Prediabetes is a medical condition characterized by increased levels of glucose in the bloodstream. There are some lifestyle modifications like exercise, dietary patterns and prevention that can reverse prediabetes. Exercise plays an important role in controlling hyperglycemia and insulin sensitivity in prediabetes.

The objective of the study is to develop a consensus driven exercise base manual programme for the prediabetic population using the Delphi Method.

A three-rounded Delphi study was conducted with 40 panelists either as Patient panelists (n = 20) or expert panelists (n=20). Round 1 included initial items selected from a systemic literature review . Initial recommendations were rated by panalists through a 5-point Likert scale. Additional items were also added by suggestion of Panelists in Round 1. Rounds 2 and 3 included all items from Round 1. All selected items were included in the final set of recommendations in Round 3 and rated as "Important" or "Very important" by at least 70% of all respondents. Descriptive data was analyzed by using SPSS version 25.

36 panellists (patients n = 17, professionals n = 19) completed Round 3. After three rounds of the Delphi process, panelists reached a consensus on the final version of the recommendations. Sixty-two items reached consensus in Round 1. In round 2 and 3 a total of sixty-four and sixty-three items were added, respectively. Fifty-seven of these reached consensuses in round 3.

The exercise-based manual programme developed by Modified Delphi study provided disease prevention education, physical activity and dietary recommendations to improve glycemic control in the prediabetic population. The exercise manual programme along with lifestyle modifications contribute to public health by improving prediabetes levels and also addressing the modifiable risk factors. An exercise protocol needs time to mitigate hyperglycemia in prediabetic individuals and to help provide information at community level.

The combination of moderate to vigorous physical activity with muscle-strengthening physical activity is increasingly recognized for its significant impact on cardiovascular health. This narrative review synthesizes current evidence to compare the cardiovascular benefits of combined physical activity versus singular forms, especially in primary prevention. The main focus is on hormonal, nervous, genetic, and molecular adaptations, critical mechanisms underlying the body's response to physical activity. Our findings endorse superior benefits for combined moderate to vigorous and muscle-strengthening physical activity for preventing cardiovascular disease (CVD). This combined approach synergistically enhances cardiovascular function and more effectively reduces risk factors than either activity alone. While more research is needed to distinguish between moderate and vigorous activity levels in combination with muscle-strengthening physical activity, current evidence supports comprehensive physical activity guidelines that maximize cardiovascular health. These findings highlight the importance of integrated physical activity regimens in public health strategies and clinical practice to mitigate the global CVD burden.

This study aims to assess the effects of different exercise types and their specific doses on glycemic control among individuals with prediabetes.

Multiple databases were subjected to a comprehensive search for randomized controlled trials (RCTs) published until 15 July 2024. The study protocol was prospectively registered with PROSPERO (CRD42024573186). The exercise interventions analyzed included aerobic exercise (AE), resistance training (RT), and combined aerobic-resistance training (AE+RT). Outcomes were quantified using standardized mean difference (SMD) with 95% credible intervals (CrIs), employing the confidence in network meta-analysis (CINeMA) framework for network meta-analysis to confirm the outcome reliability.

According to the network meta-analysis, irrespective of dose, AE+RT led to the largest decrease in fasting blood glucose (FBG) (-0.44, [-0.62 to -0.26]). AE alone resulted in the largest reductions in 2-hour post-meal blood glucose (2hPG) (-0.71, [-0.97 to -0.45]) and glycosylated hemoglobin A1c (HbA1c) (-0.30, [-0.37 to -0.22]). Dose-response (DR) analysis identified optimal doses for each exercise type: 880 metabolic equivalent of task minutes per week (METs-min/week) for both AE and RT and 800 METs-min/week for AE+RT to reduce FBG. The optimal dose for 2hPG improvement via AE was 1,100 METs-min/week, and for HbA1c reduction via RT, it was 870 METs-min/week.

Given the variety of impaired glucose regulation (IGR), we recommend that people with prediabetes engage in RT at 1,100 METs-min/week to improve 2hPG and at 870 METs-min/week to reduce HbA1c. For FBG control, a dose of 800 METs-min/week is optimal for all exercise modalities. These evidence-based recommendations provide practical guidance for designing personalized exercise prescriptions to manage prediabetes.

This study aimed to evaluate the effects of Adaptive Postural Balance Cardiac Rehabilitation Exercise (APBCRE) on glycolipid metabolism and exercise endurance in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Specifically, we compared the efficacy of APBCRE with aerobic exercise (AE) alone and irregular exercise (IE).

This randomized controlled trial included 348 patients with CAD, comprising 261 patients with T2DM and 87 non-diabetic CAD patients as a control group. Participants were randomly assigned to one of four groups: the APBCRE group, the AE group, the IE group, or the non-diabetic AE control group. The intervention lasted 8 weeks, including a structured 6-week training phase. Metabolic markers and exercise endurance were assessed at baseline (week 1) and post-intervention (week 8). Cardiopulmonary exercise testing (CPET) was utilized to individualize exercise prescriptions and optimize intervention intensity.

The APBCRE group demonstrated significant improvements in fasting blood glucose (FBG) (-11.34%, from 7.89 to 6.99 mmol/L, p < 0.05), HbA1c (-8.87%, from 7.20% to 6.56%, p < 0.05), and LDL-C levels (-12.21%, from 2.44 to 2.14 mmol/L, p < 0.05) compared to the AE and IE groups. While both APBCRE and AE improved lipid profiles, APBCRE demonstrated superior enhancements in exercise endurance, with ˙VO 2 max increasing by 18.71% (from 14.19 to 16.86 mL/min/kg, p < 0.05) and AT ˙VO 2 increasing by 16.00% (from 11.62 to 13.48 mL/min/kg, p < 0.05).

These findings support the efficacy of APBCRE in improving glycolipid metabolism, exercise endurance, and neuromuscular coordination in patients with CAD and T2DM compared to AE alone.

The health belief model (HBM) questionnaire for dietary patterns and physical activity is important for assessing behavior in prediabetes subjects. Assessing health behavior important to design intervention that can control development of prediabetes. The study aimed to examine the validity and reliability of the HBM questionnaire for dietary patterns and physical activity in prediabetes.

A descriptive method was used comprising validity and reliability tests; specifically, the content validity was assessed by 10 panelists of nutrition in public health and education experts. Meanwhile, face validity and reliability tests were performed by 10 and 30 respondents, respectively. Content validity was conducted quantitatively with the content validity index (CVI), kappa statistics score, along with qualitative assessment. The reliability test was carried out based on Cronbach's alpha.

The results showed that CVI analysis and kappa statistics obtained values between 0.77-1 and -5.24-0.99, respectively. The face validity analysis produced a value >1,5, while the reliability test obtained Cronbach's alpha value of 0,821. The final questionnaire was based on the recommendations of the panelists as well as the results of validity and reliability tests including 47 HBM item statements.

The HBM questionnaire was found to be valid and reliable for assessing behavior about dietary patterns and physical activity in prediabetic. This instrument could be used by healthcare providers in studies and clinical practice to measure behavior dietary patterns and physical activity as well as to develop interventions for prediabetes.

 The substantial rise in various risk factors for noncommunicable diseases in Qatar is well-documented, underscoring their contribution to premature morbidity and mortality. Physical exercise (PE) is pivotal, offering significant benefits for biochemical and anthropometric parameters while serving as a therapeutic and preventive measure. Community-based wellness centers within primary care provide a valuable opportunity to assess the impact of PE on different health aspects, including glycemic indices and anthropometric measurements.

 This retrospective cohort study examines the data of adults who completed a 12-week PE in Primary Health Care Corporation (PHCC) wellness centers from 2021 to 2023. A total of 909 patient data sets were extracted from electronic medical records across the seven wellness centers at PHCC. Participants completed three moderate-intensity PE sessions of 60 minutes weekly over the 12 weeks. Eligible patient data were assessed by the availability of the hemoglobin A1c glycated (HbA1c) in percentage and fasting blood glucose (FBG) levels before and after the program, looking for the mean difference significance in the two parameters. Further analysis was done to correlate the sociodemographic and anthropometrics to the glycemic indices and consider the significance at p < 0.05.

 In an eligible cohort of 739 data sets, the mean age was 48.75 ±12.83 years, and 74.56% were women. The body mass index (BMI) preintervention was 31.15 ± 5.39 kg/m2, and the fat mass (FM) was 33.91 ± 8.42 kg, indicating obese patients. The majority of the data suggested that normoglycemic individuals were at the prediabetes stage (14.34%) and within the uncontrolled diabetes range (4.48%). The mean reduction in FBG post-PE was 0.18 mmol/L (95% CI = 0.016-0.401; p = 0.000; paired t-test). In contrast, the HbA1c% decreased by a mean of 0.050% (95% CI = 0.006-0.135), with a significant association favoring the PE (p = 0.035, paired t-test). Notably, 31.13% of 106 patients with prediabetes normalized their HbA1c% after PE, while 40% of uncontrolled patients with diabetes transitioned to a controlled glycemic state out of 35 cases. All the anthropometrics demonstrated a statistically significant relation in their mean difference, favoring the effect of PE, where weight (0.95 kg; 95% CI = 0.61-1.44), BMI (0.27 kg/m2; 95% CI = 0.23-0.49), and FM (1.4 kg; 95% CI = 0.94-1.7) also correlate with the change in glycemic indices.

 The 12-week structured PE intervention at PHCC wellness centers elicited a profound and statistically significant amelioration in glycemic indices. The observed reductions substantiate the metabolic benefits of sustained PE, with notable implications for insulin sensitivity and glucose homeostasis. These results accentuate the indispensable role of exercise as a therapeutic and preventive modality, which supports the need for integrating such programs into primary healthcare frameworks.

The objective of this study was to explore whether the time of day (AM vs. PM) resistance exercise is performed influences glucose and insulin concentrations, body composition, and muscular strength in adults with prediabetes. A secondary data analysis was conducted using data from the "Resist Diabetes" study, a phase II exercise intervention. Participants (age: 59.9 ± 5.4 yr; BMI: 33 ± 3.7 kg/m2) with prediabetes and overweight or obesity were categorized into AM (n = 73) or PM (n = 80) exercisers based on when they completed all of their supervised exercise sessions during a 12-wk, 2×/wk resistance exercise intervention. Blood glucose and insulin derived from oral glucose tolerance tests, body composition, and muscular strength were assessed pre- and post resistance exercise training. Inverse propensity score weighting approach was used to estimate the efficacy of AM versus PM exercise on the change of clinical responses. Paired samples t test was used to compare pre-/post-outcomes within AM and PM groups. No differences between AM and PM exercisers were detected in the change in glucose or insulin area under the curve (AUC), body composition, or muscular strength. When exploring within-group changes, PM exercisers reduced glucose AUC (change: -800.6 mg/dL·120 min; P = 0.01), whereas no significant change was detected for AM exercisers (change: -426.9 mg/dL·120 min; P = 0.26). Only AM exercisers increased fat-free mass (change: 0.6 kg; P = 0.001). The time of day resistance exercise is performed may have some impact on glucose concentrations and body composition response. Future randomized clinical trials are needed to understand how exercise timing influences cardiometabolic outcomes in at-risk adults.NEW & NOTEWORTHY In this secondary analysis, there was no difference between AM and PM exercisers in blood glucose, insulin, body composition, or muscular strength following 12 wk of supervised exercise. However, examining within-group changes, glucose area under the curve (AUC) was significantly reduced in PM exercisers, but not in AM exercisers.

Background: Previous studies have indicated an inverse relationship between aerobic physical activity (PA) and risk of diabetes-related mortality (DRM). However, the contribution of aerobic PA across multiple domains, while also considering the contribution of muscle-strengthening activity (MSA), in reduction of risk for DRM has yet to be examined. Purpose: The aim of this study is to examine the individual and combined associations of aerobic PA and MSA with DRM. Methods: The study sample (n = 13,350) included adult (20-79 years of age) participants from the 1999 to 2006 National Health and Nutrition Examination Survey. PA was categorized into 6 categories based around the 2018 PA guidelines: category 1 (inactive), category 2 (insufficient aerobic PA and no MSA), category 3 [active (aerobic) and no MSA], category 4 (no aerobic PA and sufficient MSA), category 5 (insufficient aerobic PA and sufficient MSA), and category 6 (meeting both recommendations). The dependent variable in this study was DRM, which includes those who had diabetes as the primary cause of death as well as those with diabetes listed as an underlying cause of death. Cox proportional hazards models were used for all analyses. Results: Following adjustment for covariates, significant risk reductions for DRM were found only in category 3 (HR = 0.57; 95% confidence interval: 0.37-0.88). Conclusions: Results suggest that meeting the aerobic PA guidelines significantly reduces the risk for DRM. Those meeting versus not meeting the MSA guidelines seem to have no difference in risk for DRM independent of aerobic PA.

Despite substantial evidence emphasizing the pleiotropic benefits of exercise for the prevention and treatment of various diseases, the underlying biological mechanisms have not been fully elucidated. Several exercise benefits have been attributed to signaling molecules that are released in response to exercise by different tissues such as skeletal muscle, cardiac muscle, adipose, and liver tissue. These signaling molecules, which are collectively termed exerkines, form a heterogenous group of bioactive substances, mediating inter-organ crosstalk as well as structural and functional tissue adaption. Numerous scientific endeavors have focused on identifying and characterizing new biological mediators with such properties. Additionally, some investigations have focused on the molecular targets of exerkines and the cellular signaling cascades that trigger adaption processes. A detailed understanding of the tissue-specific downstream effects of exerkines is crucial to harness the health-related benefits mediated by exercise and improve targeted exercise programs in health and disease. Herein, we review the current in vivo evidence on exerkine-induced signal transduction across multiple target tissues and highlight the preventive and therapeutic value of exerkine signaling in various diseases. By emphasizing different aspects of exerkine research, we provide a comprehensive overview of (i) the molecular underpinnings of exerkine secretion, (ii) the receptor-dependent and receptor-independent signaling cascades mediating tissue adaption, and (iii) the clinical implications of these mechanisms in disease prevention and treatment.

Diabetes, one of the world's top ten diseases, is known for its high mortality and complication rates and low cure rate. Prediabetes precedes the onset of diabetes, during which effective treatment can reduce diabetes risk. Prediabetes risk factors include high-calorie and high-fat diets, sedentary lifestyles, and stress. Consequences may include considerable damage to vital organs, including the retina, liver, and kidneys. Interventions for treating prediabetes include a healthy lifestyle diet and pharmacological treatments. However, while these options are effective in the short term, they may fail due to the difficulty of long-term implementation. Medications may also be used to treat prediabetes. This review examines prediabetic treatments, particularly metformin, glucagon-like peptide-1 receptor agonists, sodium glucose cotransporter 2 inhibitors, vitamin D, and herbal medicines. Given the remarkable impact of prediabetes on the progression of diabetes mellitus, it is crucial to intervene promptly and effectively to regulate prediabetes. However, the current body of research on prediabetes is limited, and there is considerable confusion surrounding clinically relevant medications. This paper aims to provide a comprehensive summary of the pathogenesis of pre-diabetes mellitus and its associated therapeutic drugs. The ultimate goal is to facilitate the clinical utilization of medications and achieve efficient and timely control of diabetes mellitus.

Physical activity of any amount results in substantial health benefits. However, public awareness of physical activity benefits in chronic diseases is inadequate in India. Prediabetes is a significant health issue on a global scale. Visceral fat (VF) is considered as an early predictor of prediabetes. Ethnicity and race have a substantial impact on VF. Hence, this study intended to evaluate the effect of a customized physical activity promotion program on VF and glycemic parameters in individuals with prediabetes.

In the current, parallel group randomized controlled trial, a total of 158 participants were recruited: 79 in intervention and 79 in control group. The study included the prediabetes individuals based on American Diabetes Association criteria. Participants from the intervention group received the customized physical activity promotion program for 24 weeks. The primary outcome measures of the study were VF level and glycemic parameters that included fasting blood sugar and glycosylated hemoglobin. Two-way mixed analysis of variance was used to study the mean difference of an outcome between 2 groups over time.

The study found a statistically significant interaction between the intervention and times on VF level, F1,136 = 23.564, fasting blood sugar levels, F1,136 = 8.762, and glycosylated hemoglobin levels, F1,136 = 64.582 at the end of 24 weeks (P < .05).

This study concluded that a customized physical activity promotion program was effective in reducing VF in individuals with prediabetes as compared with controls. It improved glycemic control by reducing fasting blood sugar and glycosylated hemoglobin levels.

Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.

Type 2 diabetes and obesity characterized by hallmarks of insulin resistance along with an imbalance in brain oxidative metabolism would impair intrinsic capacities (ICs), a new concept for assessing mental and physical functioning. Here, we explored the impact of physical activity on antioxidant responses and oxidative metabolism in discrete brain areas of HFD or standard diet (STD) fed mice but also its consequences on specific domains of ICs. 6-week-old Swiss male mice were exposed to a STD or a HFD for 16 weeks and half of the mice in each group had access to an activity wheel and the other half did not. As expected HFD mice displayed peripheral insulin resistance but also a persistent inhibition of aconitase activity in cortices revealing an increase in mitochondrial reactive oxygen species (ROS) production. Animals with access to the running wheel displayed an improvement of insulin sensitivity regardless of the diet factor whereas ROS production remained impaired. Moreover, although the access of the running wheel did not influence mitochondrial biomass, in the oxidative metabolism area, it produced a slight decrease in brain SOD1 and catalase expression notably in HFD fed mice. At the behavioural level, physical exercise produced anxiolytic/antidepressant-like responses and improved motor coordination in both STD and HFD fed mice. However, this non-pharmacological intervention failed to enhance cognitive performance. These findings paint a contrasting landscape about physical exercise as a non-pharmacological intervention for positively orienting the aging trajectory.

Since prediabetes is a risk factor for metabolic syndromes, it is important to promote a healthy lifestyle to prevent prediabetes. This study aimed to determine the effects of green coffee (GC), chlorogenic acid (CGA) intake, and exercise training (EX) on hepatic lipid metabolism in prediabetes male C57BL/6 mice.

Forty-nine mice were randomly divided into two groups feeding with a normal diet (n=7) or a high-fat diet (HFD, n=42) for 12 weeks. Then, HFD mice were further divided into six groups (n=7/group): control (pre-D), GC, CGA, EX, GC+EX, and CGA+EX. After additional 10 weeks under the same diet, plasma, and liver samples were obtained.

HFD-induced prediabetes conditions with increases in body weight, glucose, insulin, insulin resistance, and lipid profiles were alleviated in all treatment groups. Acsl3, a candidate gene identified through an in silico approach, was lowered in the pre-D group, while treatments partly restored it. HFD induced adverse alterations of de novo lipogenesis- and β oxidation-associated molecules in the liver. However, GC and CGA supplementation and EX reversed or ameliorated these changes. In most cases, GC or CGA supplementation combined with EX has no synergistic effect and the GC group had similar results to the CGA group.

These findings suggest that regular exercise is an effective non-therapeutic approach for prediabetes, and CGA supplementation could be an alternative to partially mimic the beneficial effects of exercise on prediabetes.

Although there is extensive research on how much aerobic exercise to prescribe in order to reduce the risks of cardiovascular disease (CVD) and premature mortality, there is limited research on how much resistance exercise to prescribe. This review is to help fill important gaps in knowledge on effective minimum dose, beneficial optimum dose, and safe maximum dose of resistance exercise for CVD prevention and longevity.

In contrast to aerobic exercise where "some is good, more is better," recent observational studies suggested a J-shaped relation where more time in resistance exercise was associated with lower CVD risk and mortality only up to 40-60 min/week, beyond which risk reductions attenuated or even disappeared. While it remains unclear, postulated mechanisms that may underlie the higher CVD risk and mortality with higher resistance exercise doses include increased arterial stiffness and chronic inflammation. Current observational data suggest that "more may not be better" for dose-response relations of resistance exercise with CVD and mortality; however, this requires confirmation, especially from randomized controlled trials that directly test and compare multiple doses of resistance exercise. Until these data exist, it is prudent to recommend small doses of resistance exercise for cardiovascular health and longevity.

Numerous studies have shown the beneficial effects of exercise on glycemic control in people with prediabetes. However, the most effective exercise modality for improving glycemic control remains unclear. We aimed to assess which exercise training modality is most effective in improving glycemic control in a population with prediabetes.

We conducted searches in Pubmed/MEDLINE, EMBASE, SPORTDiscus, Web of Science, PEDro, BVS, and the Cochrane Library from inception to June 2022. Included studies reported fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and 2-hour postprandial (2hPP) levels and implemented an exercise program lasting at least 12 weeks in adults with prediabetes. We performed a direct meta-analysis using a random-effects model and a network meta-analysis. Cochran's Q statistic and the inconsistency I2 test were used to assess the heterogenicity between studies.

Twenty trials were included, with 15 trials (comprising 775 participants with prediabetes) combined in the meta-analysis, and 13 in the network meta-analysis. The meta-analysis results did not show a statistically significant reduction in fasting plasma glucose (FPG) after aerobic training (AT) intervention compared to a control group (mean (95%CI) difference = -5.18 (-13.48; 3.12) mg/dL, Z=1.22, p=0.22). However, a difference of -7.25 (-13.79; -0.71) mg/dL, p=0.03, in FPG after interval training (IT) intervention was detected compared to a control group. After resistance training (RT) intervention, FPG was significantly lower -6.71 (-12.65,-0.77) mg/dL, Z=2.21, p=0.03, and HbA1c by -0.13 (-0.55, 0.29), p=0.54, compared to the control group. The impact of RT compared to no intervention on 2hPP was not statistically significant (p=0.26). The network meta-analysis did not show statistical significance. Most of the studies presented an unclear risk of bias, and a low and very low-quality of evidence. According to the GRADE criteria, the strength of the body of evidence was low.

Resistance training and IT had demonstrated benefits on glycemic indices, especially on FPG, in a population with prediabetes. Further studies with larger sample sizes and a more robust methodology that compare different types of exercise modalities, frequencies, and durations, are needed to establish a beneficial exercise intervention.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=370688, identifier CRD42022370688.

To evaluate the effects of different durations of continuous aerobic exercise on prediabetic patients.

The research encompassed randomized controlled trials that examined how various durations of aerobic exercise training affected outcomes related to Body Mass Index (BMI), Fasting blood glucose (FBG), 2-hour plasma glucose (2hPG), and glycated hemoglobin (HbA1c) in individuals diagnosed with prediabetes. PubMed, Embase, Web of Science, and the Cochrane Library were searched as of January 7, 2023. The Cochrane Risk of Bias, version 2 (ROB 2) tool was used to assess the risk of bias.

A total of 10 RCTs with 815 prediabetic patients were included. The average age of the participants was 56.1 years, with a standard deviation of 5.1 years. Among the participants, 39.2% were male. The interventions consisted of aerobic dance, treadmill running, walking, and a combination of aerobic exercises. The training sessions occurred three or four times per week. In prediabetic patients, aerobic exercise demonstrated a significant reduction in BMI compared to the control group, with a weighted mean difference (WMD) of -1.44 kg/m2 (95% confidence interval [CI] -1.89, -0.98). There was a decrease in FBG levels, with WMD of -0.51 mmol/L (95% CI -0.70, -0.32). Additionally, aerobic training led to significant improvements in 2hPG levels, with a WMD of -0.76 mmol/L (95% CI -1.14, -0.38). Furthermore, prediabetic patients showed a decrease in HbA1c levels after engaging in aerobic training compared to the control group, with a WMD of -0.34% (95% CI -0.45, -0.23).

In summary, engaging in aerobic exercise can have a significant positive impact on glycemic levels in individuals with prediabetes. It can also lead to reductions in BMI, FBG, 2hPG, HbA1c, and other relevant indicators. The extent of these improvements may vary slightly depending on the duration of the aerobic exercise intervention.

PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023395515.

This article reports the evaluation of a personalized, team-based comprehensive lifestyle modification program targeting known triggers of hyperinsulinemia and insulin resistance.

A retrospective chart review was undertaken for 536 participants in a novel high-intensity lifestyle behavioral modification program. Surrogate markers of insulin resistance and metabolic syndrome‒related pathologies were measured before and after participation in the the program.

Reversal of metabolic syndrome was present in 42% of participants who met the criteria for this syndrome. Additional changes seen in this cohort include: 36% decrease in triglyceride to high-density lipoprotein cholesterol ratio; 5% (-7.2 mm Hg) decrease in systolic blood pressure and 4% (-3.8 mm Hg) decrease in diastolic blood pressure; decreased abdominal adiposity and waist circumference (-7.6 cm); increased high-density lipoprotein cholesterol (1.3 mg/dL); and 23% (-57.1 mg/dL) decrease in serum triglycerides. Hyperglycemia was normalized in 35% of participants with prediabetes. Only 2% of those with prediabetes progressed to type 2 diabetes mellitus. Among those with type 2 diabetes mellitus, 46% experienced a reduction in HbA1c to below diabetic cut offs. Compared to baseline, the Metabolic Syndrome Severity Score decreased by 30% among those with metabolic syndrome, 11% among those with prediabetes, 26% among those with type 2 diabetes mellitus, and 38% among those with uncontrolled type 2 diabetes mellitus. Cardiorespiratory fitness, measured by the calculated Metabolic Equivalent of Task maximum, increased by 30% in the metabolic syndrome cohort, 28% in the prediabetic cohort, 29% in the type 2 diabetes mellitus cohort, 29% in the uncontrolled type 2 diabetes mellitus cohort, and 32% in the cohort with obesity.

Modifying lifestyle factors that trigger hyperinsulinemia provided pleiotropic improvements to all measured surrogate markers of insulin resistance, mitigated the progressive nature of the insulin resistance and metabolic syndrome‒related chronic pathologies, reduced Metabolic Syndrome Severity Score, and improved cardiorespiratory fitness. These results suggest that earlier identification of the diagnostic criteria of metabolic syndrome and/or Metabolic Syndrome Severity Score and the prompt initiation of a comprehensive therapeutic lifestyle approach would significantly mitigate disease burden.

Regular exercise that meets or exceeds the current physical activity guidelines is associated with a reduced risk of cardiovascular disease (CVD) and mortality. Therefore, exercise training plays an important role in primary and secondary prevention of CVD. In this part 1 of a 4-part focus seminar series, we highlight the mechanisms and physiological adaptations responsible for the cardioprotective effects of exercise. This includes an increase in cardiorespiratory fitness secondary to cardiac, vascular, and skeletal muscle adaptations and an improvement in traditional and nontraditional CVD risk factors by exercise training. This extends to the role of exercise and its prescription in patients with CVDs (eg, coronary artery disease, chronic heart failure, peripheral artery disease, or atrial fibrillation) with special focus on the optimal mode, dosage, duration, and intensity of exercise to reduce CVD risk and improve clinical outcomes in these patients.

Physical activity is essential in acquiring healthy lifestyle behaviors in the early years of maturational development and preventing various diseases. Resistance training (RT) is fundamental for improving body composition and is increasingly recommended for obese adolescents. A systematic review and meta-analysis were performed to synthesize and analyze data on the effects of RT programs in this population, seeking to develop useful recommendations for health and sports professionals.

A search was performed using four databases (Web of Science, Scopus, PubMed, and ScienceDirect). According to specific inclusion criteria, twenty-one studies were selected to evaluate the impact of RT on body mass index (BMI), body fat, waist circumference, muscle strength, insulin sensitivity, lean mass and cardiorespiratory fitness.

After the RT programs, the adolescents improved their muscle strength (SMD, 1.44; 95% CI: 0.76-2.12), cardiorespiratory fitness (SMD, 1.09; 95% CI: 0.15-2.04), BMI (SMD, 0.21; 95% CI: 0.07-0.35), waist circumference (SMD, 0.27; 95% CI: 0.06-0.47) and body fat (SMD, 0.20; 95% CI: 0.05-0.34). However, insulin sensitivity (SMD, 0.32; 95% CI: - 0.47 to 1.10) and lean mass (SMD, 0.12; 95% CI: - 0.06 to 0.31) did not reveal any changes. Different RT programs were used but it seems that 2-3 times/week ∼60 min/session of RT for 12 weeks should be recommended for positive changes.

RT seems to be effective when the objective is to improve muscle strength, cardiorespiratory fitness and can be an efficient strategy to reduce obesity in adolescents by reducing body fat, waist circumference and body mass index. PROSPERO Registration number: CRD42022333411.

Ageing is associated with decreased physical activity, obesity and subsequently an increased risk of developing type 2 diabetes mellitus (T2dm). Master athletes (MA) have initiated exercise or sport later in life or pursued a physically active lifestyle for an extended period. Subsequently, MAs have been proposed as a model of successful ageing as this active lifestyle is associated with health benefits including decreased health risk of chronic diseases and a reduction in premature mortality. Given long-term physical activity/exercise has previously been shown to be protective against hyperglycemia, a risk factor for T2dm, it is plausible that MA may have protective benefit against developing hyperglycemia. Therefore, the aim of this study was to investigate the prevalence of hyperglycemia via fasting plasma glucose (FPG) in MAs competing at the World Masters Games (WMG).

This cross-sectional, observational survey utilized an online survey using open-source web-based software was used to investigate MAs physiological and medical-related parameters. Over 28,000 MAs competed in the WMG, of which 8,072 MAs completed the survey. Of these MAs, a total of 486 (males 277, females 209; range 27 to 91 years, mean age 55.1 ± 10.2 years) attained recent pathology results which included FPG which was subsequently analyzed for this study. FPG and other outcome variables were compared between genders and to the Australian and United States general population.

Mean FPG for MAs was 5.03 mmol (±1.2, 95% CI [4.9-5.1] mmol) with majority (75.5%) of MAs reporting a normal (<5.5 mmol) FPG, followed by pre-diabetes (20.2%, >5.51 to <5.99 mmol) and abnormal (4.3%, >7.0 mmol). There was no significant difference (P = 0.333) in FPG between genders however, males had a slightly higher (+2.1%) FPG as compared to females (5.08 ± 1.2 mmol (95% CI [4.9-5.22] mmol) versus 4.98 ± 1.1 mmol (95% CI 4.8-5.1 mmol)). The majority of males (71.8%) and females (80.3%) were classified with a normal FPG. With regard to an abnormal FPG level, only 4.0% of males and 4.9% of females were classified abnormal which was suggestive of undiagnosed T2dm. With regard to age by decade, there was no significant difference (P = 0.06-1.00) between age groups and no relationship between the MAs' age and FPG (r = .054, P = 0.24). As a group, MAs had a significantly lower FPG as compared to the Australian (-3.2%, P = 0.005) and United States general populations (-13.9%, P < 0.001).

Most, however not all, MAs were found to have normal glycaemia, with only a small percentage indicating a risk of developing T2dm (i.e., impaired fasting glucose) and a smaller percentage identified with an abnormal FPG, suggestive of T2dm. These findings suggest MAs appear to be at low metabolic risk for developing T2dm based upon FPG and the physical activity/exercise they complete as MAs may indeed be protective against hyperglycemia whilst maintaining an active lifestyle.

The purpose of this study was to investigate the change in cognitive reserve biomarkers of the pre-diabetic individual according to the types of leisure-time physical activity (aerobic or resistance physical activity). The research subjects (n = 184) who participated in the survey were pre-diabetic and diabetic patients who were visiting university hospitals and welfare centers. The intervention subjects (n = 36) who were elderly females with pre-diabetes volunteered to participate in the study by performing regular physical exercise (aerobic or resistance exercise). The study participants were 65 years of age or older with pre-diabetes defined by a glycated hemoglobin (HbA1c) level of (5.7−6.4)%. All research subjects performed motivation and stress questionnaire survey. All intervention subjects participated in leisure-time physical activity (LTPA) for 12 weeks. Body composition, HbA1c, and cognitive reserve biomarkers were measured at baseline, and at 6 and 12 weeks. LTPA motivation confirmed that the LTPA participants had a high level of motivation. Stress confirmed that the stress level of LTPA participants was low. Two-way within-factor ANOVA revealed significant group × time interaction for weight (p < 0.05), BMI (p < 0.01), % fat (p < 0.001), SBP (p < 0.05), HbA1c (p < 0.001), BDNF (p < 0.001), and Beta-Amyloid 1−42 (p < 0.001). In both physical activity groups, HbA1c (p < 0.001), NGF (p < 0.05), BDNF (p < 0.05), and Cathepsin B (p < 0.05) improved significantly at 12 weeks, compared to baseline and 6 weeks. In the resistance physical activity group, Beta-Amyloid 1−42 (p < 0.01) and Homocysteine (p < 0.05) significantly decreased at 12 weeks, compared to baseline and at 6 weeks. The LTPA showed high levels of integrated and identified regulation among leisure motive types, and the level of stress was found to be low. The LTPA is effective in reducing the HbA1c levels of the pre-diabetes elderly. In addition, the pre-diabetes elderly were found to have increased NGF, BDNF, and cathepsin B, and decreased Beta-Amyloid 1−42 and homocysteine. Regular leisure-time physical activity has a positive effect on cognitive reserve biomarkers through improving glycemic control by reducing weight and % fat in the pre-diabetes elderly.