RESUMO
PURPOSE: The primary purpose was to test the effect of heat suit training on hemoglobin mass (Hbmass ) in elite cross-country (XC) skiers. METHODS: Twenty-five male XC-skiers were divided into a group that added 5 × 50 min weekly heat suit training sessions to their regular training (HEAT; n = 13, 23 ± 5 years, 73.9 ± 5.2 kg, 180 ± 6 cm, 76.8 ± 4.6 ml·min-1 ·kg-1 ) or to a control group matched for training volume and intensity distribution (CON; n = 12, 23 ± 4 years, 78.4 ± 5.8 kg, 184 ± 4 cm, 75.2 ± 3.4 ml·min-1 ·kg-1 ) during the five-week intervention period. Hbmass , endurance performance and factors determining endurance performance were assessed before and after the intervention. RESULTS: HEAT led to 30 g greater Hbmass (95% CI: [8.5, 51.7], p = 0.009) and 157 ml greater red blood cell volume ([29, 285], p = 0.018) post-intervention, compared to CON when adjusted for baseline values. In contrast, no group differences were observed for changes in work economy, running velocity, and fractional utilization of maximal oxygen uptake (VÌO2max ) at 4 mmol·L-1 blood lactate, VÌO2max or 15-min running distance performance trial during the intervention. CONCLUSION: HEAT induced a larger increase in Hbmass and red blood cell volume after five weeks with five weekly heat suit training sessions than CON, but with no detectable group differences on physiological determinants of endurance performance or actual endurance performance in elite CX skiers.
Assuntos
Consumo de Oxigênio , Corrida , Volume de Eritrócitos , Hemoglobinas/análise , Temperatura Alta , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Resistência Física/fisiologiaRESUMO
The purpose of this study was to compare the effects of 3 weeks with three weekly sessions (ie, nine sessions in total) of short intervals (SI; n = 9; 3 series with 13 × 30-second work intervals interspersed with 15-second recovery and 3-minutes recovery between series) against effort-matched (rate of perceived effort based) long intervals (LI; n = 9; 4 series of 5-minute work intervals with 2.5-minutes recovery between series) on performance parameters in elite cyclists ( V Ë O 2max 73 ± 4 mL min-1 kg-1 ). There were no differences between groups in total volume and intensity distribution of training during the intervention period. SI achieved a larger (P < .05) relative improvement in peak aerobic power output than LI (3.7 ± 4.3% vs -0.3 ± 2.8%, respectively), fractional utilization of V Ë O 2max at 4 mmol L-1 [La- ] (3.0 ± 5.8 percent points vs -3.5 ± 2.7 percent points, respectively), and larger relative increase in power output at 4 mmol L-1 [La- ] (2.0 ± 6.7% vs -2.8 ± 3.4, respectively), while there was no group difference in change of V Ë O 2max . Improvements in performance measured as mean power output during 20-minute cycling test were greater (P < .01) in SI compared with LI (4.7 ± 4.4% vs -1.4 ± 2.2%, respectively). Mean effect size of the improvement in the above variables revealed a small to large effect of SI training vs LI training. The data thus demonstrate that the present SI protocol induces superior training adaptations compared with the present LI protocol in elite cyclists.
Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Treino Aeróbico/métodos , Treinamento Intervalado de Alta Intensidade/métodos , Consumo de Oxigênio , Adolescente , Adulto , Humanos , Masculino , Fatores de Tempo , Adulto JovemRESUMO
The purpose of this study was to compare the acute effects of time- and effort-matched high-intensity intervals on physiological, endocrine, and skeletal muscle molecular variables in elite cyclists. Eight elite cyclists performed short intervals (SI: 30-seconds) and long intervals (LI: 5-minutes) with work:recovery ratio 2:1, using a randomized crossover design. SI was associated with 14% ± 3% higher mean power output (SI; 421 ± 27 vs LI; 371 ± 22 W), and longer working time above 90% of maximal oxygen uptake (VO2max , 54% ± 76%) and 90% peak heart rate (HRpeak , 153% ± 148%) than LI (all P < .05), despite similar degrees of perceived exertion, blood lactate levels and muscle activation measured using EMG root mean square (EMG rms). In blood, SI was associated with more pronounced increases in testosterone and testosterone-to-sex hormone-binding globulin (SHBG) ratios, as well as prolonged cortisol responses (P < .05). In skeletal muscle (m. Vastus lateralis), SI and LI led to similar changes in mRNA abundance for a range of transcripts, with the exception of NHE1 mRNA, which decreased after SI (P < .05). Overall, SI was associated with more pronounced physiological and endocrine responses than LI in elite cyclists, suggesting that such training might lead to superior adaptations in elite cyclists.
Assuntos
Ciclismo/fisiologia , Biomarcadores/sangue , Treinamento Intervalado de Alta Intensidade/métodos , Resistência Física , Músculo Quadríceps/fisiologia , Adaptação Fisiológica , Adulto , Atletas , Estudos Cross-Over , Expressão Gênica , Humanos , Masculino , Adulto JovemRESUMO
PURPOSE: Systemic inflammation is involved in the development of several diseases, including cardiovascular disease and type 2 diabetes. It is known that vigorous exercise affects systemic inflammation, but less is known about exercise at lower intensities. Hyperglycemia can also entail pro-inflammatory responses; however, postprandial hyperglycemia is blunted if the meal is followed by exercise. Hypotheses were: (1) moderate physical exercise acutely affects levels of C-reactive protein (CRP) and serum soluble vascular cell adhesion molecule 1 (sVCAM-1) in hyperglycemic individuals and (2) the effect depends on whether the activity is performed in a post-absorptive or postprandial state. METHODS: Twelve participants diagnosed with hyperglycemia, but not using anti-diabetic medication, underwent three test days in a randomized cross-over study; 1 control day without exercise, 1 day with 60 min of treadmill walking ending 30 min before breakfast, and 1 day with an identical bout of activity 30 min after the start of breakfast. Food intake was strictly standardized and venous blood for CRP, and sVCAM-1 analysis was sampled at standardized timepoints during the first 3.5 h after breakfast and once 24 h later. RESULTS: Merged data from the two exercise days showed that sVCAM-1 increased from baseline (4 ± 16 ng/mL) compared to the control condition (-28 ± 47 ng/mL, ES = 0.7, p = 0.024). There was no statistically significant difference in changes in sVCAM-1 levels between the two exercise test days. Exercise did not affect CRP values. CONCLUSION: Moderate exercise increases sVCAM-1 in hyperglycemic individuals, whereas it does not affect CRP.
Assuntos
Proteína C-Reativa/metabolismo , Terapia por Exercício , Exercício Físico , Hiperglicemia/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Idoso , Feminino , Humanos , Hiperglicemia/terapia , Masculino , Pessoa de Meia-Idade , Período Pós-PrandialRESUMO
Elite cyclists have often a limited period of time available during their short preparation phase to focus on development of maximal strength; therefore, the purpose of the present study was to investigate the effect of 10-week heavy strength training on lean lower-body mass, leg strength, determinants of cycling performance and cycling performance in elite cyclists. Twelve cyclists performed heavy strength training and normal endurance training (E&S) while 8 other cyclists performed normal endurance training only (E). Following the intervention period E&S had a larger increase in maximal isometric half squat, mean power output during a 30-s Wingate sprint (P < 0.05) and a tendency towards larger improvement in power output at 4 mmol â L-1 [la-] than E (P = 0.068). There were no significant difference between E&S and E in changes in 40-min all-out trial (4 ± 6% vs. -1 ± 6%, respectively, P = 0.13). These beneficial effects may encourage elite cyclists to perform heavy strength training and the short period of only 10 weeks should make it executable even in the compressed training and competition schedule of elite cyclists.
Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Treinamento Resistido/métodos , Índice de Massa Corporal , Dieta , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Ácido Láctico/sangue , Perna (Membro)/fisiologia , Masculino , Força Muscular/fisiologia , Consumo de Oxigênio/fisiologia , Resistência Física/fisiologia , Adulto JovemRESUMO
The purpose of the present study was to test if one bout of moderate exercise performed in either the fasted or the postprandial state affects glucose values measured over 22 hours. Twelve participants diagnosed with hyperglycemia not using antidiabetic medications underwent 3 test days in a randomized cross-over design encompassing one test day without exercise, one test day with 60 min of treadmill walking prior to breakfast, and one test day with an identical bout of exercise 30 min after the start of breakfast. Continuous glucose monitoring was performed until the next morning (>22 hours). There was no significant effect of type of test day on the area under the glucose curve for the entire 22 hours period (p = 0.111). None of the exercise interventions had a significant effect on the area under the glucose curve after breakfast, lunch or dinner. However, the postprandial exercise bout tended to decrease the area under the glucose curve after the evening meal compared to the fasted exercise bout (24.2 ± 6.2 vs. 27.6 ± 6.0 mmol·hour·L-1, p = 0.031). Furthermore, the postprandial exercise decreased the mean of the 10 highest glucose values measured in each individual (8.6 ± 1.9 mmol·L-1) over 22 hours compared to both the control day (9.3 ± 2.1 mmol.L-1) and the day with fasted exercise (9.6 ± 1.7 mmol·L-1, p = 0.012 and 0.009 respectively). Postprandial exercise also decreased the glycemic variability compared to the control day (1.22 ± 0.49 vs. 1.58 ± 0.52 mmol·L-1, p = 0.015). We conclude that performing moderate exercise in the postprandial state after breakfast, but not in the fasted state, decreases glucose excursions during the subsequent 22 hours period in hyperglycemic individuals not using antidiabetic medications.
RESUMO
Limited data exist on the efficacy of low-load blood flow-restricted strength training (BFR), as compared directly to heavy-load strength training (HST). Here, we show that 12 wk of twice-a-week unilateral BFR [30% of one repetition maximum (1RM) to exhaustion] and HST (6-10RM) of knee extensors provide similar increases in 1RM knee extension and cross-sectional area of distal parts of musculus quadriceps femoris in nine untrained women (age 22 ± 1 yr). The two protocols resulted in similar acute increases in serum levels of human growth hormone. On the cellular level, 12 wk of BFR and HST resulted in similar shifts in muscle fiber composition in musculus vastus lateralis, evident as increased MyHC2A proportions and decreased MyHC2X proportions. They also resulted in similar changes of the expression of 29 genes involved in skeletal muscle function, measured both in a rested state following 12 wk of training and subsequent to singular training sessions. Training had no effect on myonuclei proportions. Of particular interest, 1) gross adaptations to BFR and HST were greater in individuals with higher proportions of type 2 fibers, 2) both BFR and HST resulted in approximately four-fold increases in the expression of the novel exercise-responsive gene Syndecan-4, and 3) BFR provided lesser hypertrophy than HST in the proximal half of musculus quadriceps femoris and also in CSApeak, potentially being a consequence of pressure from the tourniquet utilized to achieve blood flow restriction. In conclusion, BFR and HST of knee extensors resulted in similar adaptations in functional, physiological, and cell biological parameters in untrained women.
Assuntos
Força Muscular/genética , Força Muscular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Treinamento Resistido/métodos , Anatomia Transversal , Biópsia , Contagem de Células , Feminino , Expressão Gênica , Hormônios/sangue , Humanos , Imuno-Histoquímica , Perna (Membro)/fisiologia , Imageamento por Ressonância Magnética , Fibras Musculares Esqueléticas/fisiologia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/citologia , Músculo Esquelético/fisiologia , RNA Mensageiro/análise , RNA Mensageiro/biossíntese , Torniquetes , Adulto JovemRESUMO
PURPOSE AND METHODS: To test whether heat training performed as 5 × 50-min sessions per week for 5 wk in a heat chamber (CHAMBER) or while wearing a heat suit (SUIT), in temperate conditions, increases hemoglobin mass (Hb mass ) and endurance performance in elite cyclists, compared with a control group (CON-1). Furthermore, after the 5-wk intervention, we tested whether three sessions per week for 3 wk with heat suit (SUIT main ) would maintain Hb mass elevated compared with athletes who returned to normal training (HEAT stop ) or who continued to be the control group (CON-2). RESULTS: During the initial 5 wk, SUIT and CHAMBER increased Hb mass (2.6% and 2.4%) to a greater extent than CON-1 (-0.7%; both P < 0.01). The power output at 4 mmol·L -1 blood lactate and 1-min power output ( Wmax ) improved more in SUIT (3.6% and 7.3%, respectively) than CON-1 (-0.6%, P < 0.05; 0.2%, P < 0.01), whereas this was not the case for CHAMBER (1.4%, P = 0.24; 3.4%, P = 0.29). However, when SUIT and CHAMBER were pooled this revealed a greater improvement in a performance index (composed of power output at 4 mmol·L -1 blood lactate, Wmax , and 15-min power output) than CON-1 (4.9% ± 3.2% vs 1.7% ± 1.1%, respectively; P < 0.05). During the 3-wk maintenance period, SUIT main induced a larger increase in Hb mass than HEAT stop (3.3% vs 0.8%; P < 0.05), which was not different from the control (CON-2; 1.6%; P = 0.19), with no differences between HEAT stop and CON-2 ( P = 0.52). CONCLUSIONS: Both SUIT and CHAMBER can increase Hb mass , and pooling SUIT and CHAMBER demonstrates that heat training can increase performance. Furthermore, compared with cessation of heat training, a sustained increase in Hb mass was observed during a subsequent 3-wk maintenance period, although the number of weekly heat training sessions was reduced to 3.
Assuntos
Desempenho Atlético , Ciclismo , Hemoglobinas , Temperatura Alta , Humanos , Lactatos , Consumo de Oxigênio , Resistência FísicaRESUMO
The purpose of this study was to determine the influence of transiently elevated endogenous hormone concentrations during exercise on strength training adaptations. Nine subjects performed four unilateral strength training session per week on the elbow flexors for 11 weeks. During two of the weekly sessions, leg exercises were performed to acutely increase the systemic anabolic hormone concentration immediately before the exercises for one of the elbow flexors (L + A). On the two other weekly training sessions, the contralateral elbow flexors were trained without prior leg exercises (A). By randomizing one arm of the subjects to serve as a control and the other as experimental, both conditions have the same nutritional and genetic environment. Serum testosterone and growth hormone was significantly increased during the L - A training session, while no hormonal changes occurred in the A session. Both A and L + A increased 1RM in biceps curl, peak power in elbow flexors at 30 and 60% of 1RM, and muscle volume of the elbow flexors (p < 0.05). However, only L + A achieved increase in CSA at the part of the arm flexors with largest cross sectional area (p < 0.001), while no changes occurred in A. L + A had superior relative improvement in 1RM biceps curl and favorable muscle adaptations in elbow flexors compared to A (p < 0.05). In conclusion, performing leg exercises prior to arm exercises, and thereby increasing the levels of serum testosterone and growth hormone, induced superior strength training adaptations compared to arm training without acute elevation of hormones.
Assuntos
Adaptação Fisiológica/fisiologia , Hormônios/sangue , Força Muscular/fisiologia , Treinamento Resistido , Adulto , Braço/fisiologia , Cotovelo/fisiologia , Exercício Físico/fisiologia , Hormônios/metabolismo , Hormônios/fisiologia , Hormônio do Crescimento Humano/sangue , Hormônio do Crescimento Humano/metabolismo , Humanos , Masculino , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Educação Física e Treinamento/métodos , Treinamento Resistido/métodos , Regulação para Cima/fisiologia , Levantamento de Peso/fisiologia , Adulto JovemRESUMO
BACKGROUND: Lifestyle therapy with resistance training is a potent measure to counteract age-related loss in muscle strength and mass. Unfortunately, many individuals fail to respond in the expected manner. This phenomenon is particularly common among older adults and those with chronic diseases (e.g. chronic obstructive pulmonary disease, COPD) and may involve endocrine variables such as vitamin D. At present, the effects of vitamin D supplementation on responses to resistance training remain largely unexplored. METHODS: Ninety-five male and female participants (healthy, n = 71; COPD, n = 24; age 68 ± 5 years) were randomly assigned to receive either vitamin D3 or placebo supplementation for 28 weeks in a double-blinded manner (latitude 61°N, September-May). Seventy-eight participants completed the RCT, which was initiated by 12 weeks of supplementation-only (two weeks with 10 000 IU/day, followed by 2000 IU/day), followed by 13 weeks of combined supplementation (2000 IU/day) and supervised whole-body resistance training (twice weekly), interspersed with testing and measurements. Outcome measures included multiple assessments of muscle strength (nvariables = 7), endurance performance (n = 6), and muscle mass (n = 3, legs, primary), as well as muscle quality (legs), muscle biology (m. vastus lateralis; muscle fibre characteristics, transcriptome), and health-related variables (e.g. visceral fat mass and blood lipid profile). For main outcome domains such as muscle strength and muscle mass, weighted combined factors were calculated from the range of singular assessments. RESULTS: Overall, 13 weeks of resistance training increased muscle strength (13% ± 8%), muscle mass (9% ± 8%), and endurance performance (one-legged, 23% ± 15%; whole-body, 8% ± 7%), assessed as weighted combined factors, and were associated with changes in health variables (e.g. visceral fat, -6% ± 21%; [LDL]serum , -4% ± 14%) and muscle tissue characteristics such as fibre type proportions (e.g. IIX, -3% points), myonuclei per fibre (30% ± 65%), total RNA/rRNA abundances (15%/6-19%), and transcriptome profiles (e.g. 312 differentially expressed genes). Vitamin D3 supplementation did not affect training-associated changes for any of the main outcome domains, despite robust increases in [25(OH)D]serum (∆49% vs. placebo). No conditional effects were observed for COPD vs. healthy or pre-RCT [25(OH)D]serum . In secondary analyses, vitamin D3 affected expression of gene sets involved in vascular functions in muscle tissue and strength gains in participants with high fat mass, which advocates further study. CONCLUSIONS: Vitamin D3 supplementation did not affect muscular responses to resistance training in older adults with or without COPD.
Assuntos
Colecalciferol , Treinamento Resistido , Idoso , Colecalciferol/uso terapêutico , Suplementos Nutricionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vitamina D , VitaminasRESUMO
PURPOSE: The purpose of the present study was to test if caffeine ingestion affects rifle shooting accuracy in trained shooters. METHODS: Twenty trained shooters performed 4 shooting tests in a randomized, double-blinded, placebo controlled crossover design; 2 identical tests after placebo ingestion and 2 after ingestion of 300 mg caffeine. The tests consisted of 30 shots in prone position and 30 in standing position on a 10 ring electronic target, on a distance of 50 metres, without any time limit, at rest. RESULTS: Caffeine supplementation entailed a mean decrease in shooting performance by 11.8 points (95% CI: 6.7 to 17.0, effect size: 0.9). This was primarily a result of an 11.3 (95% CI: 7.2 to 15.4, effect size: 0.9) point decrease during shooting in standing position and not in prone position (0.6 point decrease, 95% CI: -2.1 to 3.2, effect size: 0.1). CONCLUSIONS: We conclude that prior ingestion of 300 mg caffeine impairs rifle shooting accuracy in trained shooters when performed in standing but not in prone position.
Assuntos
Cafeína/farmacologia , Desempenho Psicomotor/efeitos dos fármacos , Atletas , Cafeína/metabolismo , Método Duplo-Cego , Feminino , Armas de Fogo , Humanos , Masculino , Noruega , Distribuição Aleatória , Adulto JovemRESUMO
Previous studies have shown that a bout of moderate or light postprandial physical activity effectively blunts the postprandial increase in blood glucose. The objective of this study was to test whether regular light postprandial physical activity can improve glycemia in persons with hyperglycemia or with a high risk of hyperglycemia. We randomized 56 participants to an intervention or a control group. They were diagnosed as hyperglycemic, not using antidiabetics, or were categorized as high-risk individuals for type 2 diabetes. The intervention group was instructed to undertake a minimum 30 min of daily light physical activity, starting a maximum of 30 min after a meal in addition to their usual physical activity for 12 weeks. The control group maintained their usual lifestyle. Blood samples were taken pre- and post-test. Forty participants completed the study and are included in the results. The self-reported increase in daily physical activity from before to within the study period was higher in the intervention group compared with control (41 ± 25 vs. 2 ± 16 min, p < 0.001). Activity diaries and accelerometer recordings supported this observation. The activity in the intervention group started earlier after the last meal compared with control (30 ± 13 vs. 100 ± 57 min, p = 0.001). There were no within- or between-group differences in any glycemic variable from pre- to post-test. In conclusion, the present study does not seem to support the notion that regular light postprandial physical activity improves blood glucose in the long term in persons with hyperglycemia or with high risk of hyperglycemia.
Assuntos
Atividades Cotidianas , Exercício Físico , Hiperglicemia/terapia , Estado Pré-Diabético/terapia , Actigrafia , Adulto , Ciclismo , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Período Pós-Prandial , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/prevenção & controle , Risco , Autorrelato , CaminhadaRESUMO
PURPOSE: Irisin is a recently identified exercise-induced hormone that increases energy expenditure, at least in rodents. The main purpose of this study was to test the hypothesis that Irisin increases acutely in blood after singular sessions of intense endurance exercise (END) and heavy strength training (STR). Secondary, we wanted to explore the relationship between body composition and exercise-induced effects on irisin, and the effect of END and STR on muscular expression of the irisin gene FNDC5. METHODS: Nine moderately trained healthy subjects performed three test days using a randomized and standardized crossover design: one day with 60 minutes of END, one day with 60 minutes of STR, and one day without exercise (CON). Venous blood was sampled over a period of 24h on the exercise days. RESULTS: Both END and STR led to transient increases in irisin concentrations in blood, peaking immediately after END and one hour after STR, before gradually returning to baseline. Irisin responses to STR, but not END, showed a consistently strong negative correlation with proportions of lean body mass. Neither END nor STR affected expression of FNDC5, measured 4h after training sessions, though both protocols led to pronounced increases in PGC-1α expression, which is involved in transcriptional control of FNDC5. CONCLUSION: The results strongly suggest that single sessions of intense endurance exercise and heavy strength training lead to transient increases in irisin concentrations in blood. This was not accompanied by increased FNDC5 expression, measured 4h post-exercise. The results suggest that irisin responses to resistance exercise are higher in individuals with lower proportions of lean body mass.
Assuntos
Exercício Físico/fisiologia , Fibronectinas/sangue , Resistência Física/fisiologia , Adulto , Feminino , Humanos , Masculino , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo , Fatores de Transcrição/biossínteseRESUMO
Postprandial blood glucose concentration is a risk factor for the development of cardiovascular diseases and diabetes, even at states well below hyperglycemic levels. A previous study has shown that postmeal exercise of moderate intensity blunts the blood glucose increase after carbohydrate intake (Høstmark et al. Prev. Med. 42(5): 369-371). The objective of the present study was to examine whether even postmeal slow walking would have a similar effect. Fourteen healthy women aged >50 years participated in 3 experiments in a random crossover design: after a carbohydrate-rich meal, either they were seated (control experiment) or they performed slow postmeal walking for 15 min (W15) or 40 min (W40). Blood glucose concentration was determined prior to the meal (fasting), and at 11 time points throughout each experiment. The W15 trial lowered the blood glucose values during walking and delayed the peak blood glucose value (p = 0.003). In W40, the postmeal blood glucose increase during walking was blunted, the peak glucose value was delayed (p = 0.001), and the incremental area under the 2-h blood glucose curve (IAUC) was reduced (p = 0.014). There was a negative relationship between IAUC and walking time (p = 0.016). The individual reducing effect of walking on IAUC correlated strongly with IAUC on the control day (p < 0.001). We conclude that even slow postmeal walking can reduce the blood glucose response to a carbohydrate-rich meal. The magnitude of this effect seems to be related to the duration of walking and to the magnitude of the postprandial blood glucose response when resting after a carbohydrate-rich meal.