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Médecine

研究力量运动对肥胖成人胰岛素敏感性的急性影响的随机对照试验

Published: December 01, 2023
doi:
10.3791/65478
, , , , , , ,
1Department of Physical Education,Federal University of the Jequitinhonha and Mucuri Valleys, 2Laboratory of Exercise Biology and Immunometabolism, Centro Integrado de Pós-Graduação e Pesquisa em Saúde, Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas,Federal University of the Jequitinhonha and Mucuri Valleys, 3Occupational Safety & Health,Los Alamos National Laboratory, 4Department of Health, Exercise, and Sports Sciences,University of New Mexico, 5School of Physical Education and Sport,University of Sao Paulo

Summary

本研究描述了一项随机对照试验方案，旨在评估力量运动量对肥胖个体胰岛素敏感性的急性影响。

Abstract

急性力量运动 （SE） 可改善胰岛素敏感性 （IS） 数小时;然而，SE体积（即组数）的影响尚未得到彻底研究。虽然直觉上，一些 SE 总比没有好，而且对于改善 IS 来说，多于一些优于某些，但对于患病人群来说，大容量的疗程可能具有挑战性，尤其是肥胖的成年人，对他们来说，即使是快走也可能具有挑战性。该协议详细介绍了一项随机临床试验，以评估 SE 对肥胖成人 IS 的急性影响。纳入标准是体重指数 >30 kg/m2、向心性肥胖（女性和男性的腰围分别为 >88 cm 和 >102 cm）和年龄 >40 岁。参与者将熟悉 SE（针对主要肌肉群的 7 项练习），然后将按随机顺序进行三个疗程：第 1 节 – 高容量疗程（3 组/练习）;第 2 节 – 低音量训练（1 组/练习）;第 3 节 – 控制会话（无练习）。饮食将在会议前一天和当天进行控制。会议将在晚上完成，第二天早上将进行口服葡萄糖耐量试验，从中得出 IS 的几个指标，例如葡萄糖和胰岛素的曲线下面积 （AUC）、Matsuda 指数、Cederholm 指数、肌肉 IS 指数和 Gutt 指数。根据初步研究，与对照组相比，我们预计高容量疗程后 IS（胰岛素 AUC、Matsuda 和 Cederholm 指数）改善 ~15%，低容量疗程后改善 ~8%。这项研究将使那些发现大量 SE 会议具有挑战性但仍旨在通过投入 1/3 的时间和精力来改善他们的 IS 的个人受益。

Introduction

尽管力量训练对胰岛素敏感性的慢性影响已被反复证明 1,2,3，但即使是急性的力量锻炼也可以改善胰岛素作用长达 48 小时4。这种效果已在健康5、6、7、8、肥胖 9、老年 10、胰岛素抵抗个体4 和 2 型糖尿病患者中得到证实 11。其他人没有报告积极影响12,13,14,15,16,17，目前尚不清楚为什么会出现这些差异。

在最近的叙述性综述18 中，有人提出力量运动量（每次运动的组数）对于提高胰岛素敏感性至关重要。例如，最近的一项系统评价和荟萃分析表明，与少于 21 组或更少的疗程相比，由 21 组或更多组成的疗程可使胰岛素作用得到更大的改善19.然而，只有有限的文献证据直接支持这一观点。例如，较高的力量运动量（30 组）比较低的运动量（10 组）更能改善葡萄糖代谢20。但值得注意的是，本研究采用的是循环式力量练习，限制了与传统力量练习的比较。在另一项研究中，与 8 组方案相比，在 32 组力量锻炼方案后观察到更好的胰岛素敏感性21.然而，没有报道组后的努力程度，并且在大容量方案之后可能更大。这很重要，因为努力程度（或接近同心性肌肉衰竭，其特征是由于给定重复的同心运动失败而无法继续设置）也被认为是改善胰岛素和葡萄糖代谢的重要变量18。因此，关于该主题的现有研究有限，以及其方法学上的局限性，排除了关于力量运动量对胰岛素敏感性影响的进一步推论。

在讨论力量运动量时，另一个有趣的观点是它与时间投入有着内在的联系。根据设计，较低的运动量意味着在健身房花费的时间更少。在不坚持锻炼计划的原因中，缺乏时间位居榜首22.因此，有效提高胰岛素敏感性的低容量力量锻炼意味着更少的时间投入23，并可能导致更高的长期依从性。此外，主观感受，如自我效能感（对完成某事能力的自我感知）以及愉悦和乐趣的感觉（享受），也与运动依从性有关24,25,26。可以合理地推测，当人们进行低容量的力量锻炼时，他们可能会感到更自信，更享受他们的锻炼体验，从而改善健康。

为了解决上述文献中的空白，我们描述了一项随机、对照、交叉临床试验的方案，其主要目的是评估力量运动量对肥胖个体胰岛素敏感性的影响。作为次要目标，我们评估力量运动量对主观感受（自我效能感、感情和享受）的影响。

此处的方案描述了一项随机、对照、3 向、交叉的临床试验。该协议的时间顺序包括：参与前对健康史和人体测量测量（体重、身高、腰围和身体成分）的评估;与团队的认证营养师预约;熟悉力量练习和主观感受问卷;每次运动的力量评估;随机分配会话顺序;3 节课的表现（相隔 7-28 天），随后立即回答主观感受问卷;第二天早上进行口服葡萄糖耐量试验 （OGTT）;和数据分析。 图 1 描绘了协议设计。

Figure 1
图1：研究设计。 以下是试验方法的流程图。1：肥胖（体重指数[BMI]>30 kg/m2;腰围>102/88 cm）受试者;2：人体测量评估和熟悉;随机分配到 3：高容量力量锻炼课程（21 组），4：低容量力量锻炼课程（7 套），或 5：控制日;6：标准餐后会议;7：睡眠和过夜禁食;8：口服葡萄糖耐量试验。 请点击这里查看此图的较大版本.

Protocol

通过向当地机构审查委员会 （IRB） 或当地研究伦理委员会 （REC） 提交研究方案和知情同意书来获得研究的伦理许可。该研究只能在 IRB 或 REC 批准后开始。下面显示的结果来自一项试点研究，受试者在入组前签署了书面知情同意书。在 IRB 或 REC 批准后，前瞻性地将协议注册到公共存储库中，例如临床试验 （https://clinicaltrials.gov）。如果您所在的国家/地区有国家存储库，请在那里注册协议（例如…

Representative Results

图 2 显示了 OGTT 期间葡萄糖（图 2A）和胰岛素（图 2B）的代表性（来自初步研究）反应。通常，在30分钟测量时观察到葡萄糖和胰岛素值的峰值，随后持续下降，直到120分钟测量。葡萄糖峰值越低，结果越好，这表明抑制肝脏葡萄糖的产生。峰值后葡萄糖下降得越快，结果越好，这表明葡萄糖处理速度更快（通常与骨骼肌葡萄糖?…

Discussion

本文详细介绍了一项随机对照试验的步骤，该试验旨在评估力量运动量对肥胖成人胰岛素敏感性的影响。随机对照试验是以无偏倚的方式确定治疗因果关系的最佳研究方案49,50。具体来说，在这项研究中，我们将采用交叉设计，这意味着每个招募的受试者都将按随机顺序执行每个条件51 尽管交叉研究增加了受试者的负担，并且不适合具…

Divulgations

The authors have nothing to disclose.

Acknowledgements

这项研究得到了国家科学技术发展委员会（CNPQ：Grant#407975/2018-7和#402091/2021-3）和米纳斯吉拉斯州研究与发展局（FAPEMIG：Grant#APQ-00008-22）的支持。资助者在本研究的设计中没有发挥任何作用，在研究进行、数据解释或结果报告方面也没有发挥任何作用。这项研究以Jequitinhonha和Mucuri Valleys联邦大学（巴西Diamantina-MG）为基础，该大学提供进行研究所需的设备和空间（DXA，力量训练室，力量训练设备等）。

Materials

dual-energy X-ray absorptiometry GE DXA, Lunar, iDXA Advanced for assessing body composition
G*Power program  Heinrich-Heine-Universität Düsseldorf, Germany version 3.1.9.6 for calculating sample size
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References

  1. Ismail, A. D., et al. The effect of short-duration resistance training on insulin sensitivity and muscle adaptations in overweight men. Experimental physiology. 104 (4), 540-545 (2019).
  2. Jiahao, L., Jiajin, L., Yifan, L. Effects of resistance training on insulin sensitivity in the elderly: A meta-analysis of randomized controlled trials. Journal of Exercise Science and Fitness. 19 (4), 241-251 (2021).
  3. Liu, Y., et al. Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 16 (1), (2019).
  4. van Dijk, J. W., et al. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia. 55 (5), 1273-1282 (2012).
  5. Koopman, R., et al. A single session of resistance exercise enhances insulin sensitivity for at least 24 in healthy men. European Journal of Applied Physiology. 94 (1-2), 180-187 (2005).
  6. Andersen, E., Høstmark, A. T. Effect of a Single Bout of Resistance Exercise on Postprandial Glucose and Insulin Response the Next Day in Healthy, Strength-Trained Men. The Journal of Strength and Conditioning Research. 21 (2), 487 (2007).
  7. Tong, T. K., Kong, Z., Shi, X., Shi, Q. Comparable Effects of Brief Resistance Exercise and Isotime Sprint Interval Exercise on Glucose Homeostasis in Men. Journal of Diabetes Research. 2017, (2017).
  8. Monroe, J. C., Naugle, K. M., Naugle, K. E. Effect of Acute Bouts of Volume-Matched High-Intensity Resistance Training Protocols on Blood Glucose Levels. Journal of Strength and Conditioning Research. 34 (2), 445-450 (2020).
  9. Bittel, A. J., et al. A Single Bout of Premeal Resistance Exercise Improves Postprandial Glucose Metabolism in Obese Men with Prediabetes. Medicine and science in sports and exercise. 53 (4), (2021).
  10. Fluckey, J. D., et al. Effects of resistance exercise on glucose tolerance in normal and glucose-intolerant subjects. Journal of Applied Physiology. 77 (3), 1087-1092 (1994).
  11. Fenicchia, L. M., et al. Influence of resistance exercise training on glucose control in women with type 2 diabetes. Metabolism: Clinical and Experimental. 53 (3), 284-289 (2004).
  12. Gordon, B. A., Fraser, S. F., Bird, S. R., Benson, A. C. Insulin sensitivity not modulated 24 to 78h after acute resistance exercise in type 2 diabetes patients. Diabetes, Obesity and Metabolism. 15 (5), 478-480 (2013).
  13. Gordon, B. A., Fraser, S. F., Bird, S. R., Benson, A. C. Insulin sensitivity in response to a single resistance exercise session in apparently healthy individuals. Journal of Endocrinological Investigation. 35 (7), 665-669 (2012).
  14. Malin, S. K., Hinnerichs, K. R., Echtenkamp, B. G., Evetovich, T. K., Engebretsen, B. J. Effect of adiposity on insulin action after acute and chronic resistance exercise in non-diabetic women. European Journal of Applied Physiology. 113 (12), 2933-2941 (2013).
  15. Moreno-Cabañas, A., et al. One Bout of Resistance Training Does Not Enhance Metformin Actions in Prediabetic and Diabetic Individuals. Medicine and Science in Sports and Exercise. 54 (7), (2022).
  16. Luebbers, P. E., et al. Glucose Uptake After Resistance Training of Different Intensities but of Equal Work Volume. Journal of Strength and Conditioning Research. 22 (4), 1094-1100 (2008).
  17. Chapman, J., Garvin, A. W., Ward, A., Cartee, G. D. Unaltered insulin sensitivity after resistance exercise bout by postmenopausal women. Medicine & Science in Sports & Exercise. 34 (6), 936-941 (2002).
  18. Brown, E. C., Franklin, B. A., Regensteiner, J. G., Stewart, K. J. Effects of single bout resistance exercise on glucose levels, insulin action, and cardiovascular risk in type 2 diabetes: A narrative review. Journal of Diabetes and its Complications. 34 (8), (2020).
  19. Ishiguro, H., et al. In Search of the Ideal Resistance Training Program to Improve Glycemic Control and its Indication for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Sports Medicine. 46 (1), 67-77 (2016).
  20. Reed, M. E., Ben-Ezra, V., Biggerstaff, K. D., Nichols, D. L. The Effects of Two Bouts of High- and Low-Volume Resistance Exercise on Glucose Tolerance in Normoglycemic Women. Journal of Strength and Conditioning Research. 26 (1), 251-260 (2012).
  21. Black, L. E., Swan, P. D., Alvar, B. A. Effects of Intensity and Volume on Insulin Sensitivity During Acute Bouts of Resistance Training. Journal of Strength and Conditioning Research. 24 (4), 1109-1116 (2010).
  22. Carballo-Fazanes, A., et al. Physical Activity Habits and Determinants, Sedentary Behaviour and Lifestyle in University Students. International Journal of Environmental Research and Public Health. 17 (9), 3272 (2020).
  23. SCHOENFELD, B. J., et al. Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise. 51 (1), 94-103 (2019).
  24. Neupert, S. D., Lachman, M. E., Whitbourne, S. B. Exercise Self-Efficacy and Control Beliefs: Effects on Exercise Behavior after an Exercise Intervention for Older Adults. Journal of Aging and Physical Activity. 17 (1), 1-16 (2009).
  25. Gjestvang, C., Abrahamsen, F., Stensrud, T., Haakstad, L. A. H. Motives and barriers to initiation and sustained exercise adherence in a fitness club setting—A one-year follow-up study. Scandinavian Journal of Medicine and Science in Sports. 30 (9), (2020).
  26. Collado-Mateo, D., et al. Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: An umbrella review. International Journal of Environmental Research and Public Health. 18 (4), (2021).
  27. Riebe, D., et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Medicine & Science in Sports & Exercise. 47 (11), 2473-2479 (2015).
  28. Cortés, M. E., Alfaro, A. A. The effects of hormonal contraceptives on glycemic regulation. Linacre Quarterly. 81 (3), (2014).
  29. Kerksick, C. M., et al. ISSN exercise & sports nutrition review update: research & recommendations. , 1-57 (2018).
  30. ROBERTSON, R. J., et al. Concurrent Validation of the OMNI Perceived Exertion Scale for Resistance Exercise. Medicine & Science in Sports & Exercise. 35 (2), 333-341 (2003).
  31. Hardy, C. J., Rejeski, W. J. Not What, but How One Feels: The Measurement of Affect during Exercise. Journal of Sport and Exercise Psychology. 11 (3), (2016).
  32. Alves, E. D., Panissa, V. L. G., Barros, B. J., Franchini, E., Takito, M. Y. Translation, adaptation, and reproducibility of the Physical Activity Enjoyment Scale (PACES) and Feeling Scale to Brazilian Portuguese. Sport Sciences for Health. 15 (2), (2019).
  33. Kendzierski, D., DeCarlo, K. J. Physical Activity Enjoyment Scale: Two Validation Studies. Journal of Sport and Exercise Psychology. 13 (1), (2016).
  34. McAuley, E., Lox, C., Duncan, T. E. Long-term maintenance of exercise, self-efficacy, and physiological change in older adults. Journals of Gerontology. 48 (4), (1993).
  35. Chen, T. C., et al. Changes in Insulin Sensitivity and Lipid Profile Markers Following Initial and Secondary Bouts of Multiple Eccentric Exercises. Frontiers in Physiology. 13, (2022).
  36. Jimenez, C., Santiago, M., Sitler, M., Boden, G., Homko, C. Insulin-Sensitivity Response to a Single Bout of Resistive Exercise in Type 1 Diabetes Mellitus. Journal of Sport Rehabilitation. 18 (4), 564-571 (2009).
  37. Gonzalez, J. T., Barwood, M. J., Goodall, S., Thomas, K., Howatson, G. Alterations in whole-body insulin sensitivity resulting from repeated eccentric exercise of a single muscle group: A pilot investigation. International Journal of Sport Nutrition and Exercise Metabolism. 25 (4), 405-410 (2015).
  38. Ismail, A. D., et al. The effect of short-duration resistance training on insulin sensitivity and muscle adaptations in overweight men. Experimental Physiology. 104 (4), 540-545 (2019).
  39. de Matos, M. A., et al. High-Intensity Interval Training Improves Markers of Oxidative Metabolism in Skeletal Muscle of Individuals With Obesity and Insulin Resistance. Frontiers in Physiology. 9 (OCT), (2018).
  40. . Carbohydrate Homeostasis. New England Journal of Medicine. 283 (5), 237-246 (1970).
  41. Mari, A., Pacini, G., Murphy, E., Ludvik, B., Nolan, J. J. A Model-Based Method for Assessing Insulin Sensitivity From the Oral Glucose Tolerance Test. Diabetes Care. 24 (3), 539-548 (2001).
  42. Matsuda, M., DeFronzo, R. A. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 22 (9), 1462-1470 (1999).
  43. Cederholm, J., Wibell, L. Insulin release and peripheral sensitivity at the oral glucose tolerance test. Diabetes Research and Clinical Practice. 10 (2), 167-175 (1990).
  44. Abdul-Ghani, M. A., Matsuda, M., Balas, B., DeFronzo, R. A. Muscle and Liver Insulin Resistance Indexes Derived From the Oral Glucose Tolerance Test. Diabetes Care. 30 (1), 89-94 (2007).
  45. de Matos, M. A., et al. High-Intensity Interval Training Improves Markers of Oxidative Metabolism in Skeletal Muscle of Individuals With Obesity and Insulin Resistance. Frontiers in Physiology. 9, (2018).
  46. Gutt, M., et al. Validation of the insulin sensitivity index (ISI0,120): comparison with other measures. Diabetes Research and Clinical Practice. 47 (3), 177-184 (2000).
  47. Avignon, A., Bœgner, C., Mariano-Goulart, D., Colette, C., Monnier, L. Assessment of insulin sensitivity from plasma insulin and glucose in the fasting or post oral glucose-load state. International Journal of Obesity. 23 (5), (1999).
  48. Stumvoll, M., van Haeften, T., Fritsche, A., Gerich, J. Oral Glucose Tolerance Test Indexes for Insulin Sensitivity and Secretion Based on Various Availabilities of Sampling Times. Diabetes Care. 24 (4), 796-797 (2001).
  49. Kendall, J. M. Designing a research project: Randomised controlled trials and their principles. Emergency Medicine Journal. 20 (2), (2003).
  50. Moher, D., et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ (Clinical research ed.). 340, (2010).
  51. Sibbald, B., Roberts, C. Understanding controlled trials Crossover trials. BMJ. 316 (7146), (1998).
  52. Lim, C. Y., In, J. Considerations for crossover design in clinical study. Korean Journal of Anesthesiology. 74 (4), (2021).
  53. Taylor, H. L., et al. Post-exercise carbohydrate-energy replacement attenuates insulin sensitivity and glucose tolerance the following morning in healthy adults. Nutrients. 10 (2), (2018).
  54. Johnson-Bonson, D. A., et al. Interactive effects of acute exercise and carbohydrate-energy replacement on insulin sensitivity in healthy adults. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 46 (10), (2021).
  55. Patarrão, R. S., Wayne Lautt, W., Paula Macedo, M. Assessment of methods and indexes of insulin sensitivity. Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo. 9 (1), 65-73 (2014).
  56. DeFronzo, R. A., Tobin, J. D., Andres, R. Glucose clamp technique: A method for quantifying insulin secretion and resistance. American Journal of Physiology Endocrinology Metabolism and Gastrointestinal Physiology. 6 (3), (1979).
  57. Monzillo, L. U., Hamdy, O. Evaluation of Insulin Sensitivity in Clinical Practice and in Research Settings. Nutrition Reviews. 61 (12), 397-412 (2003).
  58. Radziuk, J. Insulin Sensitivity and Its Measurement: Structural Commonalities among the Methods 1. The Journal of Clinical Endocrinology & Metabolism. 85 (12), (2000).
  59. Gordon, B. A., Fraser, S. F., Bird, S. R., Benson, A. C. Reproducibility of multiple repeated oral glucose tolerance tests. Diabetes Research and Clinical Practice. 94 (3), (2011).
  60. Beaudry, K. M., Surdi, J. C., Mari, A., Devries, M. C. Exercise mode influences post-exercise glucose sensitivity and insulin clearance in young, healthy males and females in a sex-dependent manner: A randomized control trial. Physiological Reports. 10 (13), (2022).
  61. Aguiar, S. d. a. S., et al. Acute metabolic responses following different resistance exercise protocols. Applied Physiology, Nutrition and Metabolism. 43 (8), 838-843 (2018).
  62. Venables, M. C., Shaw, C. S., Jeukendrup, A. E., Wagenmakers, A. J. M. Effect of acute exercise on glucose tolerance following post-exercise feeding. European Journal of Applied Physiology. 100 (6), 711-717 (2007).

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Insulin SensitivityResistance ExerciseStrength ExerciseExercise VolumeObesityRandomized Controlled TrialGlucose MetabolismMetabolic Health
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Rocha Silva, L. F., Chaves Garcia, B. C., Mang, Z. A., Amorim, F. T., Dias-Peixoto, M. F., Gripp, F., Tricoli, V., Magalhães, F. d. C. Randomized Controlled Trial to Study the Acute Effects of Strength Exercise on Insulin Sensitivity in Obese Adults. J. Vis. Exp. (202), e65478, doi:10.3791/65478 (2023).
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