has advocated research on the effect of HIIT in pre- and type 2 diabetes
patients since this form of exercise training could provide a more powerful stimulus in the
improvement of metabolic complications than traditional moderate intensity exercises 8.
Accordingly, several studies have investigated the effect of HIIT on metabolic risk factors in
patients with type 2 diabetes 9-13. For example, in the study of Little et al. 11, 8 patients with type
2 diabetes performed six sessions of HIIT on the ergocycle (10 × 60 sec cycling bouts at 90 %
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
of maximal heart rate with 60 sec of rest between bouts) over a 2 week period. Results show that
mean 24 h blood glucose levels were significantly decreased after the intervention from 7.6 to
6.6 mmol/l. Improvements in the sum of the 3 h postprandial areas under the glucose curve after
breakfast, lunch and dinner were also shown after HIIT 11.
The elliptical device is widely available in fitness and rehabilitation centers as well as
home settings. With the recent increase in popularity in the use of the elliptical 14, more research
on this piece of equipment is warranted. Indeed, to our knowledge, all previous studies that have
examined the effect of HIIT on metabolic risk factors and body composition in at risk
populations were performed either on the treadmill or the ergocycle. Therefore, the purpose of
the present study was to examine the impact of elliptical HIIT on metabolic risk factors and body
composition in individuals with pre- and type 2 diabetes. We hypothesized that the elliptical
HIIT program will improve metabolic risk factors and body composition.
METHODS
Subjects: A total of twenty-five participants were recruited in the study using
advertisements in local papers and Montreal communities. Inclusion criteria of the study were:
aged 50 years old and above, pre-diabetes (fasting glucose between 5.6 and 6.9 mmol/L) or type
2 diabetes (fasting glucose 7 mmol/L) for at least 6 months, no orthopedic limitations, non-
smoker, sedentary for at least 6 months (< 2 hours a week of structured exercise), low to
moderate alcohol consumers (< 2 drinks / day), a body mass index (BMI) of 25 kg/m2 and above,
a stable weight 2 kg) for the last 6 months and an absence of menstruation for the past 12
months for women. All procedures were approved by the Ethics Committee of the Department of
Kinanthropology of the Université du Québec à Montréal. All participants were fully informed
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
about the nature, goal, procedures and risks of the study and gave their informed consent in
writing.
Procedure: A phone interview was conducted to screen for the aforementioned inclusion
criteria. After screening, each participant was invited to the Department of Kinanthropology at
the Université du Québec à Montréal in the fasting state at 07h30 for a series of tests. Upon their
arrival, fasting blood glucose, HbA1c, anthropometric measurements, body composition, blood
pressure and resting heart rate were measured. Afterward a light breakfast was served.
Thereafter, a cardiorespiratory fitness test was performed. Following their morning assessment,
participants were given instructions to complete a 3-day dietary journal. Furthermore, a
SenseWear armband was placed on the participant before leaving the laboratory for the
measurement of energy expenditure. All measurements were performed by the same investigator
(AF) pre and post intervention. Post testing was performed after 48 hours of the last training
session.
Measurements
Anthropometric: Body weight was determined using an electronic scale (Balance
Industrielles, Montreal, Canada). Height was measured using a wall stadiometer (Perspective
Enterprises, Michigan, USA). Body mass index (BMI) was calculated: Body weight (kg)/height
(m2). Waist and hip circumferences were measured to the nearest 0.5 cm by using a non-elastic
plastic tape with the participant standing upright.
Body composition: Total body fat mass percentage, leg fat mass percentage, appendicular
fat mass percentage, total lean body mass, leg lean body mass and appendicular lean body mass
were measured using dual energy X-ray absorptiometry (DXA) (General Electric Lunar Prodigy;
standard mode; software version 12.30.008, Madison, WI, USA). Calibration was executed daily
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
with a standard phantom prior to each test and the intra-class coefficient correlation for test-retest
for body fat mass percentage and total lean body mass was 0.99 (n = 18).
Blood analyses: After a 12-hour overnight fast (food and liquid), the OneTouch
UltraMini glucometer (LifeScan, Inc. Milpitas, CA) was used for the measurement of fasting
blood glucose. The method has been reported to be valid in a clinical setting 15. The intra-class
coefficient correlation for test-retest for fasting glucose was 0.97 (n = 7). Glycosylated
hemoglobin (HbA1c) levels were measured using the DCA 2000 (Bayer Diagnostics, Tarrytown,
NY). It should be noted that several studies have shown the accuracy of this device for
measuring HbA1c 16-18. The intra-class coefficient correlation for test-retest for HbA1c levels
was 0.98 (n = 7).
Blood pressure: Systolic and diastolic sitting blood pressure was determined by an
automatic sphygmomanometer machine (Spot Vital Signs® Devices, Welch Allyn, Mississauga,
ON). An appropriate cuff size was selected for each subject based on arm circumference.
Conditions were carefully standardized: no talking, cuff on the right arm and 5 min of rest. Three
measurements with 5 min of rest between measures were taken. The average of the three
measures was reported.
Estimated maximal oxygen consumption (VO2 max): The Bruce modified protocol on the
treadmill was used to measure VO2 max 19. We adopted this protocol because it is suitable for
high risk elderly adults 20. The test consisted of seven three minutes levels. A progressive
increase in the level of intensity (the inclination or the speed of the treadmill) was performed
between levels after each 3-minute periods until voluntary exhaustion was reached. The
estimated VO2 max (ml/kg/min) was calculated using the validated prediction equation specific
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
for each sex 21: Men = 14.76 - (1.137 x T) + (0.451 x T2) - (0.012 x T3); Women = (4.38 x T) -
3.9. T = Maximum time on the treadmill in minutes.
Dietary Intake: Each subject was instructed to maintain their normal dietary habits during
the intervention and data collection. Subjects were provided with a food scale and instructions on
how to complete a 3-day dietary journal. Diets were recorded during 3 consecutive days
including 1 weekend day. It should be noted that a 3-day dietary journal has been shown to be
valid in estimating dietary intakes in older adults 22. Dietary analyses were completed using the
Candat System software (version 8.0; Candat, London, ON, Canada) to determine daily energy
intake and macronutrients.
Measure of Energy Expenditure: Free living energy expenditure was measured using the
portable SenseWear armband (HealthWear Bodymedia, Pittsburgh, PA). Total and physical
activity energy expenditure was determined from the portable armband (5 x 3 x 2 cm) during a 7
consecutive day period pre and post intervention. The portable armband uses a 2-axis
accelerometer, a heat flux sensor, a galvanic skin response sensor, a skin temperature sensor, and
a near-body ambient temperature sensor to capture data. These data as well as body weight,
height, handedness and smoking status (smoker or non-smoker) are used to calculate energy
expenditure. The armband was placed on the upper right arm (on the triceps at the mid-humerus
point) of each volunteer. The net output is an indirect measure of energy expenditure (kcal)
utilized by the subject across time. This method of energy expenditure measurement has been
validated by several studies 23-27.
Intervention: The high intensity interval training program on elliptical was performed
three times a week for 12 weeks. The sessions were supervised by a kinesiologist. The 30 min
exercise session consisted of a 5 min warm-up (60-65 % of maximum heart rate (MHR)), 20 min
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
of interval training (30 sec sprints at an intensity of 80-85 % of MHR followed by 1 min 30 sec
of active recovery) and a 5 min cool-down (60-65 % of MHR). Maximum heart rate was
determined using the equation of Karvonen [((220 - age) - HR rest) x % HR target] + HR rest 28.
It should be noted that participants had to complete 80 % or more of their training sessions in
order to be included in the analysis.
Statistical analysis
The sample size calculation was based on fasting glucose levels considering an expected
change of 0.3 mmol/l ± 0.3 6. At the end of the study, sixteen patients were needed for a power of
80 % and an alpha error of 0.05. Because we predicted a 20 % dropout rate and 20 % of
participants not completing at least 80 % of their training sessions, 25 subjects were recruited at
the start of the study. Results are presented as means ± SD. Normality was verified using the
Kurtosis-test. Non parametric paired t-tests were used to identify differences before and after the
intervention. We also calculated the effect size (mean difference pre-post intervention / SD) for
all variables that were significantly improved after the intervention. Statistical analysis was
performed using SPSS 20 for Windows (Chicago, IL). Significance was accepted at p < 0.05.
RESULTS
A total of 25 participants were recruited in the study. However, 7 subjects were excluded
from the analysis since they did not complete at least 80 % of their training sessions. Two other
participants dropped out of the study. Therefore, a total of 16 subjects (8 with pre-diabetes and 8
with type 2 diabetes) completed the study and were included in the analysis. It should be noted
that mean attendance for the exercise sessions in the participants that completed the study was 88
%.
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Physical characteristics of the participants are presented in Table 1. We observed no
significant differences between pre- and post- intervention for body weight, BMI, total body fat
mass percentage and total lean body mass. However, we noted a significant improvement for
waist circumference (p = 0.03) (Effect Size (ES): 0.4), hip circumference (p = 0.01) (ES: 0.3),
appendicular fat mass (p < 0.001) (ES: 0.8), leg lean body mass (p < 0.001) (ES: 0.2) and
appendicular lean body mass (p = 0.02) (ES: 0.1) after the intervention. We also observed a
lower tendency for leg fat mass (p = 0.06) after the intervention.
Table 2 shows metabolic characteristics of the participants. No significant differences
were observed for HbA1c after the intervention. However, we found significant improvements
for systolic blood pressure (p < 0.001) (ES: 0.6), resting heart rate (p = 0.03) (ES: 0.6), VO2 max
(p = 0.03) (ES: 0.6) and fasting glucose (p = 0.04) (ES: 0.4). Furthermore, we observed a lower
tendency for diastolic blood pressure (p = 0.05) after the intervention. Finally, out of the 8
subjects with type 2 diabetes that started the intervention, 6 participants fell below a diabetes
state (< 7 mmol/l) and 1 patient even fell below a pre-diabetes state (< 5.6 mmol/l) after the
intervention. In addition, out of the 8 pre-diabetes subjects that started intervention, 1 patient fell
below 5.6 mmol/l after the intervention. When statistically adjusted for either changes in waist
circumference, hip circumference, appendicular fat mass or appendicular lean body mass,
significant differences for systolic blood pressure persisted. When statistically adjusted for either
changes in waist circumference, hip circumference or appendicular lean body mass, significant
differences for fasting glucose levels were abolished, however, when adjusted for changes in
appendicular fat mass, the differences persisted.
Dietary and energy expenditure profiles of the participants are presented in table 3. No
significant differences were observed for total energy intake, protein intake, carbohydrate intake
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
and fat intake as well as physical activity energy expenditure after the intervention. However, we
observed a higher tendency for total energy expenditure (p = 0.06) after the intervention.
DISCUSSION
Among individuals with type 2 diabetes, studies have generally focused more on
traditional resistance or aerobic exercise training protocols to study the effect of numerous
metabolic outcomes (e.g. insulin sensitivity, HbA1c and fasting glucose levels) 1, 2. Thus, the
purpose of the present study was to determine the impact of elliptical HIIT on metabolic risk
factors and body composition in individuals with pre-diabetes or type 2 diabetes. We
hypothesized that a 12-week HIIT program on the elliptical would improve metabolic risk
factors and body composition. Results of the present study support our hypothesis. That is, HIIT
on the elliptical was associated with a favorable improvement in certain metabolic risk factors
and body composition in our cohort.
There is evidence to suggest that HIIT may improve glycemic control 29, 30. In the present
study, HIIT significantly decreased fasting glucose concentrations from 7.1 to 6.5 mmol/l. This
result is in line with another study which also showed a significant decrease in fasting glucose
levels after HIIT in type 2 diabetes patients 12. A potential fundamental mechanism that could
explain the reduction in fasting glucose levels may be GLUT4 content. In support of this
hypothesis, a recent study showed that HIIT during 2 weeks increased skeletal muscle GLUT4
content in young healthy men 31. However, two other studies have shown that fasting glucose
levels did not change after HIIT in type 2 diabetes subjects 10, 13. Furthermore, HbA1c levels did
not improve after the intervention in the present study which is consistent with other studies 10, 13
but not all 12. The differences in the results may be explained by the exercise intervention used,
sample size and different populations. As for systolic blood pressure in our study, we observed a
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
significant decrease from 134 to 127 mm Hg. Other studies using HIIT have also observed a
significant improvement in systolic blood pressure in individuals with hypertension 32 and type 2
diabetes 12.
Improvements in body composition and VO2 max levels have been reported after HIIT.
For example, a significant decrease in % body fat has been observed after HIIT in patients with
type 2 diabetes 10, 12, 13. However, no improvements in body fat percentage were noted in the
present study. Indeed, a significant decrease in waist (-4 cm) and hip circumference (-3 cm) were
observed in the present study. Whyte et al. 30 also showed a significant decrease in waist (-2.4
cm) and hip circumference (-1.1 cm) in just 2 weeks of HIIT (6 sessions of 30 seconds interval
sprint with a recovery of 4.5 minutes) in sedentary overweight or obese men. In addition, a
significant increase in leg and appendicular lean body mass was observed in the present study.
These results are in line with the study of Gillen et al. 33 who also showed an increase in leg lean
body mass after HIIT in overweight/obese women. Moreover, cardiorespiratory fitness levels
(VO2 max) appear to be a strong predictor of cardiovascular disease and mortality 34. In the
present study, a significantly increase in VO2 max levels were observed after the HIIT,
confirming the results of other studies who also showed increases in VO2 max after HIIT in at
risk populations 35.
Collectively, the favorable changes in body composition in the present study may
explain, at least in part, the significant reduction in fasting glucose levels and systolic blood
pressure. When statistically controlling for either changes in waist circumference, hip
circumference or appendicular lean body mass, significant differences for fasting glucose levels
were abolished, suggesting that body composition may be a dependent factor. In addition, when
statistically adjusted for either changes in waist circumference, hip circumference, appendicular
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
fat mass or appendicular lean body mass, significant differences for systolic blood pressure
persisted, suggesting that the improvements in systolic blood pressure are independent from the
changes in body composition.
This study has several limitations. First, our small sample size was only composed of
overweight/obese pre- and type 2 diabetes patients. Therefore, our findings are limited to this
population. Second, there was no control group due to the difficulty in recruiting subjects in this
group. It should be noted that the participants did not want to be in the control group since their
goal was to improve their health. Thus, these results need to be replicated with a larger sample in
a randomized controlled study. However, it should be noted that that a wide range of pre and
post intervention assessments using validated techniques were used in the present study. Finally,
the results of the present study should be considered preliminary, but they may stimulate interest
in the impact of elliptical HIIT on metabolic diseases. Further research may want to examine the
long-term follow-up of the beneficial effect of HIIT using the elliptical.
In conclusion, this study indicates that 12 weeks of elliptical HIIT improved metabolic
risk factors (i.e. fasting glucose and blood pressure) and body composition in individuals with
pre-diabetes or type 2 diabetes. In general, a medium effect size was observed for several
metabolic risk factors and body composition components. Therefore, healthcare professionals
could recommend this form of exercise training during the planning of their interventions
programs. In support of this recommendation, recent evidence has suggested that HIIT seems to
be a well-tolerated therapeutic intervention in different at risk populations 36. In addition, health
professionals may want to consider the elliptical as another exercise equipment option during the
implementation of exercise training programs.
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
ACKNOWLEDGMENTS
We would like to thank Carole Roy for her technical assistance as well as the participants who
accepted to be part of this study. MAL is supported by the Fond de la Recherche en Santé du
Québec (FRSQ). AF was supported by the Canadian Institutes of Health Research (CIHR) and
the Fond de la Recherche en Santé du Québec (FRSQ).
FUNDING SOURCE
This study was supported from start-up funds from the Université du Québec à Montréal
(UQAM).
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
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© 2014 Human Kinetics, Inc.
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Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
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Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
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Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 1. Physical characteristics of the participants (n = 16) before and after the intervention
Variables
Pre
Post
% Δ
P
Age (years)
60.4 6.1
Sex
♀ = 12, ♂ = 4
Height (m)
1.61 0.1
Body weight (kg)
89.4 14.4
88.9 14.8
-0.5 1.9
0.4
Body mass index (kg/m2)
34.6 5.4
34.4 5.6
-0.5 1.9
0.4
Waist circumference (cm)
109 10.3
105 10.6
-2.9 6.5
0.03
Hip circumference (cm)
116 11.5
113 12.1
-2.7 3.7
0.01
Total fat mass (%)
42.3 10.4
41.8 10.4
-1.3 3.5
0.2
Leg fat mass (%)
41.6 13.5
40.4 12.7
-2.3 4.5
0.06
Appendicular fat mass (%)
81.2 27.7
78.9 26.6
-2.7 3.0
< 0.001
Total lean body mass (kg)
49.7 11.7
49.8 11.2
0.5 3.2
0.8
Leg lean body mass (kg)
16.6 4.3
17.3 4.7
4.5 6.9
< 0.001
Appendicular lean body mass (kg)
21.9 6.1
22.8 6.6
4.2 7.3
0.02
Values are mean ± SD
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 2. Metabolic characteristics of the participants (n = 16) before and after the intervention
Pre
Post
% Δ
P
134 12.2
127 11.8
-5.1 5.1
< 0.001
81.3 8.4
79.7 9.9
-2.1 5.5
0.05
66.7 7.5
62.1 8.1
-6.1 9.6
0.03
40.3 8.0
45.4 9.8
14 19
0.03
6.2 0.6
6.1 0.5
-1.1 3.7
0.4
7.1 1.1
6.5 1.7
-7.7 13
0.04
Values are mean ± SD; VO2 max: maximal oxygen consumption
Effect of Elliptical High Intensity Interval Training on Metabolic Risk Factor in Pre- and Type 2 Diabetes Patients: A Pilot
Study” by Fex A et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 3. Dietary and energy expenditure profiles of the participants (n = 13) before and after the
intervention
Variables
Pre
Post
% Δ
P
Total energy intake (kcal)
6289 1433
5646 1598
- 8.3 23
0.2
Total protein (%)
21.9 5.8
23.8 4.1
13 30
0.3
Total carbohydrate (%)
57.4 8.1
57.2 7.4
- 0.5 11
0.9
Total fat (%)
19.2 4.2
17.7 5.4
- 5.5 29
0.4
Total energy expenditure (kcal/day)
2204 369
2287 356
4.2 6.8
0.06
Physical activity energy expenditure (kcal/day)
225 135
254 145
27 57
0.4
Values are mean ± SD
... Con base en lo anterior, se obtuvieron 20 estudios experimentales (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) (Figura 1) que cumplieron con los criterios de inclusión. En la Tabla 1 se presenta la información sobre el autor, año de publicación, muestra, descripción de la intervención, frecuencia y duración, así como los niveles de glucemia y su método de toma. ...
... MICT de 30 min a 60 % de la FCM. De los resultados obtenidos, se encontró que el entrenamiento de alta intensidad con dosificaciones de 3 veces por semana y en ocasiones combinado con ejercicios aeróbicos o intensivos-moderados (19,29,30) generó un aumento del VO 2 máx y una mejora de la capacidad aeróbica (19,24,30,31,35,38) y reducción de los niveles de hemoglobina glucosilada (HbA1c), sin olvidar la limitación en la regulación autonómica cardiovascular (19,21,22,25,27,28,32,37,38) . Es importante destacar que no se presentó un aumento del riesgo de hipoglucemia durante el período de 24 horas después del HIIT o 30 minutos luego del entrenamiento a intensidad moderada continua (MICT) en ayunas (36) . ...
... Además, el HIIT mejoró la composición corporal por capacidad de oxidación de lípidos; sin embargo, la grasa subcutánea no mostró grandes cambios (20,23,25,29,38) . Por consiguiente, brindó un aporte benéfico en cuanto a factores de riesgo metabólico en pacientes con hipertensión, prediabetes o diabetes tipo 2 (26) . ...
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Introduction: Diabetes mellitus type II is a worldwide problem, which completely affects the health and quality of life of the sufferer, as well as increases the risk of mortality. Materials and methods: A systematic review was carried out with a descriptive analysis of retrospective chronology, which took into account randomization trials focused on exercise in diabetic patients and published between 2014 and 2019. The studies were identified and selected using the recommendations of the PRISMA statement and the Cochrane Collaboration. In addition, the methodological quality of the included studies was evaluated using the PEDro Scale. Results: 20 experimental studies were included, from which information on: authors, years, samples, interventions, frequencies and durations, as well as glycemic levels were rescued. The training of these studies was based on intensive or moderate aerobic exercises three times a week, which generated results such as the increase in the maximum volume of oxygen (VO2 max), aerobic capacity and reduction of glycosylated hemoglobin levels. The review showed that high intensity training (HIIT) improves the composition of lipid oxidation, improves cardiac dysfunction, increases insulin sensitivity and thus decreases triglyceride levels Conclusions: High intensity exercise improves blood glucose levels in diabetic patients, which is beneficial in terms of cardiovascular and metabolic risks, where the guidelines and dosages are determined by each patient, but remain continuous and lasting
... Indeed, HIIT significantly increases maximal oxygen consumption while reducing cardiometabolic risk factors, including fat mass, in overweight and obese adults. [14][15][16] HIIT also elicits positive mitochondrial adaptations. 17,18 Evidence also indicates that short sessions of high-intensity exercises can induce greater improvements in functional capacities, body composition, and aerobic capacity than moderate-intensity continuous exercise in older individuals. ...
... The maximal heart rate was determined using the following equation: [((220-age) À Heart Rate rest) × % Heart Rate target] + Heart Rate rest. The 30 min exercise session consisted of a 5 min warm-up at a low intensity (50-60% maximal heart rate and/or a score between 8 and 12 on Borg's scale); a 20 min HIIT of multiple 30 s sprints at a high intensity (80-85% maximal heart rate or Borg's scale > 17) alternating with 90 s at a moderate intensity (65% maximal heart rate or Borg's scale score [13][14][15][16]; and a 5 min cool-down (50-60% maximal heart rate and/or a Borg's scale score [8][9][10][11][12]. To ensure that heart rate was always above 80% during high-intensity intervals, speed and resistance of the elliptical device were continuously adjusted by trained kinesiologists or physiotherapists throughout the training session. ...
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Background: Aging is associated with a progressive decline in skeletal muscle mass and strength as well as an increase in adiposity. These changes may have devastating impact on the quality of life of older adults. Mitochondrial dysfunctions have been implicated in aging-related and obesity-related deterioration of muscle function. Impairments in mitochondrial quality control processes (biogenesis, fusion, fission, and mitophagy) may underlie this accumulation of mitochondrial dysfunction. High-intensity interval training (HIIT) was shown to improve muscle and mitochondrial function in healthy young and old adults and to improve body composition in obese older adults. Recent studies also positioned citrulline (CIT) supplementation as a promising intervention to counter obesity-related and aging-related muscle dysfunction. In the present study, our objectives were to assess whether HIIT, alone or with CIT, improves muscle function, functional capacities, adipose tissue gene expression, and mitochondrial quality control processes in obese older adults. Methods: Eighty-one-old and obese participants underwent a 12 week HIIT with or without CIT on an elliptical trainer [HIIT-CIT: 20 men/25 women, 67.2 ± 5.0 years; HIIT-placebo (PLA): 18 men/18 women, 68.1 ± 4.1 years]. Handgrip and quadriceps strength, lower limb muscle power, body composition, waist circumference, and functional capacities were assessed pre and post intervention. Vastus lateralis muscle biopsies were performed in a subset of participants to quantify markers of mitochondrial content (TOM20 and OXPHOS subunits), biogenesis (TFAM), fusion (MFN1&2, OPA1), fission (DRP1), and mitophagy (Parkin). Subcutaneous abdominal adipose tissue biopsies were also performed to assess the expression of genes involved in lipid metabolism. Results: HIIT-PLA and HIIT-CIT displayed improvements in functional capacities (P < 0.05), total (mean ± SD: HIIT-PLA: +1.27 ± 3.19%, HIIT-CIT: +1.05 ± 2.91%, P < 0.05) and leg lean mass (HIIT-PLA: +1.62 ± 3.85%, HIIT-CIT: +1.28 ± 4.82%, P < 0.05), waist circumference (HIIT-PLA: -2.2 ± 2.9 cm, HIIT-CIT: -2.6 ± 2.5 cm, P < 0.05), and muscle power (HIIT-PLA: +15.81 ± 18.02%, HIIT-CIT: +14.62 ± 20.02%, P < 0.05). Only HIIT-CIT decreased fat mass (-1.04 ± 2.42%, P < 0.05) and increased handgrip and quadriceps strength (+4.28 ± 9.36% and +10.32 ± 14.38%, respectively, P < 0.05). Both groups increased markers of muscle mitochondrial content, mitochondrial fusion, and mitophagy (P < 0.05). Only HIIT-CIT decreased the expression of the lipid droplet-associated protein CIDEA (P < 0.001). Conclusions: High-intensity interval training is effective in improving functional capacities, lean mass, muscle power, and waist circumference in obese older adults. HIIT also increases markers of mitochondrial biogenesis, mitochondrial fusion, and mitophagy. Importantly, adding CIT to HIIT results in a greater increase in muscle strength and a significant decrease in fat mass. The present study therefore positions HIIT combined with CIT as an effective intervention to improve the health status of obese older adults.
... The selection of elliptical trainer devices in the application of structured aerobic training programs is very limited in the literature. In patients with hyperglycemia, the selection of elliptical training guarantees the significant improvement of cardiometabolic risk factors as WC, blood pressure [23], and FBG [23,24]. ...
... The selection of elliptical trainer devices in the application of structured aerobic training programs is very limited in the literature. In patients with hyperglycemia, the selection of elliptical training guarantees the significant improvement of cardiometabolic risk factors as WC, blood pressure [23], and FBG [23,24]. ...
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Exercise (Ex) shares the first-line approach with pharmacological inhibitors of phosphodiesterase type 5 (PDE5-Is), including tadalafil, in the treatment of erectile dysfunction (ED) in obese men. The effect of elliptical training (ET) on ED was not questioned in the literature. This study aimed to clarify the effect of adding a 2-month consequent continuous and interval ET to once-daily 5-mg tadalafil administration on ED in obese men. Sixty obese men aged 34–56 years with ED were randomly assigned to the Ex group (n = 30) and the non-Ex group (n = 30). Both groups received 8-week oral tadalafil administration (five-milligram tablet, one time/day). Ex group only received a 1-h concurrent interval and continuous ET (three times/week for 2 months). Homeostasis model assessment of insulin resistance (HOMA-IR), insulin, body mass index (BMI), the circumference of the waist (WC), systolic blood pressure (SBP), high-density lipoprotein (HDL), diastolic blood pressure (DBP), triglycerides (TG), Five-Item Version of International Index of Erectile Dysfunction (IIEF-5), and fasting blood glucose (FBG) were screened before and after the trial. A significant statistical difference of all measures was ascertained from the within-Ex-group comparison (P < 0.05) while this significance was not achieved from the within-comparison of the non-Ex group (except IIEF-5 which showed a significant difference, P < 0.05). The established post-intervention comparison between Ex and non-Ex groups exhibited a non-significant difference in BMI, HDL, and WC while other variables exhibited a statistically-significant difference in favor of the Ex group. Adding 1-h consequent continuous and interval ET to tadalafil drug is a highly efficient procedure in improving ED than tadalafil alone in obese men.
... The studies included a total of 336 participants with mean age of 50.7 years (range 22-80 years). Nine studies recruited subjects with T2DM [31][32][33][34][35][36][37][38][39], two studies included prediabetic and subjects with diabetes [40,41], one study included T2DM subjects and healthy participants [42] and, finally, one study included subjects with T2DM, dyslipidemia, hypertension and a group of healthy subjects who carried out HIIT [43]. Four studies reported a single arm intervention, including only subjects who performed HIIT; six studies had 2-armed intervention, including participants who did HIIT exercise and MICT or not exercise; and three studies reported 3 or more-armed study groups. ...
Article
Aim: The objective of this meta-analysis was to explore the effects of high-intensity interval training (HIIT) compared with control conditions (CON) or moderate intensity continuous training (MICT) on glycemic parameters in diabetes subjects. Methods: Pubmed, Embase and Google Scholar databases were searched for HIIT interventions that were carried out in diabetic subjects and exploring fasting glucose, glycated haemoglobin (HbA1c), fasting insulin and/or HOMA-IR. Results: This systematic review retrieved a total of 1741 studies of which 32 articles fulfilled the eligibility criteria. Nineteen trials were included in the meta-analysis since they compared HIIT intervention with CON or MICT group. There was a significantly reduction of fasting glucose of 13.3 mg/dL(p<0.001), Hb1Ac -0.34% (p<0.001), insulin -2.27 UI/L (p=0.003), HOMA-IR -0.88 (p=0.005) in the HIIT-group compared with CON-group. Nevertheless, this reduction was not significantly different when comparing HIIT with MICT (p= 0.140, p=0.315, p=0.520 and p=0.389). Besides, there was a significant increase of absolute VO2max of 0.21 L/min (p<0.001) and relative VO2max of 2.94 ml/kg/min (p<0.001) in the HIIT-group compared with the CON-group and the MICT-group (0.22 L/min, p=0.025) and (0.97 ml/kg/min, p=0.045). Conclusions: These findings revealed that HIIT intervention led to significant improvement in glycemic control and insulin resistance in subjects with diabetes compared with CON-group.
... However, several other investigations that were not included in that meta-analysis because they did not meet inclusion criteria (e.g. no MICT group or non-exercising control) have measured changes in lean/fat-free mass in response to various interval training protocols involving cycling [34,37,50,[89][90][91][92][93][94][95][96][97][98][99][100][101], running [102,103], rowing [104], whole body [51,105] and elliptical-based [106] HIIT/SIT. While some of these investigations failed to detect changes in lean/fat free mass [37, 50, 90-92, 96, 98, 100, 101, 103], others reported an increase in lean/fat-free mass in response to HIIT [34, 89, 93-95, 102, 104, 107-109]. ...
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Exercise training in combination with optimal nutritional support is an effective strategy to maintain or increase skeletal muscle mass. A single bout of resistance exercise undertaken with adequate protein availability increases rates of muscle protein synthesis and, when repeated over weeks and months, leads to increased muscle fiber size. While resistance-based training is considered the ‘gold standard’ for promoting muscle hypertrophy, other modes of exercise may be able to promote gains in muscle mass. High-intensity interval training (HIIT) comprises short bouts of exercise at or above the power output/speed that elicits individual maximal aerobic capacity, placing high tensile stress on skeletal muscle, and somewhat resembling the demands of resistance exercise. While HIIT induces rapid increases in skeletal muscle oxidative capacity, the anabolic potential of HIIT for promoting concurrent gains in muscle mass and cardiorespiratory fitness has received less scientific inquiry. In this review, we discuss studies that have determined muscle growth responses after HIIT, with a focus on molecular responses, that provide a rationale for HIIT to be implemented among populations who are susceptible to muscle loss (e.g. middle-aged or older adults) and/or in clinical settings (e.g. pre- or post-surgery).
... Metabolik yanıtta ise açlık plazma insülin seviyesi ve sistolik kan basıncında anlamlı şekilde azalma görülmüştür. 46 Whyte ve ark., aşırı kilolu SED erkeklerde sağlıkla ilişkili çıktılar üzerinde "sprint" interval antrenmanın 2 haftalık etkisinin incelediği çalışmaya, 10 kişi katılmıştır. Bisiklet ergometresinde, 30 sn Wingate bisiklet testi yapılarak, 4-6 tekrar ve tekrarlar arasında 4,5 dk dinlenme verilmiştir. ...
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Modern toplumda bir norm hâline gelmiş olan hareketsizlik, birçok hastalık için risk faktörüdür. Fiziksel aktivite ve egzersiz için birçok engel bulunmakta olup, başlıca sebebi zaman eksikliğidir. Yaygın metabolik hastalıkların tedavisi ve yönetiminde rol oynayan egzersiz, sağlıklı yaşamın temel prensiplerinden biridir. Daha kısa egzersiz ve dinlenme süreleriyle uygulanan antrenman birimleri, aerobik fitness gelişimi için gelecek vaat eden bir egzersiz stratejisidir. Sağladığı kardiyovasküler, metabolik ve fiziksel yararları ile evrensel bir antrenman seçeneği olabilir. Bu derlemenin amacı, yüksek şiddetli aralıklı antrenman (HIIT) etkilerini; kardiyovasküler, metabolik ve performans yanıtlarıyla değerlendiren yapılmış araştırmalarla ilgili bir sistematik derleme sunabilmektir. Veri toplama yöntemi olarak, elektronik veri tabanları kullanılarak araştırma yapılmıştır. Tanımlanan çalışmalar, dâhil etme kriterlerini doğrulamak için eleştirel analiz ve önyargı de ve performans yanıtlarında etkili olduğunu gösteren araştırmalar gelecek için yol gösterici olabilecektir.
... However, research has established that at least eight different devices or sporting modalities can be used. These approaches include different ergometers (rowing, elliptical) (Buckley et al., 2015;Fex et al., 2015), calisthenic exercises (burpee, squatting, jumping, jumping jacks) (Blackwell et al., 2017;Mcrae et al., 2012), sporting modalities (swimming) (Bishop et al., 2007), and implements (boxing bag, battling rope). Among these, the latter has gained scientific popularity, given its considerable advantage in practicality, low impact on joints, and low cost compared to traditional models (Brewer et al., 2018;Chen et al., 2018). ...
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ntroduction: High-intensity interval exercise is a training method that has been popular according to the American College of Sports Medicine. Traditionally, we verified the predominant usage of ergometers (treadmills and cycle ergometer) during interval exercise sessions. However, battle ropes exercise are a alternative to other exercise modalities. Purpose: The aim of the study was to compare heart rate (HR) peak and oxygen consumption (VO2) peak during a sprint interval exercise (SIE) with a battling rope (BRP), using different execution strategies (simultaneous and alternate oscillations). Materials and Methods: Eight college men (24.9 ± 7.0 years, 25.2 ± 3.6 kg/m2, and 38.9 ± 3.4 ml·kg-1.min-1) having no experience with battling rope exercises completed two different experimental sessions: simultaneous and alternating arms in a random order, and a 4 × 30 s all out (4 min of passive recovery). We used two-way analysis of variance with a significance of p < .05 for the analysis between groups. Results: The average oxygen consumption peak (VO2 peak), obtained during the four bouts of alternating and simultaneous arms was 76.52 ± 12.71 % and 79.58 ± 15.58 %, respectively. The average HR peak reached during the four high-intensity bouts was 85.15 ± 7.10 % and 88.29 ± 5.14%, respectively. Conclusion: These data show that there is no difference in the acute cardiovascular response of battling rope protocol exercise involving different modes (alternate or simultaneous). These results suggest that the intensity generated during BRP exercise can be sufficient to improve and maintain maximal oxygen uptake in healthy people.
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Background Exercise – with or without dietary regimens – is the first lifestyle modification approach for metabolic syndrome (MetSyndrome) treatment. The effect of combined exercise protocol, moderate-intensity continuous training (CT) plus high-intensity interval training (HIIT), on the relatively-new elliptical trainer (ET) rehabilitation device, was not examined before. This randomised-controlled training trial aimed to explore the effect of combined CT + HIIT – conducted on ET – on body mass index (BMI) and MetSyndrome components: fasting blood glucose, systolic/diastolic blood pressure (BP), abdominal circumference, triglycerides (TGs) and high-density lipoprotein (HDL). Methods Two women and 38 men (aged 51 ± 8.21 years old) with MetSyndrome were randomly assigned to the elliptical exercise (EEX) group (1 ♂, 19 ♀) and control group (requested to maintain their usual/normal daily physical exertion). Results While there were no significant modifications within the control group, pre-to-post comparison (by paired test) after the 16-week intervention within the EEx group showed significantly improved BMI and MetSyndorme components (except HDL). Conclusions Starting an exercise session with moderate-intensity CT, then followed or augmented with HIIT three times weekly for 16 weeks on an ET device can prevent, alter or treat the deterioration of MetSyndrome components.
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In recent years, many studies have found that high-intensity interval training (HIIT) is widely applied in athlete’s training and health promotion program in the general public. The relative shorter period of training duration of HIIT can achieve similar or even better training effects in comparison with relative longer period of moderate-intensity continuous aerobic exercise. Thus, this time-efficient exercise has apparent benefits in both sport performance and health improvement. This review literature presented application of HIIT in different populations, including the general public, overweight and obese individuals, middle-aged and elderly adults, and patients with type 2 diabetes. A database search was conducted using Google Scholar, Airiti Library, PubMed (MEDLINE), and Web of Science from January 2015 to January 2021 for studies related to exercise training interventions. The results of this literature review showed that the HIIT can effectively improve cardiopulmonary capacity, body composition, blood glucose, and lipids metabolism, and reduce cardiovascular risk factors in the general public, overweight or obese individuals, middle-aged and elderly adults, and type 2 diabetic patients. Note that while applying HIIT in exercise prescription, it is necessary to properly manipulate the exercise intensity and duration for different populations to achieve health outcomes.
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Background and aims: Exercise training is a well-established therapeutic tool for treating type 2 diabetes. The purpose of this study is to examine the beneficial effects of personalized sprint interval training (SIT) and combined aerobic endurance and resistance training (Com) on insulin resistance and glycated hemoglobin A1c (HbA1c) concentration in women with type 2 diabetes. Methods: Fifty-two overweight female type 2 diabetic patients (age 45-60 years and body mass index [BMI] > 30) with HbA1c value of 6.5% or higher and fasting blood glucose (FBG) ≥ 126 mg/dL (7.0 mmol/L) were selected. Participants were recruited from patients filed in the outpatient department of Shahrekord Hospital (Shahrekord, Iran) in 2016. The participants were assigned to SIT (n=17), Com (n=17), and control groups (n=18) according to HbA1c levels. The exercises included 10 weeks of Com and SIT. Results: HbA1c concentrations decreased significantly in SIT (P=0.002) and Com (P=0.006) groups. The dependent t-test revealed that differences were significant for the FBG in the SIT groups (P<0.001). Serum insulin levels showed significant increases in the SIT (P<0.001) and Com (P<0.001) groups. Data showed significant differences in homeostasis model assessment-estimated insulin resistance (HOMA-IR) in SIT (P<0.001) and Com (P<0.001) groups. The analysis of covariance (ANCOVA) test showed significant differences in serum insulin (F=3.622, P=0.02) and HOMA-IR (F=5.511, P=0.0001) levels and no significant difference in HbA1c (F=0.597, P=0.556) and FBG concentrations (F=1.853, P=0.171). Conclusion: Results highlight that individualized exercise training, independent of the mode of training, is effective in improving glycemic control in overweight patients with type 2 diabetes.
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In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. Primary recommendation: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
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