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Steven K. Malin, Brooke R. Stephens, Carrie G. Sharoff, Todd A. Hagobian, Stuart R. Chipkin, and Barry Braun

Exercise and metformin may prevent or delay Type 2 diabetes by, in part, raising the capacity for fat oxidation. Whether the addition of metformin has additive effects on fat oxidation during and after exercise is unknown. Therefore, the purpose of this study was to evaluate the effect of metformin on substrate oxidation during and after exercise. Using a double-blind, counter-balanced crossover design, substrate oxidation was assessed by indirect calorimetry in 15 individuals taking metformin (2,000 mg/d) and placebo for 8–10 d. Measurements were made during cycle exercise at 5 submaximal cycle workloads, starting at 30% peak work (Wpeak) and increasing by 10% every 8 min to 70% Wpeak. Substrate oxidation was also measured for 50 min postexercise. Differences between conditions were assessed using analysis of variance with repeated measures, and values are reported as M ± SE. During exercise, fat oxidation (0.19 ± 0.03 vs. 0.15 ± 0.01 g/min, p < .01) and percentage of energy from fat (32% ± 3% vs. 28% ± 3%, p < .01) were higher with metformin than with placebo. Postexercise, metformin slightly lowered fat oxidation (0.12 ± 0.02 to 0.10 ± 0.02 g/min, p < .01) compared with placebo. There was an inverse relationship between postexercise fat oxidation and the rate of fat oxidation during exercise (r = –.68, p < .05). In healthy individuals, metformin has opposing actions on fat oxidation during and after exercise. Whether the same effects are evident in insulin-resistant individuals remains to be determined.

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Barry Braun

The concept that participation in exercise/physical activity reduces the risk for a host of chronic diseases is undisputed. Along with adaptations to habitual activity, each bout of exercise induces beneficial changes that last for a finite period of time, requiring subsequent exercise bouts to sustain the benefits. In this respect, exercise/physical activity is similar to other “medications” and the idea of “Exercise as Medicine” is becoming embedded in the popular lexicon. Like other medications, exercise has an optimal dose and frequency of application specific to each health outcome, as well as interactions with food and other medications. Using the prevention of type-2 diabetes as an exemplar, the application of exercise/physical activity as a medication for metabolic “rehabilitation” is considered in these terms. Some recommendations that are specific to diabetes prevention emerge, showing the process by which exercise can be prescribed to achieve health goals tailored to individual disease prevention outcomes.

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Pooja Bhati and M. Ejaz Hussain

potential co-variates (age, body mass index [BMI], sex, presence of comorbidities, such as hypertension, dyslipidemia, DM complications, such as retinopathy, nephropathy and peripheral neuropathy, and intake of metformin). Selection of independent variables (predictors) and co-variates was done on the basis

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Yuri A. Freire, Carlos A. Silva, Geovani A. D. Macêdo, Rodrigo A. V. Browne, Bruno M. de Oliveira, George Felipe C. Martins, Luiz F. Farias-Junior, Luciana C. Brito, and Eduardo C. Costa

antihypertensive medication(s). Fifteen participants were taking oral hypoglycemic agents (94%). Of the 15 participants who were taking oral hypoglycemic agents, 14 were taking metformin, either alone ( n  = 4) or combined with one ( n  = 8) or two hypoglycemic agents ( n  = 2). One participant combined three

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Marjan Mosalman Haghighi, Yorgi Mavros, and Maria A. Fiatarone Singh

, mmol/mol FBG, mmol/L Medications, % Comorbidities, % BMI, kg/m 2 Waist circumference, cm Ligtenberg et al 23 (1997) 58 34 62 (5) 8 (6) NR NR NR Metformin 34 HBP 70 30.9 (3.6) NR AHA 70 LL 12 Dunstan et al 32 (2002) 36 55.2 67 (5) 8 7.8 (1.0) 61.9 (11.4) 9.4 (2.2) OHA 85.3 HBP 55.5 31.9 (3.7) 104.4 (9

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Amie Woodward, David Broom, Caroline Dalton, Mostafa Metwally, and Markos Klonizakis

structured exercise defined as >150 minutes per week. (4) Taking metformin for fewer than 3 months. (5) Taking the oral contraceptive pill or have taken in the last month. (6) Have any medical condition that may be responsible for the symptoms of PCOS. (7) Have current, clinically defined CVD, or a history

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Ashley B. West, Adam R. Konopka, Kelli A. LeBreton, Benjamin F. Miller, Karyn L. Hamilton, and Heather J. Leach

<200 mg/dl), or a family history of Type II diabetes. Eligible participants were enrolled in an intervention examining interactions between Metformin (Amerisource Bergen NDC 57644-397-58; Belmar Pharmacy, Golden, CO; ), protein from a dairy product, and regular exercise on

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Kelsie M. Full, Eileen Johnson, Michelle Takemoto, Sheri J. Hartman, Jacqueline Kerr, Loki Natarajan, Ruth E. Patterson, and Dorothy D. Sears

participant characteristics in a trial of weight-loss and metformin in breast cancer survivors . Contemp Clin Trials . 2016 ; 47 : 64 – 71 . PubMed ID: 26706665 doi:10.1016/j.cct.2015.12.009 10.1016/j.cct.2015.12.009 32. Choi L , Liu Z , Matthews CE , Buchowski MS . Validation of accelerometer

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Michael Pratt, Andrea Ramirez Varela, and Adrian Bauman

statement from the American Heart Association . Circulation . 2018 ; 137 ( 18 ): e495 – e522 . doi:10.1161/CIR.0000000000000559 29618598 42. Knowler WC , Barrett-Connor E , Fowler SE , et al . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin . N Engl J Med

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Arun Eswaran and Brad A. Meisner

, C.A. , Sarwat , S. , & Tan , M.H. ( 2007 ). Mealtime 50/50 basal + prandial insulin analogue mixture with a basal insulin analogue, both plus metformin, in the achievement of target HbA1c and pre- and postprandial blood glucose levels in patients with type 2 diabetes: A multinational, 24-week