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Published in: Diabetologia 7/2014

01-07-2014 | Article

‘Exercise snacks’ before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance

Authors: Monique E. Francois, James C. Baldi, Patrick J. Manning, Samuel J. E. Lucas, John A. Hawley, Michael J. A. Williams, James D. Cotter

Published in: Diabetologia | Issue 7/2014

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Abstract

Aims/hypothesis

The aim of this study was to investigate whether small doses of intense exercise before each main meal (‘exercise snacks’) would result in better blood glucose control than a single bout of prolonged, continuous, moderate-intensity exercise in individuals with insulin resistance.

Methods

Nine individuals completed three exercise interventions in randomised order. Measures were recorded across 3 days with exercise performed on the middle day, as either: (1) traditional continuous exercise (CONT), comprising 30 min moderate-intensity (60% of maximal heart rate [HRmax]) incline walking before dinner; (2) exercise snacking (ES), consisting of 6 × 1 min intense (90% HRmax) incline walking intervals 30 min before each meal; or (3) composite exercise snacking (CES), encompassing 6 × 1 min intervals alternating between walking and resistance-based exercise, 30 min before meals. Meal timing and composition were controlled within participants for exercise interventions.

Results

ES attenuated mean 3 h postprandial glucose concentration following breakfast (by 1.4 ± 1.5 mmol/l, p = 0.02) but not lunch (0.4 ± 1.0 mmol/l, p = 0.22), and was more effective than CONT following dinner (0.7 ± 1.5 mmol/l below CONT; p = 0.04). ES also reduced 24 h mean glucose concentration by 0.7 ± 0.6 mmol/l (p = 0.01) and this reduction persisted for the subsequent 24 h (lower by 0.6 ± 0.4 mmol/l vs CONT, relative to their baselines; p = 0.01). CES was just as effective as ES (p > 0.05 for all glycaemic variables) at improving glycaemic control.

Conclusions/interpretation

Dosing exercise as brief, intense ‘exercise snacks’ before main meals is a time-efficient and effective approach to improve glycaemic control in individuals with insulin resistance.
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Literature
1.
go back to reference Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol 8:228–236PubMedCrossRef Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol 8:228–236PubMedCrossRef
2.
go back to reference Hawley JA, Lessard SJ (2008) Exercise training-induced improvements in insulin action. Acta Physiol (Oxf) 192:127–135CrossRef Hawley JA, Lessard SJ (2008) Exercise training-induced improvements in insulin action. Acta Physiol (Oxf) 192:127–135CrossRef
3.
go back to reference Lindström J, Ilanne-Parikka P, Peltonen M et al (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679PubMedCrossRef Lindström J, Ilanne-Parikka P, Peltonen M et al (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679PubMedCrossRef
4.
go back to reference Tucker JM, Welk GJ, Beyler NK (2011) Physical activity in US adults: compliance with the physical activity guidelines for Americans. Am J Prev Med 40:454–461PubMedCrossRef Tucker JM, Welk GJ, Beyler NK (2011) Physical activity in US adults: compliance with the physical activity guidelines for Americans. Am J Prev Med 40:454–461PubMedCrossRef
5.
go back to reference Farrell L, Hollingsworth B, Propper C, Shields MA (2013) The socioeconomic gradient in physical inactivity in England. University of Bristol, Bristol Farrell L, Hollingsworth B, Propper C, Shields MA (2013) The socioeconomic gradient in physical inactivity in England. University of Bristol, Bristol
6.
go back to reference Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001PubMedCrossRef Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001PubMedCrossRef
7.
go back to reference American Diabetes Association (2001) Postprandial blood glucose. Diabetes Care 24:775–778CrossRef American Diabetes Association (2001) Postprandial blood glucose. Diabetes Care 24:775–778CrossRef
8.
go back to reference Brownlee M (2005) The pathobiology of diabetic complications: a unifying mechanism. Diabetes 54:1615–1625PubMedCrossRef Brownlee M (2005) The pathobiology of diabetic complications: a unifying mechanism. Diabetes 54:1615–1625PubMedCrossRef
9.
go back to reference Ceriello A, Bortolotti N, Motz E et al (1998) Meal-generated oxidative stress in type 2 diabetic patients. Diabetes Care 21:1529–1533PubMedCrossRef Ceriello A, Bortolotti N, Motz E et al (1998) Meal-generated oxidative stress in type 2 diabetic patients. Diabetes Care 21:1529–1533PubMedCrossRef
10.
go back to reference Ceriello A, Esposito K, Piconi L et al (2008) Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 57:1349–1354PubMedCrossRef Ceriello A, Esposito K, Piconi L et al (2008) Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 57:1349–1354PubMedCrossRef
11.
go back to reference Da Ros R, Assaloni R, Ceriello A (2005) Postprandial hyperglycemia and diabetic complications. Recenti Prog Med 96:436–444 [article in Italian]PubMed Da Ros R, Assaloni R, Ceriello A (2005) Postprandial hyperglycemia and diabetic complications. Recenti Prog Med 96:436–444 [article in Italian]PubMed
12.
go back to reference de Vegt F, Dekker JM, Jager A et al (2001) Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 285:2109–2113PubMedCrossRef de Vegt F, Dekker JM, Jager A et al (2001) Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 285:2109–2113PubMedCrossRef
13.
go back to reference Koopman R, Manders RJF, Zorenc AHG et al (2005) A single session of resistance exercise enhances insulin sensitivity for at least 24 h in healthy men. Eur J Appl Physiol 94:180–187PubMedCrossRef Koopman R, Manders RJF, Zorenc AHG et al (2005) A single session of resistance exercise enhances insulin sensitivity for at least 24 h in healthy men. Eur J Appl Physiol 94:180–187PubMedCrossRef
14.
go back to reference Larsen J, Dela F, Kjar M, Galbo H (1997) The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients. Diabetologia 40:447–453PubMedCrossRef Larsen J, Dela F, Kjar M, Galbo H (1997) The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients. Diabetologia 40:447–453PubMedCrossRef
15.
go back to reference Garetto LP, Richter EA, Goodman MN, Ruderman NB (1984) Enhanced muscle glucose metabolism after exercise in the rat: the two phases. Am J Physiol Endocrinol Metab 246:E471–E475 Garetto LP, Richter EA, Goodman MN, Ruderman NB (1984) Enhanced muscle glucose metabolism after exercise in the rat: the two phases. Am J Physiol Endocrinol Metab 246:E471–E475
16.
go back to reference Ivy J, Holloszy J (1981) Persistent increase in glucose uptake by rat skeletal muscle following exercise. Am J Physiol Cell Physiol 241:C200–C203 Ivy J, Holloszy J (1981) Persistent increase in glucose uptake by rat skeletal muscle following exercise. Am J Physiol Cell Physiol 241:C200–C203
17.
go back to reference Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ (2012) Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab 14:575–577PubMedCrossRef Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ (2012) Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab 14:575–577PubMedCrossRef
18.
go back to reference Little JP, Gillen JB, Percival M et al (2011) Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol 111:1554–1560PubMedCrossRef Little JP, Gillen JB, Percival M et al (2011) Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol 111:1554–1560PubMedCrossRef
19.
go back to reference Gibala MJ, Little JP, MacDonald MJ, Hawley JA (2012) Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol 590:1077–1084PubMedCentralPubMedCrossRef Gibala MJ, Little JP, MacDonald MJ, Hawley JA (2012) Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol 590:1077–1084PubMedCentralPubMedCrossRef
20.
go back to reference Wisløff U, Støylen A, Loennechen JP et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation 115:3086–3094PubMedCrossRef Wisløff U, Støylen A, Loennechen JP et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation 115:3086–3094PubMedCrossRef
21.
go back to reference Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JMD, Guimaraes GV (2010) Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res 33:836–843PubMedCrossRef Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JMD, Guimaraes GV (2010) Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res 33:836–843PubMedCrossRef
22.
go back to reference World Health Organization (2010) Global recommendations on physical activity for health. World Health Organization, Geneva World Health Organization (2010) Global recommendations on physical activity for health. World Health Organization, Geneva
23.
go back to reference Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMed Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMed
24.
go back to reference Burgomaster KA, Howarth KR, Phillips SM et al (2008) Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol 586:151–160PubMedCentralPubMedCrossRef Burgomaster KA, Howarth KR, Phillips SM et al (2008) Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol 586:151–160PubMedCentralPubMedCrossRef
25.
go back to reference Gibala MJ, Little JP, van Essen M et al (2006) Short-term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance. J Physiol 575:901–911PubMedCentralPubMedCrossRef Gibala MJ, Little JP, van Essen M et al (2006) Short-term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance. J Physiol 575:901–911PubMedCentralPubMedCrossRef
26.
go back to reference McRae G, Payne A, Zelt JG et al (2012) Extremely low volume, whole-body aerobic–resistance training improves aerobic fitness and muscular endurance in females. Appl Physiol Nutr Metab 37:1124–1131PubMedCrossRef McRae G, Payne A, Zelt JG et al (2012) Extremely low volume, whole-body aerobic–resistance training improves aerobic fitness and muscular endurance in females. Appl Physiol Nutr Metab 37:1124–1131PubMedCrossRef
27.
go back to reference Koshinaka K, Sano A, Howlett KF et al (2008) Effect of high-intensity intermittent swimming on postexercise insulin sensitivity in rat epitrochlearis muscle. Metabolism 57:749–756PubMedCrossRef Koshinaka K, Sano A, Howlett KF et al (2008) Effect of high-intensity intermittent swimming on postexercise insulin sensitivity in rat epitrochlearis muscle. Metabolism 57:749–756PubMedCrossRef
28.
go back to reference Tjønna AE, Lee SJ, Rognmo Ø et al (2008) Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome. Circulation 118:346–354PubMedCentralPubMedCrossRef Tjønna AE, Lee SJ, Rognmo Ø et al (2008) Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome. Circulation 118:346–354PubMedCentralPubMedCrossRef
29.
go back to reference Hay L, Wilmshurst E, Fulcher G (2003) Unrecognized hypo-and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring. Diabetes Technol Ther 5:19–26PubMedCrossRef Hay L, Wilmshurst E, Fulcher G (2003) Unrecognized hypo-and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring. Diabetes Technol Ther 5:19–26PubMedCrossRef
30.
31.
go back to reference Praet S, Manders R, Meex R et al (2006) Glycaemic instability is an underestimated problem in type II diabetes. Clin Sci (Lond) 111:119–126CrossRef Praet S, Manders R, Meex R et al (2006) Glycaemic instability is an underestimated problem in type II diabetes. Clin Sci (Lond) 111:119–126CrossRef
32.
go back to reference Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36:228–236PubMedCentralPubMedCrossRef Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36:228–236PubMedCentralPubMedCrossRef
33.
go back to reference Hamilton MT, Healy GN, Dunstan DW, Zderic TW, Owen N (2008) Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardiovasc Risk Rep 2:292–298PubMedCentralPubMedCrossRef Hamilton MT, Healy GN, Dunstan DW, Zderic TW, Owen N (2008) Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardiovasc Risk Rep 2:292–298PubMedCentralPubMedCrossRef
34.
35.
go back to reference DiPietro L, Gribok A, Stevens MS, Hamm LF, Rumpler W (2013) Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care 36:3262–3268PubMedCrossRef DiPietro L, Gribok A, Stevens MS, Hamm LF, Rumpler W (2013) Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care 36:3262–3268PubMedCrossRef
36.
go back to reference Nybo L, Sundstrup E, Jakobsen MD et al (2010) High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc 42:1951–1958PubMedCrossRef Nybo L, Sundstrup E, Jakobsen MD et al (2010) High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc 42:1951–1958PubMedCrossRef
37.
go back to reference Takaishi T, Imaeda K, Tanaka T, Moritani T, Hayashi T (2011) A short bout of stair climbing descending exercise attenuates postprandial hyperglycemia in middle-aged males with impaired glucose tolerance. Appl Physiol Nutr Metab 37:193–196PubMedCrossRef Takaishi T, Imaeda K, Tanaka T, Moritani T, Hayashi T (2011) A short bout of stair climbing descending exercise attenuates postprandial hyperglycemia in middle-aged males with impaired glucose tolerance. Appl Physiol Nutr Metab 37:193–196PubMedCrossRef
38.
go back to reference Gillen JB, Percival ME, Ludzki A, Tarnopolsky MA, Gibala M (2013) Interval training in the fed or fasted state improves body composition and muscle oxidative capacity in overweight women. Obesity (Silver Spring) 21:2249–2255CrossRef Gillen JB, Percival ME, Ludzki A, Tarnopolsky MA, Gibala M (2013) Interval training in the fed or fasted state improves body composition and muscle oxidative capacity in overweight women. Obesity (Silver Spring) 21:2249–2255CrossRef
39.
go back to reference Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56:115–123PubMedCrossRef Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56:115–123PubMedCrossRef
40.
go back to reference Sigal RJ, Kenny GP, Boula NG et al (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med 147:357–369PubMedCrossRef Sigal RJ, Kenny GP, Boula NG et al (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med 147:357–369PubMedCrossRef
41.
go back to reference Rognmo Ø, Moholdt T, Bakken H et al (2012) Cardiovascular risk of high-versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 126:1436–1440PubMedCrossRef Rognmo Ø, Moholdt T, Bakken H et al (2012) Cardiovascular risk of high-versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 126:1436–1440PubMedCrossRef
Metadata
Title
‘Exercise snacks’ before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance
Authors
Monique E. Francois
James C. Baldi
Patrick J. Manning
Samuel J. E. Lucas
John A. Hawley
Michael J. A. Williams
James D. Cotter
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia / Issue 7/2014
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-014-3244-6

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