Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: A randomised crossover trial
Open accessAbstract
Exercise is recommended for the treatment and prevention of type 2 diabetes. However, the most effective time of day to achieve beneficial effects on health remains unknown. We aimed to determine whether exercise training at two distinct times of day would have differing effects on 24 h blood glucose levels in men with type 2 diabetes. Eleven men with type 2 diabetes underwent a randomised crossover trial. Inclusion criteria were 45–68 years of age and BMI between 23 and 33 kg/m 2 . Exclusion criteria were insulin treatment and presence of another systemic illness. Researchers were not blinded to the group assignment. The trial involved 2 weeks of either morning or afternoon high-intensity interval training (HIIT) (three sessions/week), followed by a 2 week wash-out period and a subsequent period of the opposite training regimen. Continuous glucose monitor (CGM)-based data were obtained. Morning HIIT increased CGM-based glucose concentration (6.9 ± 0.4 mmol/l; mean ± SEM for the exercise days during week 1) compared with either the pre-training period (6.4 ± 0.3 mmol/l) or afternoon HIIT (6.2 ± 0.3 mmol/l for the exercise days during week 1). Conversely, afternoon HIIT reduced the CGM-based glucose concentration compared with either the pre-training period or morning HIIT. Afternoon HIIT was associated with elevated thyroid-stimulating hormone (TSH; 1.9 ± 0.2 mU/l) and reduced T 4 (15.8 ± 0.7 pmol/l) concentrations compared with pre-training (1.4 ± 0.2 mU/l for TSH; 16.8 ± 0.6 pmol/l for T 4 ). TSH was also elevated after morning HIIT (1.7 ± 0.2 mU/l), whereas T 4 concentrations were unaltered. Afternoon HIIT was more efficacious than morning HIIT at improving blood glucose in men with type 2 diabetes. Strikingly, morning HIIT had an acute, deleterious effect, increasing blood glucose. However, studies of longer training regimens are warranted to establish the persistence of this adverse effect. Our data highlight the importance of optimising the timing of exercise when prescribing it as treatment for type 2 diabetes.
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Afternoon exercise (HITT) was found superior to morning exercise in improving glucose levels in T2DM.
“One study showed that afternoon exercise (i.e., high intensity interval training/HITT; individuals cycled at 75 rpm with a load of forced rest after 1 min, repeated six times with 1 min rest in between, three sessions/week, using continuous glucose monitoring, and recorded daily food intake) was found superior to morning exercise in improving glucose levels in T2DM [200].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [200]
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- Authors
- Savikj, M., Gabriel, B. M., Alm, P. S., Smith, J., Caidahl, K., Björnholm, M., Fritz, T., Krook, A., Zierath, J. R., & Wallberg-Henriksson, H.
- Affiliations
- University of Oslo (NO)
- Karolinska Institutet (SE)
- Karolinska University Hospital (SE)
- University of Copenhagen (DK)
- ORCID
- Venue
- Diabetologia
- Published
- 2018-11-13
- Volume
- 62
- Issue
- 2
- Pages
- 233-237
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6323076
- OpenAlex
- W2901341108
- Cited by
- 277
- References
- 11
- Citations by year
- 2026: 37 · 2025: 37 · 2024: 54 · 2023: 43 · 2022: 43 · 2021: 22 · 2020: 27 · 2019: 13
- FWCI
- 10.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetologia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Swedish Heart Lung Foundation (20150423)
- Swedish Diabetes Foundation (DIA2012-082)
- Stockholm County Council (SLL20170159)
- Swedish Research Council (2015-00165)
- Wenner-Gren Foundation
- Strategic Research Program in Diabetes at Karolinska Institutet (2009-1068)
- Novo Nordisk Foundation (NNF14OC0011493)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- type 2 diabetes, exercise timing, high-intensity interval training, blood glucose, continuous glucose monitoring, thyroid-stimulating hormone, thyroxine, morning exercise, exercise prescription
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Humans, Male, Middle Aged, Time Factors, Exercise, Treatment Outcome, Cross-Over Studies
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