Cited by 295Metabolism, Diabetes, and CancerAdipose Tissue and MetabolismNatural Antidiabetic Agents Studies

The DOI matches its Crossref record; 178 of the 179 references it cites were found in a registry or an index; 1 of the 191 sources its claims cite were checked for support.

AMPK and Exercise: Glucose Uptake and Insulin Sensitivity

Open access
O'Neill, Hayley M.·2013·Diabetes & Metabolism Journal

Abstract

AMPK is an evolutionary conserved sensor of cellular energy status that is activated during exercise. Pharmacological activation of AMPK promotes glucose uptake, fatty acid oxidation, mitochondrial biogenesis, and insulin sensitivity; processes that are reduced in obesity and contribute to the development of insulin resistance. AMPK deficient mouse models have been used to provide direct genetic evidence either supporting or refuting a role for AMPK in regulating these processes. Exercise promotes glucose uptake by an insulin dependent mechanism involving AMPK. Exercise is important for improving insulin sensitivity; however, it is not known if AMPK is required for these improvements. Understanding how these metabolic processes are regulated is important for the development of new strategies that target obesity-induced insulin resistance. This review will discuss the involvement of AMPK in regulating skeletal muscle metabolism (glucose uptake, glycogen synthesis, and insulin sensitivity).

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that AMPK is activated by exercise and is important for regulating skeletal muscle glucose uptake during exercise, while its requirement for exercise-induced improvements in insulin sensitivity remains unresolved. It synthesizes genetic mouse-model and human/rodent exercise evidence on AMPK, TBC1D1/TBC1D4, glycogen synthesis, and alternative insulin-sensitizing mechanisms.

Key findings

  • AMPK is activated during exercise in an intensity-dependent manner: α2 activity increases from 40% VO2max, whereas α1 activity increases during high-intensity contractions equivalent to >100% VO2max.
  • Muscle-specific AMPK β1β2 KO mice have undetectable AMPK activity and show reduced voluntary wheel activity (75%), maximal exercise capacity (95%), mitochondrial content (30%), and exercise-mediated skeletal muscle glucose uptake (55% to 70%); young mice have normal insulin sensitivity.
  • TBC1D1 and TBC1D4 are implicated in contraction/exercise glucose uptake: TBC1D1 4P mutants reduce contraction-mediated glucose uptake by 25% to 30%, TBC1D4 4P mutant inhibits insulin-stimulated glucose uptake in vivo by ~50%, and TBC1D1 expression is reduced by ~50% in skeletal muscle of AMPK α2 KO, α2 KD, α2iTg, and β1β2 M-KO mice.
  • Exercise improves insulin sensitivity, but whether AMPK is required is not known; proposed mechanisms include TBC1D4, TBC1D1, IL-6 (which can increase ~100-fold with exercise), adiponectin, glycogen synthesis/levels, and mTOR/p70 S6K signaling.

Methods

  • Narrative review; the abstract states it will discuss AMPK involvement in skeletal muscle metabolism (glucose uptake, glycogen synthesis, insulin sensitivity).
  • Synthesizes studies using whole-body and muscle-specific AMPK mouse models (α1, α2, β1, β2, γ3 KO; β1β2 M-KO; α2 KD/α2iTg; LKB1-MKO) plus human and rodent exercise/contraction studies.
  • Main analysis is qualitative synthesis of cited literature; no systematic search, meta-analysis, or primary data collection is described.

Limitations

  • The paper states that it is not known if AMPK is required for exercise-induced improvements in insulin sensitivity and that further studies are required to fully define the role of AMPK in mediating these effects.
  • The paper notes inconsistent observations and unresolved mechanisms, including TBC1D4/TBC1D1 phosphorylation, IL-6 effects, and glycogen/AMPK relationships.
  • Evident from the text: this is a narrative review without systematic methods or new data, so conclusions depend on the cited models and may be affected by isoform compensation, mouse strain/background differences, and reliance on pharmacological or supraphysiological stimuli.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.4093/dmj.2013.37.1.1

Cites

178 of 178 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Regulation of insulin-stimulated glucose uptake and glycogen synthesis. Insulin stimulates glucose uptake by binding to the insulin receptor (IR), this promotes autophosphorylation and subsequent activation of insulin receptor substrate 1 (IRS1) and PI3 kinase via SH2 interaction with regulatory p85 and catalytic p110 subunits. This promotes association with phosphatidylinositol 4,5-bisphosphate (PIP2) at the plasma membrane, which is converted to phosphatidylinositol 3,4,5-triphosphate (PIP3), which induces a conformational change in Akt that allows Akt phosphorylation and subsequent phosphorylation and inhibition of the Rab-GAP activating protein tre-2/USP6, BUB2, cdc16 domain family member 4 (TBC1D4). Rac/actin can also promote glucose uptake by promoting actin remodeling. Once glucose enters the cell it can be metabolized through glycolysis to produce ATP or utilized for glycogen synthesis. Glycogen synthesis involves phosphorylation and inhibition of glycogen synthase kinase 3 (GSK3) by Akt, which activates glycogen synthase (GS); promoting the conversion of glucose-6 phosphate (G6P) to G1P then uridine diphosphoglucose (UDP-G), which is targeted towards glycogen. AMPK can phosphorylate and inhibit GS; however, G6P can override this inhibitory effect. PTG, protein targeting to glycogen.
Fig. 1 Regulation of insulin-stimulated glucose uptake and glycogen synthesis. Insulin stimulates glucose uptake by binding to the insulin receptor (IR), this promotes autophosphorylation and subsequent activation of insulin receptor substrate 1 (IRS1) and PI3 kinase via SH2 interaction with regulatory p85 and catalytic p110 subunits. This promotes association with phosphatidylinositol 4,5-bisphosphate (PIP2) at the plasma membrane, which is converted to phosphatidylinositol 3,4,5-triphosphate (PIP3), which induces a conformational change in Akt that allows Akt phosphorylation and subsequent phosphorylation and inhibition of the Rab-GAP activating protein tre-2/USP6, BUB2, cdc16 domain family member 4 (TBC1D4). Rac/actin can also promote glucose uptake by promoting actin remodeling. Once glucose enters the cell it can be metabolized through glycolysis to produce ATP or utilized for glycogen synthesis. Glycogen synthesis involves phosphorylation and inhibition of glycogen synthase kinase 3 (GSK3) by Akt, which activates glycogen synthase (GS); promoting the conversion of glucose-6 phosphate (G6P) to G1P then uridine diphosphoglucose (UDP-G), which is targeted towards glycogen. AMPK can phosphorylate and inhibit GS; however, G6P can override this inhibitory effect. PTG, protein targeting to glycogen.CC BY-NC · PubMed Central
Fig. 2 Regulation of glucose uptake during exercise and muscle contractions. During contraction, there is depolarization of T-tubules (plasma membrane only found in skeletal muscle) that causes calcium (Ca2+) release from the sarcoplasmic reticulum, which triggers actin and myosin interaction (red; thick myosin and thin actin filaments). The energy demand of contraction increases the ratio of adenosine monophosphate (AMP)/adenosine triphosphate (ATP), which stimulates AMP-associated protein kinase (AMPK). Both tre-2/USP6, BUB2, cdc16 domain family member 4 and 1 (TBC1D 4 and 1) are involved in regulating glucose uptake in response to contraction; however, it has recently been discovered that TBC1D1 plays a more pivotal role. AMPK can phosphorylate both TBC1D4 and TBC1D1; however, recent studies have shown that during contraction there is a strong correlation between AMPK phosphorylation of TBC1D1 and 14-3-3 binding (proteins that are proposed to be important for regulation of GAP function of TBC1D1 upon phosphorylation), which allows dissociation of Rab proteins and glucose transporter 4 (GLUT4) translocation to the plasma membrane and glucose uptake. AK, adenylate kinase, the enzyme required for generation of AMP.
Fig. 2 Regulation of glucose uptake during exercise and muscle contractions. During contraction, there is depolarization of T-tubules (plasma membrane only found in skeletal muscle) that causes calcium (Ca2+) release from the sarcoplasmic reticulum, which triggers actin and myosin interaction (red; thick myosin and thin actin filaments). The energy demand of contraction increases the ratio of adenosine monophosphate (AMP)/adenosine triphosphate (ATP), which stimulates AMP-associated protein kinase (AMPK). Both tre-2/USP6, BUB2, cdc16 domain family member 4 and 1 (TBC1D 4 and 1) are involved in regulating glucose uptake in response to contraction; however, it has recently been discovered that TBC1D1 plays a more pivotal role. AMPK can phosphorylate both TBC1D4 and TBC1D1; however, recent studies have shown that during contraction there is a strong correlation between AMPK phosphorylation of TBC1D1 and 14-3-3 binding (proteins that are proposed to be important for regulation of GAP function of TBC1D1 upon phosphorylation), which allows dissociation of Rab proteins and glucose transporter 4 (GLUT4) translocation to the plasma membrane and glucose uptake. AK, adenylate kinase, the enzyme required for generation of AMP.CC BY-NC · PubMed Central

Verification

Claims the paper makes

111 Not checked yet · 22 Own interpretation · 2 No basis given · 1 Partly supported · accuracy not yet measured

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Show all 90 claims

  • It may state two separate claims as one. 42
  • Probably not a substantial claim. 4
46 of 46
  • The paper relies on this without support.

    Exercise improves insulin sensitivity.

    “Importantly, GLUT4 translocation during exercise is normal in skeletal muscle of type 2 diabetics [64], and exercise also improves insulin sensitivity.”
    “Exercise improves insulin sensitivity and it was originally proposed that this may involve the direct interaction of AMPK with IRS1 [145].”
  • The paper relies on this without support.

    Obesity and type 2 diabetes are causally linked through their association with skeletal muscle insulin resistance.

    “Obesity and type 2 diabetes are casually linked through their association with skeletal muscle insulin resistance.”
  • The paper relies on this without support.

    AICAR is a specific activator of AMPK.

    “Skeletal muscle-specific deletion of LKB1 (LKB1-MKO) from mice results in greatly reduced α2 AMPK T172 phosphorylation following activation by AICAR (a cell-permeable adenosine analog that can be phosphorylated to form 5-aminoimidazoel4-carboxamide-1-d-riborfuronosil-5'monophosphate) or muscle contractions/exercise [17-19]”
  • The paper relies on this without support.

    Exercise enhances insulin-stimulated glucose uptake, an effect that can persist for hours following an acute bout of exercise.

    “Exercise enhances insulin-stimulated glucose uptake, an effect that can persist for hours following an acute bout of exercise.”
  • The paper relies on this without support.

    Glycogen synthesis is increased following exercise and during insulin stimulation, and insulin-stimulated glycogen synthesis is enhanced following exercise.

    “Glycogen synthesis is increased following exercise and during insulin stimulation, and insulin-stimulated glycogen synthesis is enhanced following exercise.”
  • The paper relies on this without support.

    Contraction and insulin promote glycogen synthesis by distinct mechanisms but both involve multisite dephosphorylation and activation of glycogen synthase (GS).

    “Contraction and insulin promote glycogen synthesis by distinct mechanisms but both involve multisite dephosphorylation and activation of glycogen synthase (GS).”
  • The paper relies on this without support.

    In the case of insulin-stimulated glycogen synthesis, insulin signaling thru Akt inactivates GSK3 by phosphorylation at S9 and 21, and this in turn activates GS.

    “In the case of insulin-stimulated glycogen synthesis, insulin signaling thru Akt inactivates GSK3 by phosphorylation at S9 and 21, and this in turn activates GS.”
  • The paper relies on this without support.

    Insulin-stimulated glucose transport enhances cellular G6P, which in turn promotes glycogen synthesis.

    “Insulin-stimulated glucose transport enhances cellular G6P, which in turn promotes glycogen synthesis.”
  • The paper relies on this without support.

    Exercise promotes glycogen resynthesis.

    “Exercise promotes glycogen resynthesis and this may be important for improving insulin sensitivity postexercise.”
  • The paper relies on this without support.

    JNK and IKK can phosphorylate serine residues on IRS1 and impair insulin signaling.

    “JNK and IKK can phosphorylate serine residues on IRS1 and impair insulin signaling; therefore, these studies may suggest that activation of AMPK during exercise may help restore insulin signaling that is impaired by these serine kinases in obesity.”
  • The paper relies on this without support.

    Circulating IL-6 levels are elevated in obesity and during exercise.

    “Circulating IL-6 levels are elevated in obesity and during exercise; however, in obesity high levels of IL-6 have been linked to insulin resistance whereas during exercise IL-6 may enhance glucose uptake via AMPK and improve insulin sensitivity given IL-6 is additive to insulin in promoting glucose uptake.”
  • The paper relies on this without support.

    Both acute exercise and AICAR activate AMPK and increase insulin sensitivity.

    “Both acute exercise and AICAR activate AMPK and increase insulin sensitivity.”
12 of 12

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Citations

Cites

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Show all 179 references

Research works printed but not linked: 10

  1. Arad, 2002, J Clin Invest, 109, 357, 10.1172/jci0214571 · DOI
  2. Hutber, 1997, Am J Physiol, 272, E262
  3. Ihlemann, 1999, Am J Physiol, 277, E208
  4. Winder, 1996, Am J Physiol, 270, E299
  5. Martin, 1995, Am J Physiol, 269, E583
  6. Han, 1995, Am J Physiol, 269, R544
  7. King, 1993, Am J Physiol, 265, R447
  8. Steinberg, 2010, J Biol Chem, 285, 37198
  9. Fischer, 2006, Exerc Immunol Rev, 12, 6
  10. Friedrichsen, Mol Cell Endocrinol

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Metadata

Authors
O'Neill, H. M.
Affiliations
Protein Chemistry and Metabolism Unit, St. Vincent's Institute of Medical Research, Fitzroy, Australia.
Venue
Diabetes & Metabolism Journal
Published
2013
Volume
37
Issue
1
Pages
1
ISSN
  • 2233-6079 (ISSN-L)
  • 2233-6087
OpenAlex
W2134304387
Cited by
295
References
179
Citations by year
2026: 26 · 2025: 21 · 2024: 23 · 2023: 23 · 2022: 24 · 2021: 24 · 2020: 20 · 2019: 17 · 2018: 31 · 2017: 17 · 2016: 13 · 2015: 25 · 2014: 22 · 2013: 7
FWCI
10.00
Type
journal article
Language
en
Open access
Locations
  • Diabetes & Metabolism Journal (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
  • Health Sciences › Medicine › Physiology (medical) › Adipose Tissue and Metabolism
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
Keywords
AMPK, physical activity, glucose uptake, insulin sensitivity, insulin resistance, obesity, skeletal muscle metabolism, glycogen synthesis, fatty acid oxidation, mitochondrial biogenesis

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