CONTEXT: Reduction of 50% excess body weight, using a very low-calorie diet (VLCD; 450 kcal/d) improves insulin sensitivity in obese type 2 diabetes mellitus patients. OBJECTIVE: The objective of the study was to evaluate whether adding exercise to the VLCD has additional benefits. DESIGN: This was a randomized intervention study. SETTING: The study was conducted at a clinical research center in an academic medical center. SUBJECTS:Twenty-seven obese [body mass index 37.2 ± 0.9 kg/m(2) (mean ± sem)] insulin-treated type 2 diabetes mellitus patients. INTERVENTION: Patients followed a 16-wk VLCD. Thirteen of them simultaneously participated in an exercise program (E) consisting of 1-h, in-hospital training and four 30-min training sessions on a cycloergometer weekly. OUTCOME MEASURES: Insulin resistance was measured by a hyperinsulinemic euglycemic clamp. Insulin signaling, mitochondrial DNA (mtDNA) content, and intramyocellular lipid content was measured in skeletal muscle biopsies. RESULTS: Baseline characteristics were identical in both groups. Substantial weight loss occurred (-23.7 ± 1.7 kg VLCD-only vs. -27.2 ± 1.9 kg VLCD+E, P = NS within groups). The exercise group lost more fat mass. Insulin-stimulated glucose disposal increased similarly in both study groups [15.0 ± 0.9 to 39.2 ± 4.7 μmol/min(-1) · kg lean body mass (LBM(-1)) VLCD-only vs. 17.0 ± 1.0 to 37.5 ± 3.5 μmol/min(-1) · kg LBM(-1) in VLCD+E], as did phosphorylation of the phosphatidylinositol 3-kinase-protein kinase B/AKT insulin signaling pathway. In contrast, skeletal muscle mtDNA content increased only in the VLCD+E group (1211 ± 185 to 2288 ± 358, arbitrary units, P = 0.016 vs. 1397 ± 240 to 1196 ± 179, P = NS, VLCD-only group). Maximum aerobic capacity also only increased significantly in the VLCD+E group (+6.6 ± 1.7 ml/min(-1) · kg LBM(-1) vs. +0.7 ± 1.5 ml/min(-1) · kg LBM(-1) VLCD-only, P = 0.017). CONCLUSION: Addition of exercise to a 16-wk VLCD induces more fat loss. Exercise augments maximum aerobic capacity and skeletal muscle mtDNA content. These changes are, however, not reflected in a higher insulin-stimulated glucose disposal rate.
RCT Entities:
CONTEXT: Reduction of 50% excess body weight, using a very low-calorie diet (VLCD; 450 kcal/d) improves insulin sensitivity in obese type 2 diabetes mellituspatients. OBJECTIVE: The objective of the study was to evaluate whether adding exercise to the VLCD has additional benefits. DESIGN: This was a randomized intervention study. SETTING: The study was conducted at a clinical research center in an academic medical center. SUBJECTS: Twenty-seven obese [body mass index 37.2 ± 0.9 kg/m(2) (mean ± sem)] insulin-treated type 2 diabetes mellituspatients. INTERVENTION: Patients followed a 16-wk VLCD. Thirteen of them simultaneously participated in an exercise program (E) consisting of 1-h, in-hospital training and four 30-min training sessions on a cycloergometer weekly. OUTCOME MEASURES: Insulin resistance was measured by a hyperinsulinemic euglycemic clamp. Insulin signaling, mitochondrial DNA (mtDNA) content, and intramyocellular lipid content was measured in skeletal muscle biopsies. RESULTS: Baseline characteristics were identical in both groups. Substantial weight loss occurred (-23.7 ± 1.7 kg VLCD-only vs. -27.2 ± 1.9 kg VLCD+E, P = NS within groups). The exercise group lost more fat mass. Insulin-stimulated glucose disposal increased similarly in both study groups [15.0 ± 0.9 to 39.2 ± 4.7 μmol/min(-1) · kg lean body mass (LBM(-1)) VLCD-only vs. 17.0 ± 1.0 to 37.5 ± 3.5 μmol/min(-1) · kg LBM(-1) in VLCD+E], as did phosphorylation of the phosphatidylinositol 3-kinase-protein kinase B/AKTinsulin signaling pathway. In contrast, skeletal muscle mtDNA content increased only in the VLCD+E group (1211 ± 185 to 2288 ± 358, arbitrary units, P = 0.016 vs. 1397 ± 240 to 1196 ± 179, P = NS, VLCD-only group). Maximum aerobic capacity also only increased significantly in the VLCD+E group (+6.6 ± 1.7 ml/min(-1) · kg LBM(-1) vs. +0.7 ± 1.5 ml/min(-1) · kg LBM(-1) VLCD-only, P = 0.017). CONCLUSION: Addition of exercise to a 16-wk VLCD induces more fat loss. Exercise augments maximum aerobic capacity and skeletal muscle mtDNA content. These changes are, however, not reflected in a higher insulin-stimulated glucose disposal rate.
Authors: Ricardo Augusto Leoni De Sousa; Caíque Olegário Diniz de Magalhães; Isabella Rocha Dias; Lucas Renan Sena de Oliveira; Alex Cleber Improta-Caria; Ricardo Cardoso Cassilhas Journal: Rev Assoc Med Bras (1992) Date: 2022-07 Impact factor: 1.712
Authors: Trevor Teich; Emily C Dunford; Deanna P Porras; Jacklyn A Pivovarov; Jacqueline L Beaudry; Hazel Hunt; Joseph K Belanoff; Michael C Riddell Journal: Am J Physiol Endocrinol Metab Date: 2016-05-03 Impact factor: 4.310
Authors: Tineke van de Weijer; Lauren Marie Sparks; Esther Phielix; Ruth Carla Meex; Noud Antonius van Herpen; Matthijs Karel C Hesselink; Patrick Schrauwen; Vera Bettina Schrauwen-Hinderling Journal: PLoS One Date: 2013-02-13 Impact factor: 3.240
Authors: Maria A Sleddering; Albert J Markvoort; Harish K Dharuri; Skhandhan Jeyakar; Marieke Snel; Peter Juhasz; Moira Lynch; Wade Hines; Xiaohong Li; Ingrid M Jazet; Aram Adourian; Peter A J Hilbers; Johannes W A Smit; Ko Willems Van Dijk Journal: PLoS One Date: 2014-11-21 Impact factor: 3.240
Authors: A Goday; D Bellido; I Sajoux; A B Crujeiras; B Burguera; P P García-Luna; A Oleaga; B Moreno; F F Casanueva Journal: Nutr Diabetes Date: 2016-09-19 Impact factor: 5.097
Authors: Julia Otten; Andreas Stomby; Maria Waling; Andreas Isaksson; Anna Tellström; Lillemor Lundin-Olsson; Søren Brage; Mats Ryberg; Michael Svensson; Tommy Olsson Journal: Diabetes Metab Res Rev Date: 2016-06-30 Impact factor: 4.876