Issue 95 Item 11 Aerobics are Key to Improving Insulin Sensitivity
23% increase in insulin sensitivity
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The extent to which lifestyle must be altered to improve insulin sensitivity
has not been established. This study compares the effect on insulin sensitivity
of current dietary and exercise recommendations with a more intensive intervention
in normoglycemic insulin-resistant individuals.
Seventy-nine normoglycemic insulin-resistant (determined by the euglycemic
insulin clamp) men and women were randomized to either a control group or one
of two combined dietary and exercise programs. One group (modest level) was
based on current recommendations and the other on a more intensive dietary and
exercise program. Insulin sensitivity was measured using a euglycemic insulin
clamp, body composition was measured using dual-energy X-ray absorptiometry,
and anthropometry and aerobic fitness were assessed before and after a 4-month
intervention period. Four-day dietary intakes were recorded, and fasting glucose,
insulin, and lipids were measured.
Only the intensive group showed a significant improvement in insulin sensitivity
(23% increase, P=0.006 vs. 9% in the modest group, P=0.23). This was associated
with a significant improvement in aerobic fitness (11% increase in the intensive
group, P=0.02 vs. 1% in the modest group, P=0.94) and a greater fiber intake,
but no difference in reported total or saturated dietary fat.
CONCLUSIONS— These data have important public health implications in countries
with high rates of type 2 diabetes, and they have a bearing on intervention
trials involving people with IGT. In those who have already developed IGT and
are prescribed modest exercise as part of their program, it appears that a substantial
number will still go on to develop type 2 diabetes. The greatest benefit of
lifestyle intervention may be seen when instituted in insulin-resistant individuals
who have not yet developed IGT and who have achieved an improved level of aerobic
fitness.
Current clinical dietary and exercise recommendations, even when vigorously
implemented, did not significantly improve insulin sensitivity; however, a more
intensive program did. Improved aerobic fitness appeared to be the major difference
between the two intervention groups, although weight loss and diet composition
may have also played an important role in determining insulin sensitivity.
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