Effects Of Exercise Training On Circulating Branched-chain Amino Acid And Ketone Levels In Diabetics

Abstract

PURPOSE: Elevated levels of circulating branched-chain amino acid (BCAA) and ketone bodies are recognized as biomarkers for cardiovascular disease (CVD) and other pathological conditions in type-2 diabetes mellitus (T2DM). Aerobic exercise interventions have previously shown decreases in levels of these markers, suggesting improved metabolic status and reduced risk of CVD. However, the efficacy of resistance training and concurrent programs in reducing BCAA and ketone body levels has not been well researched. METHODS: The current study was performed as a secondary analysis of the HART-D trial, a 9-month randomized, controlled exercise-training trial of 262 participants with T2DM. Participants were randomized to one of four groups; non-exercise control, aerobic training (AT), resistance training (RT), or a combined aerobic-resistance training (ATRT). The effects of the 9-month intervention on BCAAs (leucine, valine, and isoleucine) and ketone bodies (β-hydroxy-butyrate, BHB; acetoacetate, AcAc; and acetone) were examined across groups using generalized linear models adjusting for age, race, sex, and baseline BMI. We performed per-protocol analyses limited to all control participants (n=33) and only the exercise group participants who met the criteria of at least 70% adherence to their exercise prescription for 6 months (AT, n=62; RT, n=55; ATRR, n=64). RESULTS: AcAc (-17.6 ± 6.4, p=0.006), acetone (-10.6 ± 3.6, p=0.003), and total ketone body (-51.4 ± 20.0, p=0.01) concentrations (shown as mean ± SE in μmol/L) decreased in the RT group compared to the control group. Acetone also decreased in ATRT compared to the control group (-10.2 ± 3.5 μmol/L, p=0.004). CONCLUSIONS: Our results suggest that RT and ATRT programs could improve ketone body metabolism in those with T2DM.