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Out of the potential participants who met the inclusion criteria, 56 were interested and invited to a laboratory visit. During this visit, detailed information regarding the study was provided and the potential participants completed a screening and health questionnaire.

The eligibility criteria for this study were as follows: Exclusion criteria included the following: Finally, 34 patients participated in the study. All patients were informed about possible risks of all study procedures prior to testing.

1. Organization of article

The study was conducted according to the Declaration of Helsinki. Written informed consent was obtained from each participant prior to enrolment in the study. This study was a randomized crossover trial. Subjects reported to the laboratory on four different occasions, each separated by a minimum of one day Figure 1. Therefore, each exercise session was separated by a minimum of 48 hours. Thereafter, subjects were familiarized with the cycle ergometer and tested for maximal aerobic power by an incremental cycle ergometer test.

During the subsequent laboratory visits, subjects performed a single session of high-intensity interval training HIIT 30 EX30 , 60 EX60 , or 90 EX90 minutes following breakfast and metformin administration in a randomized order. Subjects arrived in a fasted state on each laboratory visit. Standardized breakfast and metformin were administered at 8: On exercise days, cycling was performed at 8: EX60 , or 9: Capillary blood was collected from the fingertip for assessing blood glucose and lactate concentrations.

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Venous blood samples were drawn before and immediately after the cycling exercise. The participants did not change their medication during the study. Body height and weight were measured using standardized procedures. Dietary intake was standardized on the evening prior to each laboratory day as well as between 8: The meals were provided by the research personnel and eaten at the laboratory.

The timing of meals was as follows: The proportion of macronutrients were as follows: Water was allowed throughout all testing days ad libitum. All exercise tests were supervised by a clinical doctor. The initial load for all subjects was 30 watts, and the load was increased every 2 minutes by 20 watts until volitional exhaustion.

Verbal encouragement was provided throughout the test.

Maximal aerobic power W max was determined by the following equation [ 24 ]: Blood lactate and glucose concentrations were determined after each high-intensity bout as well as immediately postexercise, while RPE and HR were recorded both before and after each high-intensity bout. Serum glucose, total cholesterol, high-density lipoprotein cholesterol HDL-C , low-density lipoprotein cholesterol LDL-C , and triglycerides were analyzed by the enzymatic, colorimetric method by an automatic biochemical analyzer Mindray BS, Shenzhen, China.

Insulin was measured by an electrochemiluminescence immunoassay on a Cobas e Roche Diagnostics International Ltd. Capillary blood samples were collected from the fingertip at 8: Gender differences in the descriptive data were evaluated using an unpaired t -test or Wilcoxon rank sum test nonnormally distributed data. Linear mixed-effects modelling was conducted to assess the differences between experimental conditions in the measures of glucose allowing for repeated measurements from the same individuals. No significant interactions were found.

Therefore, the interaction term was removed from the final model.

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Since no significant modification effects of doses were observed, the interaction term was removed from the final model. Out of the 34 participants, 26 completed all test procedures. Four patients dropped out due to personal reasons i. Four patients were excluded before exercise tests due to unreported diseases or medication. The analyses were conducted on the 26 participants.

Physical characteristics, anthropometrics, biochemical information, and metformin dose in the morning are presented in Table 1. Men were heavier and taller than women both. Men also had greater maximal aerobic capacity than women. No significant differences of other baseline characteristics were observed between women and men. Blood lactate concentrations were significantly increased to a similar extent during all three exercise sessions Figure 2 b. Changes in capillary blood glucose during the day are presented in Figure 3 and Supplementary Table 2.

On the Metf day, the postprandial peak glucose was observed after one hour and began to decrease thereafter. The declines in EX30 day were larger than that in EX90 day. The changes in glucose in the remaining hours after the exercise i. The pattern of changes in insulin was similar to the changes in glucose.

Total SOD activity was increased from 8: The current study examined the acute effects of the timing of exercise on the glycemic control during and after exercise in T2D. The findings indicated that the timing of exercise may be a modifiable factor influencing postexercise glycemic control when combining exercise with metformin therapy. HIIT is a time-efficient exercise mode to improve cardiovascular fitness and some cardiometabolic risk factors in patients with cardiometabolic disease [ 28 , 29 ].

In the current study, a single bout of HIIT was performed at 30 minutes, 60 minutes, and 90 minutes postbreakfast, which led to continuous decreases in blood glucose and insulin as well as increases in blood lactate concentrations during the exercise session. Our results were in accordance with previous studies [ 31 , 32 ], which supported the beneficial role of HIIT in glycemic control.

A recent study by Hansen et al. They showed that the combined effects of metformin and exercise improved glucose metabolic clearance rate with no risk of hypoglycemia. Therefore, the authors concluded that metformin and exercise can be administered in combination. Our findings also confirmed the findings from Erickson et al. However, the current study extended previous findings by examining the timing effects of exercise on glycemic responses to a standardized meal and metformin administration.

When a bout of HIIT was performed at 30 minutes postbreakfast, the peak glucose was blunted, thereby further stabilizing the postprandial glucose fluctuation.

Type 2 Diabetes and Exercise

This finding has clinical implications, since glycemic fluctuations are a therapeutic target for managing T2D [ 33 , 34 ] and high glycemic fluctuations were previously linked with increased oxidative stress and a number of complications [ 34 — 36 ]. This exercise condition also led to larger reductions in glucose levels compared with exercise being carried out at 90 minutes postbreakfast. Although exercising at 90 minutes postbreakfast did not cause hypoglycemia, the absolute postexercise glucose concentration was the lowest among the three experimental conditions.

Taken together, the results suggest that timing of exercise is a modifiable factor influencing postexercise glycemic control and exercise at 30 minutes postbreakfast may be preferred in terms of lowering and stabilizing postprandial glucose levels in patients treated with metformin. In a previous study, Boule et al.

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Jazz Exercise No. 2 by Oscar Peterson

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