Influence of exercise on insulin sensitivity.

An important determinant of insulin sensitivity in humans, the insulin-induced glucose uptake in skeletal muscle (directed into glycogen synthesis), has been found to be markedly enhanced in endurance-trained individuals compared with sedentary controls. This enhanced insulin action is accompanied by a decreased insulin response during an oral glucose load. Available evidence indicates that the enhanced insulin action is not a genuine training effect, but merely a lasting effect of the previous exercise session(s). In the young, insulin sensitivity increases with a single exercise session, but the increase may appear only after several training sessions in middle-aged or older individuals. The effect disappears after 3-6 days. The exercise-induced reduction in muscle glycogen is an important factor underlying the increased insulin sensitivity in the period after exercise. There are reports that endurance and strength training enhances whole-body insulin sensitivity to a similar extent, and available evidence suggests that, provided total energy expenditure is held constant, low-intensity and high-intensity exercise are equally effective in promoting insulin sensitivity. Differences in sex steroids may explain the observation of a markedly higher insulin sensitivity in women than in men. Adaptations, which might underlie the increased insulin sensitivity in trained individuals, include increases in levels of the glucose transporter protein GLUT-4 and in muscle glycogen synthase activity, a decrease in the serum triglyceride concentration and, possibly, an increase in the muscle capillary network.