Combined low-carbohydrate diet and long-term exercise in hypoxia in type 2 diabetes: A randomized controlled trial protocol to assess glycemic control, cardiovascular risk factors and body composition.

Background: Cardiovascular disease is the leading cause of mortality associated with diabetes, which is characterized by chronic hyperglycemia. Low-carbohydrate diet has gained popularity as an intervention in patients with type 2 diabetes mellitus, acting to improve glycemic profile and serum lipids. In its turn, exercise in hypoxia induces specific adaptations, mostly modulated via hypoxia-induced transcription factor signaling cascade, which increases with exposure to altitude, and promotes angiogenesis, glycogen supply, glucose tolerance, and raises GLUT-4 expression. Aim: Given that hyperglycemia decreases HIF-1α and it is better controlled when following a low-carbohydrate diet, this study aims to examine the hypothesis that a combination of both low-carbohydrate diet and chronic exercise in hypoxia in type 2 diabetes mellitus is associated with improved glycemic control and cardiovascular parameters, whose protocol is described. Methods: Patients with type 2 diabetes mellitus (n = 48) will be recruited and randomized into one of the three groups: (a) Control group: Control diet (low-fat and moderate-carbohydrate diet) + exercise in normoxia; (2) exercise in hypoxia group: Control diet + exercise in hypoxia; (3) intervention group: Low-carbohydrate diet (low-carbohydrate and high-fat diet) + exercise in hypoxia. Before and after 8 weeks of interventions, cardiopulmonary tests (Bruce protocol), body composition and blood pressure will be evaluated. Blood samples will be collected to measure hypoxia-induced transcription factor, C-reactive protein, glycemic and lipid profiles. Summary: This will be the first trial to examine the isolated and combined effect of chronic exercise in hypoxia and low-carbohydrate diet in type 2 diabetes mellitus. This trial will help to fill a significant research gap, guide future research and contribute to the combined nutrition and exercise approach to type 2 diabetes mellitus.

Effects of Normobaric Hypoxia on Matched-severe Exercise and Power-duration Relationship.

We investigated the effects of hypoxia on matched-severe intensity exercise and on the parameters of the power-duration relationship. Fifteen trained subjects performed in both normoxia and normobaric hypoxia (FiO2=0.13, ~3000 m) a maximal incremental test, a 3 min all-out test (3AOT) and a transition from rest to an exercise performed to exhaustion (Tlim) at the same relative intensity (80%∆). Respiratory and pulmonary gas-exchange variables were continuously measured (K5, Cosmed, Italy). Tlim test's V̇O2 kinetics was calculated using a two-component exponential model. V̇O2max (44.1±5.1 vs. 58.7±6.4 ml.kg-1.min-1, p<0.001) was decreased in hypoxia. In Tlim, time-to-exhaustion sustained was similar (454±130 vs. 484±169 s) despite that V̇O2 kinetics was slower (τ1: 31.1±5.8 vs. 21.6±4.7 s, p<0.001) and the amplitude of the V̇O2 slow component lower (12.4±5.4 vs. 20.2±5.7 ml.kg-1.min-1, p<0.05) in hypoxia. CP was reduced (225±35 vs. 270±49 W, p<0.001) but W' was unchanged (11.3±2.9 vs. 11.4±2.7 kJ) in hypoxia. The changes in CP/V̇O2max were positively correlated with changes in W' (r = 0.58, p<0.05). The lower oxygen availability had an impact on aerobic related physiological parameters, but exercise tolerance is similar between hypoxia and normoxia when the relative intensity is matched despite a slower V̇O2 kinetics in hypoxia.

Cortisol and insulin behaviors during an ultramarathon event: are they real markers of extreme exertion?

BACKGROUND: The current work aimed to describe and compare the cortisol and insulin concentrations behavior and rate of perceived exertion (RPE) during a 115 km ultramarathon race. METHODS: Nine ultrarunners (eight males) were evaluated six times (0, 37, 60, 76, 89 and 115 km). At each moment, saliva samples (for cortisol and insulin assessment) and RPE (CR10 scale) were collected. Statistical analysis included correlation, one-way repeated measure ANOVA, and Statistical Parametric Mapping to define discrete and continues changes and compare cortisol, insulin and RPE profiles. RESULTS: Our main findings revealed an early peak in cortisol and RPE, accompanied by a decline in insulin responses (402±49 min of the race, P<0.05). Cortisol and insulin only showed magnitude differences with inverse behaviors until ~6% (7 km) of the ultramarathon duration. Cortisol and RPE presented similar behaviors, rising from the beginning of the race and remaining elevated throughout the race (η2=0.91 and η2=1.0, P<0.001). Insulin levels decreased when the race started, remaining below 60% of baseline values from the midpoint to the end of the race (P=0.04). CONCLUSIONS: The study showed an imbalance in the catabolic/anabolic hormone profile during an ultramarathon race, with a prominence in catabolic state. It should be considered in the ultramarathon races preparation and participation due to its possible detrimental effect on the athlete's health.

Correction: Kindlovits et al. Eight Weeks of Intermittent Exercise in Hypoxia, with or without a Low-Carbohydrate Diet, Improves Bone Mass and Functional and Physiological Capacity in Older Adults with Type 2 Diabetes. Nutrients 2024, 16, 1624.

In the original publication [...].

Eight Weeks of Intermittent Exercise in Hypoxia, with or without a Low-Carbohydrate Diet, Improves Bone Mass and Functional and Physiological Capacity in Older Adults with Type 2 Diabetes.

In an increasingly aging and overweight population, osteoporosis and type 2 diabetes (T2DM) are major public health concerns. T2DM patients experience prejudicial effects on their bone health, affecting their physical capacity. Exercise in hypoxia (EH) and a low-carbohydrate diet (LCD) have been suggested for therapeutic benefits in T2DM, improving bone mineral content (BMC) and glycemic control. This study investigated the effects of EH combined with an LCD on body composition and functional and physiologic capacity in T2DM patients. Older T2DM patients (n = 42) were randomly assigned to the following groups: (1) control group: control diet + exercise in normoxia; (2) EH group: control diet + EH; (3) intervention group: LCD + EH. Cardiopulmonary tests (BRUCE protocol), body composition (DEXA), and functional capacity (6MWT, handgrip strength) were evaluated. Body mass index (kg/m2) and body fat (%) decreased in all groups (p < 0.001). BMC (kg) increased in all groups (p < 0.001) and was significantly higher in the EH and EH + LCD groups (p < 0.001). VO2peak improved in all groups (p < 0.001), but more so in the hypoxia groups (p = 0.019). Functional capacity was increased in all groups (p < 0.001), but more so in the EH group in 6MWT (p = 0.030). EH with and without an LCD is a therapeutic strategy for improving bone mass in T2DM, which is associated with cardiorespiratory and functional improvements.

Dietary Nitrate Supplementation Is Not Helpful for Endurance Performance at Simulated Altitude Even When Combined With Intermittent Normobaric Hypoxic Training.

Introduction: Training intensity and nutrition may influence adaptations to training performed in hypoxia and consequently performance outcomes at altitude. This study investigates if performance at simulated altitude is improved to a larger extent when high-intensity interval training is performed in normobaric hypoxia and if this is potentiated when combined with chronic dietary nitrate (NO3 -) supplementation. Methods: Thirty endurance-trained male participants were allocated to one of three groups: hypoxia (13% FiO2) + NO3 -; hypoxia + placebo; and normoxia (20.9% FiO2) + placebo. All performed 12 cycling sessions (eight sessions of 2*6 × 1 min at severe intensity with 1 min recovery and four sessions of 4*6*10 s all-out with 20 s recovery) during a 4-week period (three sessions/week) with supplementation administered 3-2.5 h before each session. An incremental exhaustion test, a severe intensity exercise bout to exhaustion (T lim) and a 3 min all-out test (3AOT) in hypoxia (FiO2 = 13%) with pulmonary oxygen uptake ( V ˙ O2), V ˙ O2 kinetics, and changes in vastus lateralis local O2 saturation (SmO2) measured were completed by each participant before and after training. Results: In all tests, performance improved to the same extent in hypoxia and normoxia, except for SmO2 after T lim (p = 0.04, d = 0.82) and 3AOT (p = 0.03, d = 1.43) which were lower in the two hypoxic groups compared with the normoxic one. Dietary NO3 - supplementation did not bring any additional benefits. Conclusion: Performance at simulated altitude was not improved to a larger extent when high-intensity interval training was undertaken in normobaric hypoxic conditions, when compared with normoxic training. Additionally, dietary NO3 - supplementation was ineffective in further enhancing endurance performance at simulated altitude.