DiPietro, Loretta, James Dziura, Catherine W. Yeckel, and P. Darrell Neufer. Exercise and improved insulin sensitivity in older women: evidence of the enduring benefits of higher intensity training. J Appl Physiol 100: 142-149, 2006. First published September 1, 2005 doi:10.1152/japplphysiol.00474.2005.-Few studies have compared the relative benefits of moderate-vs. higher intensity exercise training on improving insulin sensitivity in older people while holding exercise volume constant. Healthy older (73 Ϯ 10 yr) women (N ϭ 25) who were inactive, but not obese, were randomized into one of three training programs (9-mo duration): 1) high-intensity [80% peak aerobic capacity (V O2 peak); TH] aerobic training; 2) moderate-intensity (65% V O2 peak; TM) aerobic training; or 3) low-intensity (stretching) placebo control (50% V O2 peak; CTB). Importantly, exercise volume (300 kcal/session) was held constant for subjects in both the TH and the TM groups. V O2 peak was determined by using a graded exercise challenge on a treadmill. Total body fat and lean mass were determined with dual-energy X-ray absorptiometry. The rate of insulin-stimulated glucose utilization as well as the suppression of lipolysis were determined ϳ72 h after the final exercise bout by using a two-step euglycemic-hyperinsulinemic clamp. We observed improved glucose utilization at the higher insulin dose with training, but these improvements were statistically significant only in the TH (21%; P ϭ 0.02) compared with the TM (16%; P ϭ 0.17) and CTB (8%; P ϭ 0.37) groups and were observed without changes in either body composition or V O2 peak. Likewise in the TH group, we detected a significant improvement in insulin-stimulated suppression (%) of adipose tissue lipolysis at the low-insulin dose (38 -55%, P Ͻ 0.05). Our findings suggest that long-term higher intensity exercise training provides more enduring benefits to insulin action compared with moderate-or low-intensity exercise, likely due to greater transient effects.elderly; endurance training; diabetes WHILE THERE ARE DATA SUGGESTING some degree of mandatory decline in insulin sensitivity and glucose tolerance with aging (8,19,28,35), the extent of these pathophysiological alterations is likely modulated by several other potentially confounding factors that also change with age, namely, increased adiposity, decreased lean mass, and reduced physical activity (26,31,34,39,40). Older people who exercise regularly appear to be protected from the development of insulin resistance and glucose intolerance (4,5,24,30,33), and this protection may be independent of exercise-related changes in body composition (6,9,38). However, the magnitude of improvement in insulin-stimulated glucose disposal with exercise training (performed at the same relative intensity) may be attenuated in older compared with younger people (31). This blunted response may be dependent on the absolute exercise intensity, as well as the volume (i.e., energy expenditure) of each training bout. The initial degree of insulin resistanc...