Insulin sensitivity improvement with exercise training is mediated by body weight loss in subjects with metabolic syndrome.

AIM: To determine whether exercise training improves insulin actions through concomitant body weight loss (BWL).
METHODS: Subjects (aged 55±8 years) with metabolic syndrome (MetS), prediabetes (fasting blood glucose: 111±2mg·dL-1, HbA1c: 5.85±0.05%) and abdominal obesity (waist circumference: 104±7.9cm) were randomly allocated to either a group performing aerobic interval training (EXER; n=76) or a sedentary group receiving lifestyle counselling (CONT; n=20) for 16 weeks.
RESULTS: At baseline, insulin sensitivity (according to HOMA2 and intravenous glucose tolerance test; CSI), body composition and VO2max were similar between the groups. After the intervention, both groups had similar BWL (1-2%), but only the EXER group showed decreased [mean (95% CI)] trunk fat mass [from 18.2 (17.4-18.9) to 17.3kg (16.6-17.9); P<0.001] and HOMA2 scores [from 1.6 (1.5-1.7) to 1.4 (1.3-1.5); P=0.001], and increased VO2max [from 2.07 (1.92-2.21) to 2.28 (2.11-2.45) LO2·min-1; P<0.001]. However, CSI did not improve in any group. Within-group subdivision by BWL (≤0%, 0-3%, ≥3%) revealed higher CSI in those with BWL≥3% in both groups. Trunk fat mass reductions were closely associated with CSI and HOMA-IR improvement (r=-0.452-0.349; P<0.001).
CONCLUSION: In obese MetS subjects with prediabetes, 3% BWL is required for consistent improvement in insulin sensitivity. Thus, exercise-training programmes should be combined with calorie restriction to achieve BWL levels that prevent the development of diabetes.

RCT Entities:   Population Interventions Outcomes