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Shelby L. Francis, Ajay Singhvi, Eva Tsalikian, Michael J. Tansey and Kathleen F. Janz

Purpose:

Determining fitness is important when assessing adolescents with type 1 diabetes mellitus (T1DM). Submaximal tests estimate fitness, but none have been validated in this population. This study cross-validates the Ebbeling and Nemeth equations to predict fitness (VO2max (ml/kg/min)) in adolescents with T1DM.

Methods:

Adolescents with T1DM (n = 20) completed a maximal treadmill test using indirect calorimetry. Participants completed one 4-min stage between 2.0 and 4.5 mph and 5% grade (Ebbeling/Nemeth protocol). Speed and grade were then increased until exhaustion. Predicted VO2max was calculated using the Ebbeling and Nemeth equations and compared with observed VO2max using paired t tests. Pearson correlation coefficients, 95% confidence intervals, coefficients of determination (R2), and total error (TE) were calculated.

Results:

The mean observed VO2max was 47.0 ml/kg/min (SD = 6.9); the Ebbeling and Nemeth mean predictions were 42.4 (SD = 9.4) and 43.5 ml/kg/min (SD = 6.9), respectively. Paired t tests resulted in statistically significant (p < .01) mean differences between observed and predicted VO2max for both predictions. The association between the Ebbeling prediction and observed VO2max was r = .90 (95% CI = 0.76, 0.96), R 2 = .81, and TE = 6.5 ml/kg/min. The association between the Nemeth prediction and observed VO2max was r = .81 (95% CI = 0.57, 0.92), R 2 = .66, and TE = 5.6 ml/kg/min.

Conclusion:

The Nemeth submaximal treadmill protocol provides a better estimate of fitness than the Ebbeling in adolescents with T1DM.

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Jean Gutierrez, Andrei Gribok, William Rumpler, Avinash Chandran and Loretta DiPietro

Background:

People with a family history of type 2 diabetes have lower energy expenditure (EE) and more obesity than those having no such family history. Resistance exercise (RE) may induce excess postexercise energy expenditure (EPEE) and reduce long-term risk for obesity in this susceptible group.

Purpose:

To determine the effect of RE on EPEE for 15 hr after a single exercise bout in healthy, untrained young men having a family history of type 2 diabetes.

Design:

Seven untrained men (23 ± 1.2 years, BMI 24 ± 1.1) completed a 48-hr protocol in a whole room calorimeter. The first day served as a control day, with a moderate 40-min RE bout occurring on the second day. Differences in postexercise EE were compared with matched periods from the control day for cumulative 15-min intervals (up to 150 min) and 15 hr after the RE bout was completed.

Results:

The most robust difference in EPEE between the experimental and control days was observed in the first 15-min postexercise period (M = 1.4Kcal/min; SD = 0.7; p < .05). No statistically significant differences in EPEE were noted beyond 90-min of continuous measurement.

Conclusions:

Young people with a family history of type 2 diabetes may not show EPEE after a single RE bout when observed for 15 hr after RE and long-term resistance training may be required to promote EPEE.

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Annie Fex, Jean-Philippe Leduc-Gaudet, Marie-Eve Filion, Antony D. Karelis and Mylène Aubertin-Leheudre

Objectives:

The purpose of the current study was to examine the impact of 12 weeks of elliptical high intensity interval training (HIIT) on metabolic risk factors and body composition in pre- and type 2 diabetes patients.

Methods:

Sixteen pre- (n = 8) and type 2 diabetes (n = 8) participants completed this study. Fasting blood glucose, HbA1c, anthropometric measurements, body composition (DXA), blood pressure, resting heart rate, VO2max, and dietary factors, as well as total and physical activity energy expenditure, were measured. The HIIT program on the elliptical was performed 3 times a week for 12 weeks.

Results:

After the intervention, we observed a significant improvement for fasting blood glucose, waist and hip circumference, appendicular fat mass, leg lean body mass and appendicular lean body mass, systolic blood pressure, resting heart rate, and VO2max (P < .05). In addition, we noted a lower tendency for leg fat mass (P = .06) and diastolic blood pressure (P = .05) as well as a higher tendency for total energy expenditure (P = .06) after the intervention.

Conclusions:

The current study indicates that elliptical HIIT seems to improve metabolic risk factors and body composition in pre- and type 2 diabetes patients.

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Denise Rodrigues Bueno, Maria de Fátima Nunes Marucci, Clara Suemi da Costa Rosa, Rômulo Araújo Fernandes, Yeda Aparecida de Oliveira Duarte and Maria Lucia Lebão

prevalence of both arterial hypertension (HBP) and diabetes mellitus (DM) ( Nascimento et al., 2015 ). An insufficient physical activity level (PAL) can result in unfavorable control of these diseases, leading to a significant economic impact related to the associated complications ( Bertoldi et al., 2013

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Denise M. Roche, Sarah Edmunds, Tim Cable, Mo Didi and Gareth Stratton

No studies to date have evaluated the relationship between exercise and microvascular function in youth with type 1 diabetes mellitus (T1DM). Twenty-nine complication free children and adolescents with T1DM were assessed for skin microvascular reactivity, aerobic fitness (VO2peak) and physical activity. VO2peak but not physical activity was significantly and independently associated with maximal hyperemia of the skin microcirculation (p < .01). No significant associations were found between venoarte-riolar reflex (VAR) vasoconstriction and VO2peak or physical activity. Aerobic fitness may be an important indicator or mediator of effective microvascular endothelial function in youth with T1DM.

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Evangelos Papataxiarchis, Demosthenes B. Panagiotakos, Venetia Notara, Matina Kouvari, Yannis Kogias, Petros Stravopodis, George Papanagnou, Spyros Zombolos, Yannis Mantas, Christos Pitsavos and for the GREECS Study Investigators, Greece

The association between physical activity, diabetes mellitus (DM), and long-term acute coronary syndrome (ACS) prognosis was evaluated. The GREECS study included 2,172 consecutive ACS patients from six Greek hospitals (2003–2004). In 2013–2014, a 10-year follow up was performed with 1,918 patients. Physical activity was categorized in never, rarely (monthly basis), 1–2 and ≥ 3 times/week. Multi-adjusted analysis revealed that 1–2 and ≥ 3 times/week vs. no physical activity had a protective effect on ACS incidence (OR = 0.63 95% CI 0.38, 1.05) and (OR = 0.63 95% CI 0.40, 0.99) respectively, only in patients without prior baseline CVD event. In a subgroup analysis, with DM as strata in these patients, engagement in physical activity (i.e., 1–2 times/week) had a significant protective effect among patients with diabetes (OR = 0.51, 95% CI 0.27, 0.96, p = .037). These findings revealed the beneficial role of exercise in secondary ACS prevention, even in DM patients. Public health-oriented policies should incorporate regular physical activity as a key protective factor in disease prognosis.

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Binh Nguyen, Adrian Bauman and Ding Ding

Purpose:

To examine the combined effects of body mass index (BMI), physical activity (PA) and sitting on incident type 2 diabetes mellitus (T2DM) among Australian adults.

Methods:

A sample of 29,572 adults aged ≥45 years from New South Wales, Australia, completed baseline (2006–2008) and follow-up (2010) questionnaires. Incident T2DM was defined as self-reported, physician-diagnosed diabetes at follow-up. BMI was categorized as normal/overweight/obese. PA was tertiled into low/medium/ high. Sitting was dichotomized as higher/lower sitting (≥ 8 hours/day or < 8 hours/day). Odds ratios (OR) were estimated for developing T2DM using logistics regression for individual and combined risk factors, and data stratified by BMI categories.

Results:

During a mean 2.7 (SD: 0.9) years of follow-up, 611 (2.1%) participants developed T2DM. In fully adjusted models, BMI was the only independent risk factor for incident T2DM. In stratified analyses, the association between BMI and T2DM did not differ significantly across sitting or PA categories. Overweight/obese individuals with high PA and lower sitting had higher odds of incident T2DM than normal counterparts with low PA and higher sitting.

Conclusions:

High PA/low sitting did not attenuate the risk of T2DM associated with overweight/obesity. Maintaining a healthy weight, by adopting healthy lifestyle behaviors, is critical for T2DM prevention.

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Steven T. Johnson, Clark Mundt, Weiyu Qiu, Allison Soprovich, Lisa Wozniak, Ronald C. Plotnikoff and Jeffrey A. Johnson

Objective:

To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care.

Methods:

Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models.

Results:

198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes.

Conclusions:

A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.

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Sarah Edmunds, Denise Roche and Gareth Stratton

Background:

The current study objectively assessed physical activity (PA) levels and patterns in children and adolescents with type 1 diabetes and compared the metabolic and physiologic health profiles of those achieving and those not achieving the current recommendation of 60 minutes a day (minutes·D−1) of at least moderate intensity PA.

Method:

37 children and adolescents (20 boys, 17 girls) aged 12.7 ± 2.1 years (mean ± SD), disease duration 5.9 ± 3.0 years participated. PA was assessed using heart rate monitoring. Peak VO2, BMI, sum of 5 skinfolds, HbA1c, and daily insulin dosage were also determined.

Results:

Mean accumulated time in moderate-to-vigorous intensity PA was 53.6 ± 31.4 minutes·D−1. Levels of vigorous-intensity PA were low, mean 8.3 ± 10.2 minutes·D−1. When controlling for age, no differences in metabolic or physiologic health outcomes were evident between those individuals achieving, and those not achieving, 60 minutes·D−1 of moderate-to-vigorous intensity PA. PA predominantly occurred in short bouts lasting 5 minutes or less.

Conclusion:

The efficacy of accumulating 60 minutes·D−1 of moderate-to-vigorous intensity PA, in the form of short duration, intermittent bouts of largely unplanned PA, to promote health gains in children and adolescents with type 1 diabetes is questionable.

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Gina Alexander, Kim E. Innes, Cheryl Bourguignon, Viktor E. Bovbjerg, Pamela Kulbok and Ann Gill Taylor

Background:

The current study described patterns of yoga practice and examined differences in physical activity over time between individuals with or at risk for type 2 diabetes who completed an 8-week yoga intervention compared with controls.

Methods:

A longitudinal comparative design measured the effect of a yoga intervention on yoga practice and physical activity, using data at baseline and postintervention months 3, 6, and 15.

Results:

Disparate patterns of yoga practice occurred between intervention and control participants over time, but the subjective definition of yoga practice limits interpretation. Multilevel model estimates indicated that treatment group did not have a significant influence in the rate of change in physical activity over the study period. While age and education were not significant individual predictors, the inclusion of these variables in the model did improve fit.

Conclusions:

Findings indicate that an 8-week yoga intervention had little effect on physical activity over time. Further research is necessary to explore the influence of yoga on behavioral health outcomes among individuals with or at risk for type 2 diabetes.