Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
Sports Med. 2021 Sep;51(9):1949-1966. doi: 10.1007/s40279-021-01473-2. Epub 2021 Apr 27.
Elevated glucose and insulin levels are major risk factors in the development of cardiometabolic disease. Aerobic exercise is widely recommended to improve glycaemic control, yet its acute effect on glycaemia and glucoregulatory hormones has not been systematically reviewed and analysed in healthy adults.
To determine the effect of a single bout of continuous aerobic exercise on circulating glucose, insulin, and glucagon concentrations in healthy adults.
CENTRAL, CINAHL, Embase, Global Health, HMIC, Medline, PubMed, PsycINFO, ScienceDirect, Scopus and Web of Science databases were searched from inception to May 2020. Papers were included if they reported a randomised, crossover study measuring glucose and/or insulin and/or glucagon concentrations before and immediately after a single bout of continuous aerobic exercise (≥ 30 min) compared to a time-matched, resting control arm in healthy adults. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and GRADE approach, respectively. Random-effects meta-analyses were performed for glucose, insulin, and glucagon. Sub-group meta-analyses and meta-regression were performed for categorical (metabolic state [postprandial or fasted], exercise mode [cycle ergometer or treadmill]) and continuous (age, body mass index, % males, maximal aerobic capacity, exercise duration, exercise intensity) covariates, respectively.
42 papers (51 studies) were considered eligible: glucose (45 studies, 391 participants), insulin (38 studies, 377 participants) and glucagon (5 studies, 47 participants). Acute aerobic exercise had no significant effect on glucose concentrations (mean difference: - 0.05 mmol/L; 95% CI, - 0.22 to 0.13 mmol/L; P = 0.589; I: 91.08%, large heterogeneity; moderate-quality evidence). Acute aerobic exercise significantly decreased insulin concentrations (mean difference: - 18.07 pmol/L; 95% CI, - 30.47 to - 5.66 pmol/L; P = 0.004; I: 95.39%, large heterogeneity; moderate-quality evidence) and significantly increased glucagon concentrations (mean difference: 24.60 ng/L; 95% CI, 16.25 to 32.95 ng/L; P < 0.001; I: 79.36%, large heterogeneity; moderate-quality evidence). Sub-group meta-analyses identified that metabolic state modified glucose and insulin responses, in which aerobic exercise significantly decreased glucose (mean difference: - 0.27 mmol/L; 95% CI, - 0.55 to - 0.00 mmol/L; P = 0.049; I: 89.72%, large heterogeneity) and insulin (mean difference: - 42.63 pmol/L; 95% CI, - 66.18 to - 19.09 pmol/L; P < 0.001; I: 81.29%, large heterogeneity) concentrations in the postprandial but not fasted state. Meta-regression revealed that the glucose concentrations were also moderated by exercise duration and maximal aerobic capacity.
Acute aerobic exercise performed in the postprandial state decreases glucose and insulin concentrations in healthy adults. Acute aerobic exercise also increases glucagon concentrations irrespective of metabolic state. Therefore, aerobic exercise undertaken in the postprandial state is an effective strategy to improve acute glycaemic control in healthy adults, supporting the role of aerobic exercise in reducing cardiometabolic disease incidence.
CRD42020191345.
升高的血糖和胰岛素水平是导致代谢性心血管疾病的主要危险因素。广泛建议进行有氧运动以改善血糖控制，但在健康成年人中，其对血糖和糖调节激素的急性影响尚未得到系统的综述和分析。
确定单次持续有氧运动对健康成年人循环葡萄糖、胰岛素和胰高血糖素浓度的影响。
从建库到 2020 年 5 月，在 CENTRAL、CINAHL、Embase、Global Health、HMIC、Medline、PubMed、PsycINFO、ScienceDirect、Scopus 和 Web of Science 数据库中进行了检索。如果研究报告了一项随机交叉研究，即在健康成年人中，与时间匹配的休息对照臂相比，单次持续有氧运动（≥30 分钟）后立即测量葡萄糖和/或胰岛素和/或胰高血糖素浓度，则将其纳入研究。使用 Cochrane 偏倚风险工具和 GRADE 方法评估风险偏倚和证据质量。对葡萄糖、胰岛素和胰高血糖素进行随机效应荟萃分析。对分类（代谢状态[餐后或空腹]、运动模式[踏车或跑步机]）和连续（年龄、体重指数、%男性、最大有氧能力、运动持续时间、运动强度）协变量进行亚组荟萃分析和元回归。
42 篇论文（51 项研究）被认为符合纳入标准：葡萄糖（45 项研究，391 名参与者）、胰岛素（38 项研究，377 名参与者）和胰高血糖素（5 项研究，47 名参与者）。急性有氧运动对葡萄糖浓度没有显著影响（平均差异：-0.05mmol/L；95%置信区间，-0.22 至 0.13mmol/L；P=0.589；I：91.08%，高度异质性；中等质量证据）。急性有氧运动显著降低胰岛素浓度（平均差异：-18.07pmol/L；95%置信区间，-30.47 至-5.66pmol/L；P=0.004；I：95.39%，高度异质性；中等质量证据），并显著升高胰高血糖素浓度（平均差异：24.60ng/L；95%置信区间，16.25 至 32.95ng/L；P<0.001；I：79.36%，高度异质性；中等质量证据）。亚组荟萃分析发现，代谢状态改变了葡萄糖和胰岛素的反应，其中有氧运动显著降低了葡萄糖（平均差异：-0.27mmol/L；95%置信区间，-0.55 至-0.00mmol/L；P=0.049；I：89.72%，高度异质性）和胰岛素（平均差异：-42.63pmol/L；95%置信区间，-66.18 至-19.09pmol/L；P<0.001；I：81.29%，高度异质性）浓度在餐后但不在空腹状态下。元回归显示，运动持续时间和最大有氧能力也调节了葡萄糖浓度。
餐后进行的急性有氧运动可降低健康成年人的血糖和胰岛素浓度。急性有氧运动还会增加胰高血糖素浓度，无论代谢状态如何。因此，餐后进行的有氧运动是改善健康成年人急性血糖控制的有效策略，支持有氧运动在降低代谢性心血管疾病发病率方面的作用。
PROSPERO 注册号：CRD42020191345。
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