Decline in insulin action with age in endurance-trained humans.

We tested the hypothesis that regular endurance exercise prevents the age-related decline in insulin action typically observed in healthy, sedentary adults. An index of whole body insulin sensitivity (ISI), obtained from minimal model analysis of insulin and glucose concentrations during a frequently sampled intravenous glucose tolerance test, was determined in 126 healthy adults: 25 young [27 +/- 1 (SE) yr; 13 men/12 women] and 43 older (59 +/- 1 yr; 20/13) sedentary and 25 young (29 +/- 1 yr; 12/13) and 33 older (60 +/- 1 yr; 20/13) endurance trained. ISI values were lower in the older vs. young adults in both sedentary (-53%; 3.9 +/- 0.3 vs. 7.0 +/- 0.7 x10(-4) x min(-1) x microU(-1) x ml(-1); P < 0.01) and endurance-trained (-36%; 7.9 +/- 0.6 vs. 12.4 +/- 1.0 x 10(-4) min(-1) x microU(-1) x ml(-1); P < 0.01) groups, but the value was 72-102% higher in the trained subjects at either age (P < 0.01). In subgroup analysis of sedentary and endurance-trained adults with similar body fat levels (n = 62), the age-related reduction in ISI persisted only in the endurance-trained subjects (12.9 +/- 1.9 vs. 8.7 +/- 1.2 x 10(-4) x min(-1) x microU(-1) x ml(-1); P < 0.01). The results of the present study suggest that habitual endurance exercise does not prevent the age-associated decline insulin action. Moreover, the age-related reduction in ISI in endurance-trained adults appears to be independent of adiposity.     

Exogenous glucose oxidation during exercise in endurance-trained and untrained subjects

Jeukendrup, A. E., M. Mensink, W. H. M. Saris, and A. J. M. Wagenmakers. Exogenous glucose oxidation during exercise in endurance-trained and untrained subjects. J. Appl.Physiol. 82(3): 835-840, 1997.To investigate theeffect of training status on the fuel mixture used during exercise withglucose ingestion, seven endurance-trained cyclists (Tr; maximumO₂ uptake 67 ± 2.3 ml ^· kg^{1 ·} min¹)and eight untrained subjects (UTr; 48 ± 2 ml ^· kg^{1 ·} min¹)were studied during 120 min of exercise at ~60% maximumO₂ uptake. At the onset of exercise, 8 ml ^· kg^{1 ·} min¹of an 8% naturally enriched[¹³C]glucose solutionwas ingested and 2 ml/kg every 15 min thereafter. Energy expenditurewas higher in Tr subjects compared with UTr subjects (3,404 vs. 2,630 kJ; P < 0.01). During the secondhour, fat oxidation was higher in Tr subjects (37 ± 2 g) comparedwith UTr subjects (23 ± 1 g), whereas carbohydrateoxidation was similar (116 ± 8 g in Tr subjects vs. 114 ± 4 g in UTr subjects). No differences were observed in exogenousglucose oxidation (50 ± 2 g in Tr subjects and 45 ± 3 g in UTr subjects, respectively). Peak exogenous glucose oxidationrates were similar in the two groups (0.95 ± 0.07 g/min in Trsubjects and 0.96 ± 0.03 g/min in UTr subjects). It is concluded that the higher energy expenditure in Tr subjects during exercise atthe same relative exercise intensity is entirely met by a higher rateof fat oxidation without changes in the rates of exogenous andendogenous carbohydrates.

     

Insulin secretion and action in the hyperthyroid rat

To gain insight into the mechanism of the altered carbohydrate metabolism in thyrotoxicosis, intravenous glucose tolerance tests (IVGTT) and pancreatic suppression tests (PST) were performed in hyperthyroid rats (0.1 mg/kg T4 X 5 days) to assess insulin secretion and action in vivo. Thyroid hormone injections significantly increased T4 levels (182.8 nM +/- 11.6 (SEM) versus 50.2 +/- 6.4; P less than 0.001) and baseline glucose concentrations (9.3 mM +/- 0.2 versus 7.1 +/- 0.2; P less than 0.001). Body weights, basal insulin concentrations, glucose concentrations during IVGTT, glucose disappearance rates and steady state plasma glucose levels (SSPG) were normal. Insulin concentrations during the glucose tolerance test and during the PST were significantly decreased. The metabolic clearance rate of insulin (ml/min/kg +/- SEM) was significantly (P less than 0.01) increased (54.4 +/- 3.5 versus 41.6 +/- 2.3) in the hyperthyroid rats. If the different baseline glucose values were subtracted from the glucose concentrations achieved during the 2 tests, both the glucose disappearance rate and the fall in SSPG levels were significantly enhanced in the T4-injected animals. Thus, in the hyperthyroid rat, insulin secretion is decreased, the clearance of insulin is increased and insulin sensitivity is either normal or possibly enhanced.     

Comparison of leucine kinetics in endurance-trained and sedentary humans

Whole body leucine kinetics was compared inendurance-trained athletes and sedentary controls matched for age,gender, and body weight. Kinetic studies were performed during 3 h ofrest, 1 h of exercise (50% maximal oxygen consumption), and 2 h ofrecovery. When leucine kinetics were expressed both per unit of bodyweight and per unit of fat-free mass, both groups demonstrated anincrease in leucine oxidation during exercise(P < 0.01). Trained athletes had agreater leucine rate of appearance during exercise and recovery compared with their sedentary counterparts(P < 0.05) and an increased leucineoxidation at all times on the basis of body weight(P < 0.05). However, all of thesebetween-group differences were eliminated when leucine kinetics werecorrected for fat-free tissue mass. Therefore, correctionof leucine kinetics for fat-free mass may be important whencross-sectional investigations on humans are performed. Furthermore,leucine oxidation, when expressed relative to whole-body oxygenconsumption during exercise, was similar between groups. It isconcluded that there was no difference between endurance-trained andsedentary humans in whole body leucine kinetics during rest, exercise,or recovery when expressed per unit of fat-free tissue mass.

     

Relationship between muscle blood flow and oxygen uptake during exercise in endurance-trained and untrained men.

A recent study showed good correlation between regional blood flow (BF) and oxygen uptake (Vo(2)) 30 min after exhaustive exercise. The question that remains open is whether there is similar good correlation between BF and Vo(2) also during exercise. We reanalyzed our previous data from a study in which BF and Vo(2) was measured in different quadriceps femoris muscles in seven healthy endurance-trained and seven healthy untrained men at rest and during low-intensity intermittent static knee-extension exercise (Kalliokoski KK, Oikonen V, Takala TO, Sipila H, Knuuti J, and Nuutila P. Am J Physiol Endocrinol Metab 280: E1015-E1021, 2001). When the mean values of each muscle were considered, there was good correlation between BF and Vo(2) during exercise in both groups (r(2) = 0.82 in untrained and 0.97 in trained). However, when calculated individually, the correlations were poorer, and the mean correlation coefficient (r(2)) was significantly higher in the trained men (0.71 +/- 0.07 vs. 0.40 +/- 0.11, P = 0.03). These results suggest that there is large individual variation in matching BF to Vo(2) in human skeletal muscles during exercise, ranging from very poor to excellent. Furthermore, this matching seems to be better in the endurance-trained than in untrained men.     

Insulin and C-peptide secretion and kinetics in humans: direct and model-based measurements during OGTT

To directly evaluate prehepatic secretion of pancreatic hormones during a 3-h oral glucose tolerance test (OGTT), we measured insulin and C-peptide in six healthy control, six obese, and six type 2 diabetic subjects in the femoral artery and hepatic vein by means of the hepatic catheterization technique. Hypersecretion in obesity was confirmed (309 +/- 66 nmol in obese vs. 117 +/- 22 in control and 79 +/- 13 in diabetic subjects, P 0.3, r(2) = 0.93), whereas estimation of hepatic insulin extraction and insulin clearance needs further investigation for improvement.     

The acute effects of low-intensity exercise on plasma lipids in endurance-trained and untrained young adults.

The acute effects of low-intensity exercise on plasma lipids were assessed in 22 healthy, normolipidaemic volunteers [mean age (SEM) 21.1 (0.2) years] of whom 11 were untrained and 11 endurance trained. Each subject walked for 2 h on a treadmill at a speed selected to elicit 30% [29.8 (3.9)%] of his or her maximal oxygen uptake. All subjects consumed a similar diet, i.e. 48% of energy from carbohydrate, for 2 days prior to the test. Pre-exercise, high-density lipoprotein (HDL) cholesterol concentration was higher in the trained group than in the untrained group [0.88 (0.06) mmol.l-1 vs 0.73 (0.09) mmol.l-1, P less than 0.05]. The walk elicited an increase in blood lactate concentration (P less than 0.01) but glucose homeostasis was well maintained by both groups. After 2 h of walking total cholesterol had increased by 13 (0.6)% (P less than 0.05). HDL cholesterol concentration increased by 17 (1.6)%, so that the ratio of total to HDL cholesterol was lower after the walk than pre-exercise (P less than 0.05). In the endurance-trained group HDL cholesterol concentration increased progressively, being 7.9 (2.4)% higher after 1 h and 19.7 (1.6)% higher after 2 h. A different response was evident in the untrained group where a rise after the 1st h [25.1 (2.3)%] was followed by a decrease towards pre-exercise values. These results show that one prolonged bout of low-intensity exercise modifies lipoprotein metabolism and hold out the interesting possibility that this response may differ in trained and untrained individuals.     

Insulin secretion: Combined tolbutamide, forskolin and TPA mimic action of glucose

We have proposed that the two phases of glucose-induced insulin secretion are regulated by two distinct branches of the calcium messenger system: the initial phase by a calmodulin branch, and the sustained phase by a C-kinase branch. To provide further support for this concept, we examined the separate and combined effects of tolbutamide, TPA, and forskolin upon insulin secretion from rat islets perifused in the absence of added fuels. Addition of 200 μM tolbutamide to the perifusate induces only a first phase of insulin secretion, addition of 200 nM TPA only a second phase, and addition of 10 μM forskolin only a small elevation in the basal rate of secretion. The combination of tolbutamide and TPA induces a biphasic secretory response qualitatively and quantitatively similar to that evoked by an increase in glucose concentration from 2.75 to 7 mM. The combination of TPA, tolbutamide, and forskolin evokes a biphasic pattern of insulin secretion qualitatively and quantitatively similar to that evoked by an increase in glucose concentration from 2.75 to 10 mM.     

Cutaneous blood flow during exercise is higher in endurance-trained humans.

This study determined whether cutaneous blood flow during exercise is different in endurance-trained (Tr) compared with untrained (Untr) subjects. Ten Tr and ten Untr men (62.4 +/- 1.7 and 44.2 +/- 1.8 ml. kg(-1). min(-1), respectively; P < 0.05) underwent three 20-min cycling-exercise bouts at 50, 70, and 90% peak oxygen uptake in this order, with 30 min rest in between. The environmental conditions were neutral ( approximately 23-24 degrees C, 50% relative humidity, front and back fans at 2.5 m/s). Because of technical difficulties, only seven Tr and seven Untr subjects completed all forearm blood flow and laser-Doppler cutaneous blood flow (CBF) measurements. Albeit similar at rest, at the end of all three exercise bouts, forearm blood flow was approximately 40% higher in Tr compared with Untr subjects (50%: 4.64 +/- 0.50 vs. 3. 17 +/- 0.20, 70%: 6.17 +/- 0.61 vs. 4.41 +/- 0.37, 90%: 6.77 +/- 0. 62 vs. 5.01 +/- 0.37 ml. 100 ml(-1). min(-1), respectively; n = 7; all P < 0.05). CBF was also higher in Tr compared with Untr subjects at all relative intensities (n = 7; all P < 0.05). However, esophageal temperature was not different in Tr compared with Untr subjects at the end of any of the aforementioned exercise bouts (50%: 37.8 +/- 0.1 vs. 37.9 +/- 0.1 degrees C, 70%: 38.1 +/- 0.1 vs. 38.1 +/- 0.1 degrees C, and 90%: 38.8 +/- 0.1 vs. 38.6 +/- 0.1 degrees C, respectively). We conclude that a higher CBF may allow Tr subjects to achieve an esophageal temperature similar to that of Untr, despite their higher metabolic rates and thus higher heat production rates, during exercise at 50-90% peak oxygen uptake.     

Sympathetic neural regulation in endurance-trained humans: fitness vs. fatness.

We tested the hypothesis that muscle sympathetic nerve activity (MSNA) would be higher in endurance-trained (ET) compared with sedentary (Sed) men with similar levels of total body and abdominal adiposity. We further hypothesized that sympathetic baroreflex gain would be augmented in ET compared with Sed men independent of the level of adiposity. To address this, we measured MSNA (via microneurography), sympathetic and vagal baroreflex responses (the modified Oxford technique), body composition (dual-energy X-ray absorptiometry), and waist circumference (Gulick tape) in Sed (n = 22) and ET men (n = 8). The ET men were also compared with a subgroup of Sed men (n = 6) with similar levels of total body and abdominal adiposity. Basal MSNA was greater in the ET compared with Sed men with similar levels of total body and abdominal adiposity (28 +/- 2.0 vs. 21 +/- 2.0 bursts/min; P < 0.05) but similar to the larger group of Sed men (n = 22) with higher total body and abdominal adiposity (vs. 26 +/- 3 bursts/min; P > 0.05). In contrast to our hypothesis, sympathetic baroreflex gain was lower in the ET compared with Sed men (-6.4 +/- 0.8 vs. -8.4 +/- 0.4 arbitrary integrative units x beat(-1) x mmHg(-1); P < 0.05) regardless of the level of adiposity. Taken together, the results of the present study suggest that MSNA is higher in ET compared with Sed men with similar levels of total body and abdominal adiposity. In addition, sympathetic baroreflex gain is lower in ET compared with Sed men. That sympathetic baroreflex gain was lower in ET compared with Sed men regardless of the level of adiposity suggests an influence of the ET state per se.     

Insulin secretion and sensitivity in hyperthyroidism

To examine the effect of hyperthyroidism on carbohydrate metabolism, we studied glucose-stimulated insulin secretion and glucose utilization in 8 subjects with Graves' disease before and after treatment for hyperthyroidism and 8 age-, sex- and weight-matched normal subjects. Subjects with Graves' disease had significant elevated serum levels of thyroxine (24.81 +/- 2.44 micrograms/dl, mean +/- SEM) and triiodothyronine (459 +/- 5.5 ng/dl, mean +/- SEM). Simultaneous measurement of plasma glucose, serum insulin and C-peptide levels during fasting and every 30 minutes up to 180 minutes after 75 g oral glucose loading was determined. In addition, plasma glucose, serum insulin and serum C-peptide were measured during euglycemic glucose clamp with insulin infusion of 40 mU/m2 min-1. Mean fasting plasma glucose (P less than 0.05, serum insulin (P less than 0.005) and serum C-peptide (P less than 0.005) levels were significantly higher in the hyperthyroid patients. After glucose loading, the plasma glucose (P less than 0.05), serum insulin (P less than 0.05) and C-peptide (P less than 0.05) responses were significantly higher in hyperthyroid patients at all times up to 180 minutes. During euglycemic clamp studies, the steady-state serum insulin levels were identical in the two groups. The glucose disposal rate was lower in hyperthyroid patients before treatment (P less than 0.01) than in normal subjects. After thyroid function had been normalized for 2 to 4 weeks, the glucose disposal rate increased significantly (P less than 0.05), but was still significantly lower than those of normal subjects (P less than 0.05). Our data show that patients with Graves' hyperthyroidism manifest glucose intolerance, hyperinsulinemia and insulin resistance.     

Insulin secretion and sensitivity in acromegaly

To examine the effect of excess growth hormones on carbohydrate metabolism, we studied glucose-stimulated insulin secretion and glucose utilization in 6 patients with acromegaly and 6 age-, sex- and weight-matched normal subjects. The levels of plasma glucose and serum insulin were determined during fasting and every 30 min up to 180 min after 75 g of oral glucose loading. In addition, plasma glucose, serum insulin and serum C-peptide were measured during euglycemic glucose clamp with insulin infusion of 40 mU/m2,min-1. The acromegalic patients had significantly higher mean levels of fasting plasma glucose (p less than 0.05) and insulin (p less than 0.01). After glucose loading for 3 h, the acromegalic patients also had a higher incremental area under the curve of plasma glucose (p less than 0.05) and serum insulin (p less than 0.05). However, no significant difference in the fasting molar ratio of C-peptide/IRI was noted between these two groups. During euglycemic clamp studies, the steady-state serum insulin levels were identical between the two groups. The glucose disposal rate was lower in acromegalics than in normal subjects (p less than 0.01). The results demonstrated that glucose intolerance, hyperinsulinemia and insulin resistance are present in acromegalic patients.