This research article shows that a high intensity exercise program compared to a low intensity exercise program of the same session duration and frequency, increases insulin sensitivity to a larger extend in healthy subjects. It also shows that the short insulin tolerance test can be used to detect differences in insulin sensitivity in intervention studies.
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Review of the effects of physical activity on insulin sensitivity
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Insulin sensitivity and metabolic flexibility decrease in response to bed rest, but the temporal and causal adaptations in human skeletal muscle metabolism are not fully defined. Here, we use an integrative approach to assess human skeletal muscle metabolism during bed rest and provide a multi-system analysis of how skeletal muscle and the circulatory system adapt to short- and long-term bed rest (German Clinical Trials: DRKS00015677). We uncover that intracellular glycogen accumulation after short-term bed rest accompanies a rapid reduction in systemic insulin sensitivity and less GLUT4 localization at the muscle cell membrane, preventing further intracellular glycogen deposition after long-term bed rest. We provide evidence of a temporal link between the accumulation of intracellular triglycerides, lipotoxic ceramides, and sphingomyelins and an altered skeletal muscle mitochondrial structure and function after long-term bed rest. An intracellular nutrient overload therefore represents a crucial determinant for rapid skeletal muscle insulin insensitivity and mitochondrial alterations after prolonged bed rest.
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Background: Weight loss is key to treatment of older adults with obesity and type 2 diabetes, but also a risk for muscle mass loss. This study investigated whether a whey protein drink enriched with leucine and vitamin D could preserve muscle mass and improve glycemic control during combined lifestyle intervention in this population. Methods: 123 older adults with obesity and type 2 diabetes were randomized into a 13-week lifestyle intervention with dietary advice and exercise, receiving either the enriched protein drink (test) or an isocaloric control (control). Muscle mass was assessed with dual-energy X-ray absorptiometry and glycemic control by oral glucose tolerance test. Statistical analyses were performed using a linear mixed model. Results: There was a nonsignificant increase in leg muscle mass (+0.28 kg; 95% CI, −0.01 to 0.56) and a significant increase in appendicular muscle mass (+0.36 kg; 95% CI, 0.005 to 0.71) and total lean mass (+0.92 kg; 95% CI, 0.19 to 1.65) in test vs. control. Insulin sensitivity (Matsuda index) also increased in test vs. control (+0.52; 95% CI, 0.07 to 0.97). Conclusions: Use of an enriched protein drink during combined lifestyle intervention shows beneficial effects on muscle mass and glycemic control in older adults with obesity and type 2 diabetes.
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Rationale: While combined lifestyle interventions have multiple health benefits, their impact on the oral microbiome is not known. We explored the effects of a lifestyle intervention including protein drink on the oral microbiome in older adults with obesity and type 2 diabetes (T2D).Methods: In a post-hoc analysis of the PROBE study, 87 subjects (66.5±6.1 years, 33% female) with tongue dorsum samples at baseline and week 13 were included. All subjects participated in a 13-week lifestyle intervention with exercise (3x/week) and hypocaloric diet (-600 kcal/day), and had been randomized to receive a test product (21g whey protein enriched with leucine and vitamin D) or isocaloric control (0g protein) 10x/week. T2D was subtyped as muscle insulin resistance (MIR, n=34) or no-MIR (n=36) based on available muscle insulin sensitivity index. Microbiome was analysed by V4 16s rDNA sequencing. Diversity, measured as species richness and Shannon diversity index, was statistically analysed with paired (within group) and independent (between groups) samples t-test.Results: displayed below. Conclusion: Consuming a whey protein drink enriched with leucine and vitamin D during a combined lifestyle intervention increased species richness of the oral microbiome in obese T2D subjects with muscle insulin resistance.
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Postprandial high glucose and insulin responses after starchy food consumption, associated with an increased risk of developing several metabolic diseases, could possibly be improved by altering food structure. We investigated the influence of a compact food structure; different wheat products with a similar composition were created using different processing conditions. The postprandial glucose kinetics and metabolic response to bread with a compact structure (flat bread, FB) was compared to bread with a porous structure (control bread, CB) in a randomized, crossover study with ten healthy male volunteers. Pasta (PA), with a very compact structure, was used as the control. The rate of appearance of exogenous glucose (RaE), endogenous glucose production, and glucose clearance rate (GCR) was calculated using stable isotopes. Furthermore, postprandial plasma concentrations of glucose, insulin, several intestinal hormones and bile acids were analyzed. The structure of FB was considerably more compact compared to CB, as confirmed by microscopy, XRT analysis (porosity) and density measurements. Consumption of FB resulted in lower peak glucose, insulin and glucose-dependent insulinotropic polypeptide (ns) responses and a slower initial RaE compared to CB. These variables were similar to the PA response, except for RaE which remained slower over a longer period after PA consumption. Interestingly, the GCR after FB was higher than expected based on the insulin response, indicating increased insulin sensitivity or insulin-independent glucose disposal. These results demonstrate that the structure of wheat bread can influence the postprandial metabolic response, with a more compact structure being more beneficial for health. Bread-making technology should be further explored to create healthier products.
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Aim and method: To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results: Total fat mass and waist circumference decreased 1.4 kg (p = .03) and 3.1 cm (p = .005) respectively. The distance in the Six-Minute Walk Test increased 41 meters (p = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (p = .008), self-esteem (p = .004), and public distress (p = .04). Increased perceived exercise benefits (p = .02) and decreased embarrassment (p = .03) were observed. Conclusions: Aquajogging was associated with reduced body fat and waist circumference, and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.
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De relatie tussen fysieke activiteit en gezondheid is onomstotelijk vastgesteld. Zo kan fysieke activiteit onder andere ischaemische hart- en vaatziekten, dikke-darmkanker, hersenbloedingen, overgewicht en type 2 diabetes helpen voorkomen. Daarom is het schrikbarend hoe weinig mensen in de westerse maatschappij bewegen. De leeropdrachten van het lectoraat Fysieke Activiteit en Gezondheid zijn toegespitst op de maatschappelijke problematiek van bewegingsarmoede en de daarmee samenhangende gezondheidsproblemen. Deze luiden: - Wat zijn geschikte richtlijnen voor primaire en secundaire ziektepreventie door middel van fysieke activiteit? - Wat kan de rol zijn van het bewegingsonderwijs in het stimuleren van gezond bewegingsgedrag?
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Proefschrift dat onder andere een tweejarig interventie-onderzoek beschrijft naar het effect van een bewegingsprogramma bij personen met type 2 diabetes.
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Er lijkt een duidelijke mate van evidentie te bestaan betreffende de relatie fysieke activiteit, respectievelijk fitheid en gezondheid in de algemene populatie en bij bepaalde pathologieën. Er is evenwel nog behoefte aan verder wetenschappelijk onderzoek naar mogelijke determinanten en onderliggende mechanismen, als ook naar evidentie bij bepaalde, specifieke aandoeningen. Tevens mag duidelijk zijn dat ondanks de bestaande evidentie fysieke activiteit/oefening te weinig toegepast wordt in de gezondheidszorg. Het onderzoek naar de effectiviteit van gezondheidskundige interventies is dan ook uitermate belangrijk. Dit lectoraat hoopt dan ook een bescheiden bijdrage hieraan te kunnen leveren. Hiervoor heeft zij reeds afspraken tot samenwerking met de academische en medische wereld (in Utrecht, Amsterdam, Maastricht en Leuven), met de gezondheidszorg (RIVM Bilthoven en GG&GD Utrecht) en met de beroepen- of bedrijfswereld (Politie regio Utrecht; Enraf Nonius, Delft). De beoogde doelstellingen zullen echter naar alle waarschijnlijkheid beduidend meer tijd in beslag nemen dan de periode van 4 jaar die de Stichting Kennis Ontwikkeling voorzien heeft met betrekking tot het oprichten en financieren van de lectoraten.
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