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.

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.

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.