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Cited by 277Physical Activity and HealthDiabetes Management and ResearchCardiovascular and exercise physiology

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Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial

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Savikj, Mladen, Gabriel, Brendan M., Alm, Petter S., Smith, Jonathon, Caidahl, Kenneth, Björnholm, Marie, Fritz, Tomas, Krook, Anna, Zierath, Juleen R., Wallberg-Henriksson, Harriet·2019·Diabetologia
DOI 10.1007/s00125-018-4767-zPMC PMC6323076
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Abstract

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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Fig. 1 CGM-based glucose levels in response to HIIT. CGM-based glucose levels were assessed during the pre-training period and on exercise days (Exercise) and subsequent days (Rest). Blood glucose readings on Exercise days in (a) week 1 (n = 11) and (b) week 2 (n = 9), and on Rest days in (c) week 1 (n = 11) and (d) week 2 (n = 8). Red lines and symbols, morning exercise; blue lines and symbols, afternoon exercise; grey lines and symbols, matched pre-training days. Red arrows, time of morning exercise; blue arrows, time of afternoon exercise; grey arrows, snack offered. Using two-way ANOVA: §p < 0.05 for the effect of time; ¶p < 0.05 for the interaction between exercise and time. Using Tukey’s multiple comparison test: *p < 0.05 for the difference between exercise trials; †p < 0.05 for the difference between morning exercise trial and pre-training period; ‡p < 0.05 for the difference between afternoon exercise trial and pre-training period. Values are means + SEM
Fig. 1 CGM-based glucose levels in response to HIIT. CGM-based glucose levels were assessed during the pre-training period and on exercise days (Exercise) and subsequent days (Rest). Blood glucose readings on Exercise days in (a) week 1 (n = 11) and (b) week 2 (n = 9), and on Rest days in (c) week 1 (n = 11) and (d) week 2 (n = 8). Red lines and symbols, morning exercise; blue lines and symbols, afternoon exercise; grey lines and symbols, matched pre-training days. Red arrows, time of morning exercise; blue arrows, time of afternoon exercise; grey arrows, snack offered. Using two-way ANOVA: §p < 0.05 for the effect of time; ¶p < 0.05 for the interaction between exercise and time. Using Tukey’s multiple comparison test: *p < 0.05 for the difference between exercise trials; †p < 0.05 for the difference between morning exercise trial and pre-training period; ‡p < 0.05 for the difference between afternoon exercise trial and pre-training period. Values are means + SEMCC BY · PubMed Central

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Metadata

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
Publisher
Springer Science and Business Media LLC
Published
2018-11-13
Volume
62
Issue
2
Pages
233-237
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-018-4767-z
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
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 › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Physiology (medical) › 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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