Abstract
Insulin resistance is a key etiological factor in promoting not only type 2 diabetes mellitus but also cardiovascular disease (CVD). Exercise is a first-line therapy for combating chronic disease by improving insulin action through, in part, reducing hepatic glucose production and lipolysis as well as increasing skeletal muscle glucose uptake and vasodilation. Just like a pharmaceutical agent, exercise can be viewed as a “drug” such that identifying an optimal prescription requires a determination of mode, intensity, and timing as well as consideration of how much exercise is done relative to sitting for prolonged periods (e.g., desk job at work). Furthermore, proximal nutrition (nutrient timing, carbohydrate intake, etc.), sleep (or lack thereof), as well as alcohol consumption are likely important considerations for enhancing adaptations to exercise. Thus, identifying the maximal exercise “drug” for reducing insulin resistance will require a multi-health behavior approach to optimize type 2 diabetes and CVD care.
Highlights
Cardiovascular disease (CVD) has remained the leading cause of death above all other major diagnostic groups for the better part of a decade [1]
Insulin resistance is associated with metabolic inflexibility, highlighting that altered mitochondrial function may contribute to reduced insulin sensitivity via reduced oxidative capacity [22]
While high-intensity interval training (HIIT) improves insulin resistance in metabolic syndrome (MetS) patients [52], several studies show that when energy expended is matched between low to high exercise intensity conditions, no additional effects are observed on insulin action or endothelial function [53,54,55,56,57]
Summary
Cardiovascular disease (CVD) has remained the leading cause of death above all other major diagnostic groups for the better part of a decade [1]. A key challenge for many scientists and healthcare providers is determining the optimal “dose” for each component that works in synergy to maximize CVD risk reduction. From this perspective, exercise could be viewed as a “drug” and be considered in a similar manner as traditional pharmaceutical drugs (i.e., exogenous stimuli) intended to prevent and/or treat disease via physiological adaptations of bodily structure and function [10]. Nutrient intake, sleep and/or alcohol consumption surrounding exercise may be critical for optimizing the beneficial health gains through improved insulin sensitivity and reduced CVD risk [11]. We will conclude with clinical perspective on considering such behaviors for maximizing the exercise “drug”
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