High-intensity Interval Training Prescriptions to Reduce the Risk of Complications Linked to Type 2 Diabetes: the Role of Interval Length on Clinical Benefits and on Physiological Mechanisms
NCT ID: NCT04986345
Last Updated: 2023-03-30
Study Results
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Basic Information
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UNKNOWN
NA
15 participants
INTERVENTIONAL
2021-10-04
2023-08-31
Brief Summary
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To lower CVD risk and to maintain an adequate glycemic control, Diabetes Canada recommends aerobic exercise of high-intensity interval training (HIIT). The leading hypothesis of this study is that longer intervals will favor an anti-inflammatory immune state, and that and that it will be correlated with reduced arterial stiffness and blood pressure.
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Detailed Description
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To lower CVD risk and to maintain an adequate glycemic control, Diabetes Canada recommends aerobic exercise of high-intensity interval training (HIIT). However, this recommendation is solely based on the improvement of cardiorespiratory fitness in type 2 diabetes individuals (level of evidence: grade B, level 2). Furthermore, most of these studies use exercise protocols with ergocycles, which limit the ecological validity considering that the elderly population prefers to walk. Though, it is essential to evaluate the impact of different walking HIIT protocols on clinical targets such as arterial pressure, glycemic variability/control using ambulatory blood pressure monitors (ABPM) and CGM.
The preliminary data collected in our laboratory shows that a low volume HIIIT program (6 × 1 min) is insufficient to improve glycemic control/variability and ambulatory blood pressure over 24 hours in elderly diabetic women, despite reducing inflammatory gene expression in monocytes. Interestingly, pro-inflammatory monocytes are linked with hyperglycemia and play a crucial role in the atherosclerotic process, while also being associated with arterial stiffening in individuals with kidney failure, a common T2D complication.
These results raise several questions, including the role played by the length of HIIT intervals on clinical targets. While our preliminary results didn't impact ambulatory blood pressure over 24 hours with shorter intervals (6 × 1 min), other studied showed a reduction of this parameter with longer intervals (4 x 4 min). Therefore, the leading hypothesis of this study is that longer high intensity intervals (Wisløff protocol: 4 x 4 min) will reduce ambulatory blood pressure over 24 hours in a greater extent than shorter intervals (10 x 1 min). Indeed, reduced shear stress induced by shorter intervals could damper cellular and molecular responses to exercise bouts, thereby limiting the effects on arterial stiffness and blood pressure in the hours following exercise. Moreover, changes in gene expression do not guarantee changes at the protein level, and proteins are the real effectors of cellular response. Hence, proteomics will be useful to better understand monocyte response to different HIIT protocols and, possibly, the clinical benefits of this training method. Indeed, longer intervals could induce greater variations to the monocytes' proteome, favoring an anti-inflammatory phenotype, and those changes could be associated with reduced arterial stiffness and blood pressure.
The primary objective of this study is therefore to compare the effect of two treadmill HIIT modalities (4x4 min vs. 10x1 min) on arterial stiffness, ambulatory blood pressure over 24 hours and on glycemic variability in elderly women with T2D. The secondary objective is to assess the proteomic changes in monocytes induced by the two HIIT modalities and to correlate them with changes in clinical parameters.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
BASIC_SCIENCE
NONE
Study Groups
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Rest, HIIT-4, HIIT-10
Both arms start with the rest condition and the order of the two other conditions (HIIT-4 and HIIT-10) is determined at random.
This arm's sequence of intervention is : 1-Rest; 2- HIIT-4 and 3- HIIT-10.
High-intensity interval training (HIIT)-4
4 intervals of 4 minutes at 90% of maximum cardiac frequency, interspersed with 3-minute rests at 70% of maximum cardiac frequency. The session will last 32 minutes, including warm-up and cooldown.
High-intensity interval training (HIIT)-10
10 intervals of 1 minutes at 90% of maximum cardiac frequency, interspersed with 1-minute rests at 70% of maximum cardiac frequency. The session will last 34 minutes, including warm-up and cooldown.
Rest
Participants are to stay seated for 30 minutes while reading or watching television.
Rest, HIIT-10, HIIT-4
Both arms start with the rest condition and the order of the two other conditions (HIIT-4 and HIIT-10) is determined at random.
This arm's sequence of intervention is : 1- Rest; 2- HIIT-10 and 3- HIIT-4.
High-intensity interval training (HIIT)-4
4 intervals of 4 minutes at 90% of maximum cardiac frequency, interspersed with 3-minute rests at 70% of maximum cardiac frequency. The session will last 32 minutes, including warm-up and cooldown.
High-intensity interval training (HIIT)-10
10 intervals of 1 minutes at 90% of maximum cardiac frequency, interspersed with 1-minute rests at 70% of maximum cardiac frequency. The session will last 34 minutes, including warm-up and cooldown.
Rest
Participants are to stay seated for 30 minutes while reading or watching television.
Interventions
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High-intensity interval training (HIIT)-4
4 intervals of 4 minutes at 90% of maximum cardiac frequency, interspersed with 3-minute rests at 70% of maximum cardiac frequency. The session will last 32 minutes, including warm-up and cooldown.
High-intensity interval training (HIIT)-10
10 intervals of 1 minutes at 90% of maximum cardiac frequency, interspersed with 1-minute rests at 70% of maximum cardiac frequency. The session will last 34 minutes, including warm-up and cooldown.
Rest
Participants are to stay seated for 30 minutes while reading or watching television.
Eligibility Criteria
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Inclusion Criteria
* Arterial hypertension (controlled at rest)
* Low or no alcohol consumption (≤ 7 alcoholic beverages/week)
* Non-smoking
* Physically active ( \> 60 minutes of structured and scheduled physical activity/week for the previous 3 months)
Exclusion Criteria
* Use of beta blockers
* Unstable medication in the past 6 months
* Stroke in the past 6 months, or with consequences limiting physical activity practice
* Coronary disease without revascularization, or peripheral artery disease
* Neuropathy, retinopathy of nephropathy diagnostics
* Orthopedic limitations, or medical counter-indication for physical activity practice
* Surgery scheduled during the study period
60 Years
80 Years
FEMALE
No
Sponsors
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Université de Sherbrooke
OTHER
Responsible Party
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Locations
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Centre de recherche sur le vieillissement
Sherbrooke, Quebec, Canada
Countries
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Central Contacts
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Facility Contacts
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References
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Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuniga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018 Aug 31;17(1):122. doi: 10.1186/s12933-018-0762-4.
Nalysnyk L, Hernandez-Medina M, Krishnarajah G. Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes Metab. 2010 Apr;12(4):288-98. doi: 10.1111/j.1463-1326.2009.01160.x.
Shalev V, Chodick G, Heymann AD, Kokia E. Gender differences in healthcare utilization and medical indicators among patients with diabetes. Public Health. 2005 Jan;119(1):45-9. doi: 10.1016/j.puhe.2004.03.004.
Peters SA, Huxley RR, Sattar N, Woodward M. Sex Differences in the Excess Risk of Cardiovascular Diseases Associated with Type 2 Diabetes: Potential Explanations and Clinical Implications. Curr Cardiovasc Risk Rep. 2015;9(7):36. doi: 10.1007/s12170-015-0462-5.
Diabetes Canada Clinical Practice Guidelines Expert Committee; Sigal RJ, Armstrong MJ, Bacon SL, Boule NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes. 2018 Apr;42 Suppl 1:S54-S63. doi: 10.1016/j.jcjd.2017.10.008. No abstract available.
Amireault S, Baier JM, Spencer JR. Physical Activity Preferences Among Older Adults: A Systematic Review. J Aging Phys Act. 2018 Oct 25:1-12. doi: 10.1123/japa.2017-0234. Online ahead of print.
Shanmugam N, Reddy MA, Guha M, Natarajan R. High glucose-induced expression of proinflammatory cytokine and chemokine genes in monocytic cells. Diabetes. 2003 May;52(5):1256-64. doi: 10.2337/diabetes.52.5.1256.
Roy-Chowdhury E, Brauns N, Helmke A, Nordlohne J, Brasen JH, Schmitz J, Volkmann J, Fleig SV, Kusche-Vihrog K, Haller H, von Vietinghoff S. Human CD16+ monocytes promote a pro-atherosclerotic endothelial cell phenotype via CX3CR1-CX3CL1 interaction. Cardiovasc Res. 2021 May 25;117(6):1510-1522. doi: 10.1093/cvr/cvaa234.
Lee JW, Cho E, Kim MG, Jo SK, Cho WY, Kim HK. Proinflammatory CD14(+)CD16(+) monocytes are associated with vascular stiffness in predialysis patients with chronic kidney disease. Kidney Res Clin Pract. 2013 Dec;32(4):147-52. doi: 10.1016/j.krcp.2013.08.001. Epub 2013 Sep 26.
Ramirez-Jimenez M, Morales-Palomo F, Pallares JG, Mora-Rodriguez R, Ortega JF. Ambulatory blood pressure response to a bout of HIIT in metabolic syndrome patients. Eur J Appl Physiol. 2017 Jul;117(7):1403-1411. doi: 10.1007/s00421-017-3631-z. Epub 2017 May 10.
Ito S. High-intensity interval training for health benefits and care of cardiac diseases - The key to an efficient exercise protocol. World J Cardiol. 2019 Jul 26;11(7):171-188. doi: 10.4330/wjc.v11.i7.171.
Tremblay R, Marcotte-Chenard A, Deslauriers L, Boulay P, Boisvert FM, Geraldes P, Gayda M, Christou DD, Little JP, Mampuya W, Riesco E. Acute Effect of High-Intensity Interval Exercise on Blood Pressure in Females Living with Type 2 Diabetes and Hypertension. Med Sci Sports Exerc. 2025 May 1;57(5):951-961. doi: 10.1249/MSS.0000000000003639. Epub 2024 Dec 30.
Low JL, Marcotte-Chenard A, Tremblay R, Islam H, Falkenhain K, Mampuya WM, Mari A, McManus AM, Riesco E, Little JP. An acute bout of 4 x 4-min or 10 x 1-min HIIT improves beta cell glucose sensitivity in postmenopausal females with type 2 diabetes: a secondary analysis. J Appl Physiol (1985). 2025 Jan 1;138(1):311-317. doi: 10.1152/japplphysiol.00777.2024. Epub 2024 Dec 18.
Other Identifiers
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DT2-HIIT-Prot
Identifier Type: -
Identifier Source: org_study_id
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