The benefits of physical exercise for the health of the pancreatic β‐cell: a review of the evidence

Curran, Michelle; Drayson, Mark T.; Zoppi, Cláudio C.; Barlow, Jonathan; Solomon, Thomas P. J.; Narendran, Parth

doi:10.1113/ep088220

Cited by 43 publications

(32 citation statements)

References 94 publications

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“…However, due to the short duration of the majority of the trials, the differential effects of exercise according to remaining beta-cell function or diabetes duration may not appear. If the mechanisms of improved beta-cell function involve beta-cell rest due to an increased peripheral insulin sensitivity and thus reduced glucotoxicity or decreased low-grade inflammation ( 43 ), the trial duration should be prolonged (>4 weeks) until such effects would become apparent ( 44 ). Literature suggests that long-term adaptations from regular exercise improve glucose metabolism through increased glucose uptake capacity but may decrease the temporary insulin sensitizing effect after an acute bout of exercise ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Physical Activity on Glycemic Variability Assessed by Continuous Glucose Monitoring in Patients With Type 2 Diabetes Mellitus: A Systematic Review

et al. 2020

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Aim: Patients with Type 2 Diabetes Mellitus (T2DM) have increased risk of developing vascular complications due to chronic hyperglycemia. Glycemic variability (GV) has been suggested to play an even more important role in the risk of developing diabetic complications than sustained hyperglycemia. Physical activity (PA) has shown reducing effects on mean plasma glucose; however, the effect on GV in T2DM needs further description. The objective of this review is to evaluate the effect of PA on GV, assessed by continuous glucose monitoring (CGM) in people with T2DM. Methods: A systematic literature search was conducted on MEDLINE and Embase to find randomized controlled trials (RCTs) covering the aspects T2DM, PA, and CGM. Following eligibility screening, variables of population characteristics, PA interventions, and GV outcomes were extracted and processed through qualitative synthesis. Risk of bias (ROB) was assessed using Cochrane ROB tool v2.0. Results: Of 1,825 identified articles, 40 full texts were screened. In the ten included RCTs matching the eligibility criteria, sample sizes ranged from nine to 63, mean age from 51 (SD 11) to 65 (SD 2) years and mean T2DM duration from four (SD 3) to ten (SD 6) years. Eight RCTs examined GV following single bouts of exercise, while two RCTs examined GV following training interventions. One RCT applied parallel group design, while nine RCTs applied crossover design. Numeric reductions in GV following acute exercise were seen, with four RCTs reaching statistical significance. Numeric reductions in GV were seen following training interventions, with one RCT reaching statistical significance. Numeric reductions of GV after PA appeared independently of intensity and T2DM progression but higher in participants with high baseline HbA1c and GV than with low. 80% of the trials were evaluated as uncertain/high ROB. Conclusion: The systematic literature search revealed limited and biased evidence showing that acute PA numerically reduced GV in patients with T2DM. PA reduced GV independently of PA intensity and T2DM progression. Prolonged RCTs with low ROB are needed to confirm reducing effects of PA on GV and to assess the influence of patient- and intervention characteristics on the effect of PA on GV.

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Section: Discussionmentioning

confidence: 99%

The Impact of Physical Activity on Glycemic Variability Assessed by Continuous Glucose Monitoring in Patients With Type 2 Diabetes Mellitus: A Systematic Review

et al. 2020

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“…Insulin secretion is primarily adjusted according to the amount of glucose taken up by beta cells. Insulin secretion during a glucose challenge is dramatically altered by exercise undertaken during the previous days and hours in both healthy individuals and in those with insulin resistance and type 2 diabetes [73]. Exercise cessation drives up insulin secretion, while one bout of exercise can lower insulin secretion, showing that insulin secretion is tightly regulated by exercise-driven pathways [74].…”

Section: Muscle-centric Vs Integrative View Of the Impact Of Exercisementioning

confidence: 99%

Exercise and metabolic health: beyond skeletal muscle

2020

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Regular exercise is a formidable regulator of insulin sensitivity and overall systemic metabolism through both acute events driven by each exercise bout and through chronic adaptations. As a result, regular exercise significantly reduces the risks for chronic metabolic disease states, including type 2 diabetes and non-alcoholic fatty liver disease. Many of the metabolic health benefits of exercise depend on skeletal muscle adaptations; however, there is plenty of evidence that exercise exerts many of its metabolic benefit through the liver, adipose tissue, vasculature and pancreas. This review will highlight how exercise reduces metabolic disease risk by activating metabolic changes in non-skeletal-muscle tissues. We provide an overview of exercise-induced adaptations within each tissue and discuss emerging work on the exercise-induced integration of inter-tissue communication by a variety of signalling molecules, hormones and cytokines collectively named 'exerkines'. Overall, the evidence clearly indicates that exercise is a robust modulator of metabolism and a powerful protective agent against metabolic disease, and this is likely to be because it robustly improves metabolic function in multiple organs.

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“…We postulate that protein glycosylation was decreased secondary to increased metabolic activity and glucose turnover caused by physical activity. It is also possible that a decrease in HbA1c with walking was related to improvements in pancreatic beta-cell function (24). Importantly, it has been well documented that each 1% reduction in HbA1c is associated with a 14% reduction of myocardial infarction and a 21% decrease of risk of death related to diabetes (69a), illustrating the potentially impactful nature of this finding on T2D health.…”

Section: Discussionmentioning

confidence: 97%

Skeletal muscle microvascular insulin resistance in type 2 diabetes is not improved by eight weeks of regular walking

Park

Parks

Pettit‐Mee

et al. 2020

Journal of Applied Physiology

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We aimed to examine if individuals with type 2 diabetes (T2D) exhibit suppressed leg vascular conductance and skeletal muscle capillary perfusion in response to a hyperinsulinemic-euglycemic clamp, and to test whether these two variables are positively correlated. Subsequently, we examined if T2D-associated skeletal muscle microvascular insulin resistance, as well as overall vascular dysfunction, would be ameliorated by an eight-week walking intervention (45 minutes at 60% of heart rate reserve, 5 sessions/week). We report that, relative to healthy subjects, overweight and obese individuals with T2D exhibit depressed insulin-stimulated increases in leg vascular conductance, skeletal muscle capillary perfusion, and Akt phosphorylation. Notably, we found that within individuals with T2D, those with lesser increases in leg vascular conductance in response to insulin exhibited the lowest increases in muscle capillary perfusion, suggesting that limited muscle capillary perfusion may be, in part, linked to the impaired ability of the upstream resistance vessels to dilate in response to insulin. Furthermore, we show that the eight-week walking intervention, which did not evoke weight loss, was insufficient to ameliorate skeletal muscle microvascular insulin resistance in previously sedentary, overweight/obese subjects with T2D, despite high adherence and tolerance. However, the walking intervention did improve (P<0.05) popliteal artery flow-mediated dilation (+4.52%) and reduced HbA1c (-0.75%). It is possible that physical activity interventions that are longer in duration, engage large muscle groups with recruitment of the maximum number of muscle fibers, and lead to a robust reduction in metabolic risk factors may be required to overhaul microvascular insulin resistance in T2D.

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The benefits of physical exercise for the health of the pancreatic β‐cell: a review of the evidence

Cited by 43 publications

References 94 publications

The Impact of Physical Activity on Glycemic Variability Assessed by Continuous Glucose Monitoring in Patients With Type 2 Diabetes Mellitus: A Systematic Review

The Impact of Physical Activity on Glycemic Variability Assessed by Continuous Glucose Monitoring in Patients With Type 2 Diabetes Mellitus: A Systematic Review

Exercise and metabolic health: beyond skeletal muscle

Skeletal muscle microvascular insulin resistance in type 2 diabetes is not improved by eight weeks of regular walking

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