Skip to main content

Advertisement

SpringerLink
Log in

Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aim

To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol.

Methods

Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring.

Results

Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI − 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from − 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (− 1.56 mmol/L; 95% CI − 2.18, − 0.95, p < 0.001).

Conclusion

Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed.

Trial registration: NCT02834689.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Devlin JT, Hirshman M, Horton ED, Horton ES (1987) Enhanced peripheral and splanchic insulin sensitivity in NIDDM after single bout of exercise. Diabetes 36:434–439

    Article  CAS  PubMed  Google Scholar 

  2. Perseghin G, Price T, Petersen KF et al (1996) Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. New Engl J Med 335:1357–1362

    Article  CAS  PubMed  Google Scholar 

  3. Sigal RJ, Armstrong MJ, Bacon SL et al (2018) Clinical practice guidelines for the prevention and management of diabetes in Canada: physical activity and diabetes. Can J Diabetes 42(2018):S54–S63

    Article  PubMed  Google Scholar 

  4. Colberg SR, Sigal RJ, Yardley JE et al (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39(11):2065–2079

    Article  PubMed  PubMed Central  Google Scholar 

  5. MacLeod SF, Terada T, Chahal BS, Boule NG (2013) Exercise lowers postprandial glucose but not fasting glucose in type 2 diabetes: a meta-analysis of studies using continuous glucose monitoring. Diabetes Metab Res Rev 29(8):593–603

    Article  CAS  PubMed  Google Scholar 

  6. Savikj M, Gabriel B, Alm P et al (2019) Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial. Diabetologia 62(2):223–237

    Article  CAS  Google Scholar 

  7. Sealed Envelope LTD, Create a blocked randomization, (2017) Available from: https://www.sealedenvelope.com/simple-randomiser/v1/lists

  8. Freckmann G, Baumstark A, Jendrike N, et al (2010) System accuracy evaluation of 27 blood glucose monitoring systems according to DIN EN ISO 15197, Diabetes Technol Ther 12(3)

  9. Forbes CC, Plotnikoff RC, Courneya KS, Boule NG (2010) Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences. Diabetes Educ 36(5):801–815

    Article  PubMed  Google Scholar 

  10. Tanaka H, Monahan KD, Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37(1):153–156

    Article  CAS  PubMed  Google Scholar 

  11. Donahoo WT, Levine JA, Melanson EL (2004) Variability in energy expenditure and its components. Curr Opin Clin Nutr Metab Care 7:599–605

    Article  PubMed  Google Scholar 

  12. Dworatzek PD, Arcudi K, Gougeon R et al (2013) Canadian diabetes association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada: nutrition therapy. Can J Diabetes 37(Suppl 1):S45–S55

    Article  PubMed  Google Scholar 

  13. F.J. Service (2013) Glucose variability. Diabetes 62(5):1398–1404

    Article  CAS  Google Scholar 

  14. Manders RJ, Van Dijk JW, van Loon LJ (2010) Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc 42(2):219–225

    Article  CAS  PubMed  Google Scholar 

  15. Terada T, Wilson BJ, Myette-Cote E et al (2016) Targeting specific interstitial glycemic parameters with high-intensity interval exercise and fasted-state exercise in type 2 diabetes. Metab Clin Exp 65(5):599–608

    Article  CAS  PubMed  Google Scholar 

  16. DiPietro L, Bribok A, Stevens MS, Hamm LF, Rumpler W (2013) Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care 36(10):3262–3268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. MacDonald AL, Philp A, Harrison M, Bone AJ, Watt PW (2006) Monitoring exercise-induced changes in glycemic control in type 2 diabetes. Med Sci Sports Exerc 38(2):201–207

    Article  CAS  PubMed  Google Scholar 

  18. Praet SF, Manders RJ, Lieverse AG et al (2006) Influence of acute exercise on hyperglycemia in insulin-treated type 2 diabetes. Med Sci Sports Exerc 38(12):2037–2044

    Article  CAS  PubMed  Google Scholar 

  19. Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36(2):228–236

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bacchi E, Negri C, Trombetta M et al (2012) Differences in the acute effects of aerobic and resistance exercise in subjects with type 2 diabetes: results from the RAED2 randomized trial. PLoS ONE 7(12):e49937

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. van Dijk JW, Manders RJ, Tummers K et al (2012) 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

    Article  CAS  PubMed  Google Scholar 

  22. Van Dijk JW, Manders RJ, Canfora EE et al (2013) Exercise and 24-h glycemic control: equal effects for all type 2 diabetes patients? Med Sci Sports Exerc 45(4):628–635

    Article  CAS  PubMed  Google Scholar 

  23. Oberlin DJ, Mikus CR, Kearney ML et al (2014) One bout of exercise alters free-living postprandial glycemia in type 2 diabetes. Med Sci Sports Exerc 46(2):232–238

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Poirier P, Tremblay A, Catellier C et al (2000) Impact of time interval from last meal on glucose resoponse to exercise in subjects with type 2 diabetes. J Clin Endocrinol Metab 85(8):2860–2864

    CAS  PubMed  Google Scholar 

  25. Gaudet-Savard T, Ferland A, Broderick TL et al (2007) Safety and magnitude of changes in blood glucose levels following exercise performed in the fasted and the postprandial state in men with type 2 diabetes. Eur J Cardiovasc Prev Rehabil 14:831–836

    Article  PubMed  Google Scholar 

  26. Colberg SR, Zarrabi L, Bennington L et al (2009) Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. JAMDA 10(6):394–397

    PubMed  Google Scholar 

  27. Dasgupta K, Joseph L, Pilote L et al (2010) Daily steps are low year-round and dip lower in fall/winter: findings from a longitudinal diabetes cohort. Cardiovasc Diabetol 9:81

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are grateful for the support of Noah Schwabe, Micah Medinski, Jasmine Paquin, Camille Genest, Michele Bisson and Larissa Wilhelm for data collection and analysis.

Funding

The E-PAraDIGM protocol was developed with funding from a Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant (Application #334972). An investigator-initiated grant awarded to JPL and NGB from Medtronic Canada provided continuous glucose monitors and sensors in-kind and partially supported provision of standardized diets. The authors acknowledge Johnson & Johnson for providing glucometers, test strips and lancets at the Sherbrooke site, as well as Solo GI Nutrition for in-kind provision of SoLo GI bars. JPL is supported by a CIHR New Investigator Salary Award (MSH-141980) and a Michael Smith Foundation for Health Research (MSFHR) Scholar Award (16890). CMP is supported by a CIHR New Investigator Salary Award and the Campus Alberta Research Chair Program. The study sponsors were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; or the decision to submit the report for publication.

Author information

Authors and Affiliations

  1. Faculty of Kinesiology, Sport, and Recreation, and Alberta Diabetes Institute, University of Alberta, Edmonton, AB, T6G 2H9, Canada

    Jordan L. Rees, Jane E. Yardley & Normand G. Boulé

  2. School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, V1V 1V7, Canada

    Courtney R. Chang, Monique E. François, Mary Jung & Jonathan P. Little

  3. Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada

    Alexis Marcotte-Chénard, Adeline Fontvieille & Eléonor Riesco

  4. Research Center on Aging, CIUSSSE – CHUS, Sherbrooke, QC, J1H 4C4, Canada

    Alexis Marcotte-Chénard, Adeline Fontvieille & Eléonor Riesco

  5. Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada

    Nika D. Klaprat

  6. Augustana Faculty, University of Alberta, Camrose, AB, T4V 2R3, Canada

    Rebecca A. Dyck, Deanna R. Funk, Gary Snydmiller & Jane E. Yardley

  7. Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Kent Bastell

  8. Department of Kinesiology, McMaster University, Hamilton, ON, L8S 4K1, Canada

    Florence E. Godkin & Martin J. Gibala

  9. DREAM Research Theme, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, R3E 3P4, Canada

    Jon M. McGavock

  10. Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Ronald J. Sigal

  11. Department of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada

    Marie-Christine Dubé & S. John Weisnagel

  12. Department of Agriculture and Food Science, Université Laval, Quebec City, QC, G1V 0A6, Canada

    Marie-Christine Dubé & S. John Weisnagel

  13. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2E1, Canada

    Carla M. Prado

  14. Faculty of Health and Medical Sciences, University of Surrey, Guilford, GU2 7WG, UK

    Ralph Manders

  15. Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada

    Terry Lee & Joel Singer

Authors
  1. Jordan L. Rees
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Courtney R. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monique E. François
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexis Marcotte-Chénard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adeline Fontvieille
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nika D. Klaprat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rebecca A. Dyck
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Deanna R. Funk
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gary Snydmiller
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kent Bastell
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Florence E. Godkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marie-Christine Dubé
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Eléonor Riesco
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jon M. McGavock
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jane E. Yardley
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ronald J. Sigal
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Martin J. Gibala
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. S. John Weisnagel
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Carla M. Prado
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Mary Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Ralph Manders
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Terry Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Joel Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Normand G. Boulé
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Jonathan P. Little
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JLR, CRC, MEF, AMC, AF, NDK, RAD, DRF, GS, KB, FEG and MCD collected the data. JLR, ER, JMM, JEY, RJS, MJG, JSW, CMP, MJ, RM, NGB and JPL provided substantial contributions to the conception or design of the work. JLR, NGB and JPL drafted the article, and all others revised it critically for important intellectual content. TL and JS designed and performed the statistical analyses. All authors provide final approval of the submitted version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Normand G. Boulé or Jonathan P. Little.

Ethics declarations

Conflict of interest

JEY has received in-kind research support from Animas Canada, Dexcom Canada and Abbott Nutrition Canada. JPL is a scientific advisor and shareholder with Metabolic Insights Inc., a start-up company developing a noninvasive metabolic monitoring device. JPL is a volunteer chief scientific officer for the not-for-profit Institute for Personalized Therapeutic Nutrition (www.therapeuticnutrition.org).

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Alberta Health Research Ethics Board: Pro00059779, The University of British Columbia Clinical Research Ethics Board: H1600377, Conjoint Health Research Ethics Board at the University of Calgary: REB16-1049, University of Manitoba Health Research Ethics Board: HS20322, Hamilton Integrated Research Ethics Board: 1695, Comité d’éthique de la recherche du CIUSSS de l’Estrie-CHUS: #MP-31-2017-1601) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. 

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available as participants did not provide consent to this form of data sharing. Aggregated data and additional analyses are available from the corresponding author on reasonable request.

Additional information

Managed by Massimo Porta.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rees, J.L., Chang, C.R., François, M.E. et al. Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol 56, 755–765 (2019). https://doi.org/10.1007/s00592-019-01358-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-019-01358-x

Keywords

Search

Navigation