Exercising Tactically for Taming Postmeal Glucose Surges

Table 1

Glucose response to different exercise conditions: moderate exercise, before meal [8–21] and after meal [22–30]; high-intensity exercise, before meal [31–34] and after meal [35–39]; comparisons of training, fast versus fed [40–43], timings [44, 45], and durations [46].

Study	Subjects	Exercise protocol	Results
	T1D (type 1 diabetes); T2D (type 2 diabetes)	HIT (high-intensity interval training)	FFA (free fatty acid), PPG (postprandial glucose), Ra (rate of appearance), and AUC (area under the curve)
Gaudet-Savard et al. [8]	43 men with T2D	Light, before meal for 1 h versus after meal tested at 6 time intervals 0-1, 1-2, 2-3, 3-4, 4-5, and 5–8, 60%	Exercise in fasted state is safe, no hypoglycemia; decrease in blood glucose depends on preexercise glucose level
Poirier et al. [9]	10 men with T2D	Light exercise, before meal versus 2 h after meal, both at 60%   for 1 h	Moderate exercise in fasted state has minimal impact on blood glucose; exercise 2 h after meal decreases plasma glucose
Poirier et al. [10]	19 men with T2D	Light exercise, before meal for 1 h versus after meal tested at 6 time intervals 0-1, 1-2, 2-3, 3-4, 4-5, and 5–8, 60%	Exercise in fasted state does not decrease blood glucose; blood glucose decreases with postprandial exercise, no clinical hypoglycemia is observed, and in postprandial state low blood sugar is seen
Derave et al. [11]	7 men with metabolic syndrome	Light exercise before meal, versus 1 h after meal, 60%   for 45 min versus no exercise	Blunted glucose response with postmeal exercise, excessive glucose response with premeal exercise, and later meals unaffected
Colberg et al. [12]	12 men and women with T2D	Brisk walk, before meal versus 30 min after meal, for 20 min versus no exercise	Postdinner walking better for blunting postprandial glucose excursion and the postdinner glucose peak bigger with predinner exercise
DiPietro et al. [13]	10 prediabetes men and women	Light walks, 1 h after meal for 15 min each ×3 and 2.5 h and 4.5 h after meal (before dinner) for 45 min	Postmeal walks improve 24 h glycemia, there is no 24 h glucose improvement with predinner walk, and 3 bouts of 15 min postmeal walk are more effective than 45 min of morning or afternoon walk
Yamanouchi et al. [14]	6 patients with T1D	Premeal walk versus postmeal walk at 60 min after meal, 50%   for 30 min versus no walk	Glucose levels and glucose-AUC significantly lower only in the postmeal walking (premeal walk 17.8, postmeal walk 3.8, and no walk 11.8 h mM)
Francois et al. [15]	9 individuals with insulin resistance	Premeal HIT (three 10 min bouts) versus moderate premeal exercise, 60%   for 30 min	Premeal HIT exercise results in improved insulin sensitivity; moderate exercise leads to postprandial glucose elevation
Melton et al. [16]	16 prediabetes women	Moderate premeal exercise, 65%   for 45 min versus no exercise	No effect on glucose, triglyceride, or oxidative stress
Kirwan et al. [17]	6 healthy women	Exercise before meal versus after meal (45 min), 60%   to exhaustion	As insulin and glucose go up, FFA and glycerol are suppressed for 120 min of postmeal exercise, glucose is steady with premeal exercise for 120 minutes, and duration is not altered
Borer et al. [18]	9 healthy postmenopausal women	Premeal exercise, versus postmeal exercise (1 h) at 43%  max effort, 2 bouts of 2 h each	Only prolonged light premeal exercise improves fasting glucose; FFA and D-3 hydroxybutyrate go up more during premeal exercise indicating liver glycogen depletion
Marmy-Conus et al. [19]	6 healthy men	Moderate premeal exercise versus moderate postmeal exercise starting 30 min after meal, 71%   for 60 min	Muscle glucose uptake increased, liver glucose output decreased by 62%  with the postmeal exercise, and glucose level goes up 20 min into the exercise
Short et al. [20]	Study 2: 11 young adults	Moderate aerobic exercise 17 h before meal versus 1 h before meal, 75%   for 45 min versus no exercise	Glucose-AUC 6%  lower with the 1 h premeal trial within 3 h after the exercise, the effect not seen at 17 h after exercise
Oberlin et al. [21]	9 sedentary patients with T2D	Moderate premeal exercise 60–75%   for 1 h versus no exercise	Glucose-AUC improved 15%  after the 2nd meal
Høstmark et al. [22]	9 young and 10 middle-aged sedentary women, 10 young and 10 middle-aged trained women	Light bicycling starting 15 min after meal for 30 min versus no exercise	Light postmeal physical activity reduces blood glucose by a magnitude similar to that obtained by using drugs
Aadland and Høstmark [23]	9 healthy people	Very light intensity (VLI) and light intensity (LI) walk starting 15 min after meal for 30 min versus no walking	Both VLI and LI exercise blunted and delayed the rise in blood glucose
Nygaard et al. [24]	14 healthy women	Slow walking starting 15 min after meal for 15 min versus 40 min versus no walking	Even slow postmeal walking reduces postprandial glucose response to meal; this response is dose dependent on duration
Rasmussen et al. [25]	7 people with T1D	Bicycling starting 15 min after meal, 65%   for 30 min versus no exercise	Moderate postmeal exercise starting 15 min after meal for 30 min reduces blood glucose response by one-third
Nelson et al. [26]	9 people with T1D, 7 heathy people	Exercise starting 30 min after meal, 55%   for 45 min	Glycemic response to breakfast entirely normalized, symptomatic hypoglycemia seen after 35 min into exercise
Caron et al. [27]	8 people with T1D	Exercise starting 30 min after meal, 50%   for 45 min	Glucoregulation improves with strategically timed postmeal exercise
Shin et al. [28]	8 young healthy men	Exercise starting 30 min after meal, 50%   for 60 min	Higher insulin action decreases glucose, free fatty acid levels, and fat oxidation and increases growth hormone levels during exercise
Larsen et al. [29]	9 sedentary men with T2D	Exercise starting 45 min after meal, 53%   for 45 min versus no exercise versus diet	Moderate postmeal exercise decreases glycemia, the effect does not persist to affect subsequent meal, and the effect is similar to what follows decreased calorie intake
Van Dijk et al. [30]	60 T2D men (23 insulin-treated)	Endurance exercise, 2 h after meal, 35%–50%  , for 45–60 min versus no exercise	With exercise glycemic control per continuous glucose monitoring improves throughout the subsequent day. is related to the magnitude of response to exercise
Kjaer et al. [31]	7 men with T2D and 7 healthy men	Single bout premeal HIT exercise at 100–110%	60 min of postexercise hyperglycemia in T2D followed by increased insulin effect on glucose disposal that is present 24 h after exercise. This has less therapeutic value in T2D
Kreisman et al. [32]	10 healthy men for premeal exercise and 8 healthy men for postmeal exercise	High-intensity exercise before meal versus 3 h after meal	Ra response to high-intensity exercise is preserved in postprandial exercise. Postexercise hyperglycemia is relatively reduced in postprandial exercise
Mitchell et al. [33]	8 T1D and 8 healthy	High-intensity premeal exercise at 80%	Postexercise hyperglycemia for 2 h, diabetes control deteriorates with intense premeal exercise
Yale et al. [34]	8 lean and 12 obese people	High-intensity premeal exercise to exhaustion	Obese people had greater postexercise insulin resistance
Larsen et al. [35]	8 sedentary men with T2D	High-intensity postmeal exercise, 45 min after meal, 98%   versus no exercise	Intense postmeal exercise does not deteriorate glucose homeostasis, effect related to energy expenditure, and the effect does not help lunch
Gillen et al. [36]	7 adults with T2D	HIT 90 min after meal versus no exercise	HIT exercise at 90 min after meal reduces postprandial hyperglycemia up to 24 h
Little et al. [37]	10 inactive obese men	HIT 2 h after breakfast versus continuous moderate intensity exercise, 65%   for 30 min versus no exercise	No effect on lunch. PPG-AUC for dinner and for next breakfast better for HIT, absolute AUC and absolute spikes not different
Szewieczek et al. [38]	14 T2D and 14 healthy	HIT 2 h after meal versus no exercise	Hyperglycemia reduced during recovery period with HIT
Heden et al. [39]	13 obese T2D patients	Resistance exercise (RE) 45 min after dinner, before dinner versus no exercise	Predinner RE improves postprandial glucose concentration; postdinner exercise improves both glucose and TAG concentrations
Gillen et al. [40]	16 women	HIT, fasted versus fed, starting at 60 min, 3/week for 6 weeks	HIT is time efficient, fed versus fasted: both improve body composition and muscle oxidative capacity
De Bock et al. [41]	20 healthy men	Endurance training, 10 fasted versus 10 fed starting at 90 min ×3/week for 6 weeks at 75%	Fat oxidation similar, glycogen breakdown less in fasted training
van Proeyen et al. [42]	27 healthy men	Endurance training, 10 fasted versus 10 fed starting at 90 min, ×4/week for 6 weeks versus 7 no training	Fasted training is (slightly) more potent in muscle adaptations
Nybo et al. [43]	15 healthy men	Endurance training, 7 fasted versus 8 fed starting at 3 h postprandial ×4/week for 8 weeks at 70–85%	Muscular adaptations similar in fast versus fed training except GLUT4 and glycogen content more in fasted training
Achten and Jeukendrup [44]	8 healthy men	45 min after meal 40%, 65%, 80%   for 20 min	Insulin peaks at 30 min after meal; insulin and glucose levels decrease in 10 min similarly (then glucose level goes up for 80%)
Manders et al. [45]	9 sedentary men with T2D	Starting 60 min after meal light (35%  ) for 60 min versus moderate intensity (70%  ) exercise for 30 min	Light exercise as opposed to moderate exercise reduces hyperglycemia throughout the subsequent 24 h, prevalence of hyperglycemia 50%  versus 19%
Van Dijk et al. [46]	30 patients with T2D	90 min after meal, 50%   30 min every day versus 60 min every other day versus no exercise	Hyperglycemia lower in both exercise regimens