Cattedra di Semeiotica Medica dell'Universitfi di Torino * Cattedra di Clinica Medica I dell'Universit'~ di Torino ** Divisione di Cardiologia, Ospedale Maggiore S. Giovanni Batrista, Torino ***
METABOLIC AND HORMONAL CHANGES DURING EXERCISE IN HEALTHY, DIABETIC AND OBESE SUBJECTS ° GIANFRANCO PAGANO *
MAR[ELLA TROVATI * : ' ¢
ANDREA AIRALDI "'¢ ELISABETTA P I S U ;;-e,-
WALTER MARTINY **r~
GIOVANNA CANTINO :';'; GIANFRANCO LENTI ~:'~'~
A standard physical exercise was performed to compare the metabolic responses of healthy (HS), insulin-dependent diabetic (IDD) and obese (OS) subjects: it was felt more interesting to determine the metabolic reactions of such subjects during their habitual l_~ves (e.g. during a short run or climbing stairs) by exposing them to the same work, as opposed to the previous approach whereby different work was imposed to obtain the same work load in subjects with different weight is. In the situations of ~he former type, each subject faces very different difficulties with respect to his own weight, quite apart from individual work training. Since compliance with the environment rather than the contrary is the usual rule, we used the same tapis-roulant speed and inclination for all subjects, so that the exercise load varied in function of weight. Obese subjects thus faced a significantly heavier work load in overcoming this light obstacle in comparison with HS and IDD whose weights were much the same on average. The object of this study was to compare the metabolic and hormonal changes measured in the peripheral blood in HS and IDD, in the light of direct visceral measurements performed by FELIG a n d WAHREN 7,8.9.28.29,~0,31.32and to see whether OS in fact display smaller hormone responses to exercise, as reported by other authors ~s Key-words: Cor~iso[; Diabetes; Exercise: Glucagon," Growth hormone; Insulin; Obesity. °The work was supported in part by C.N.R. (ConsigIio Nazionale delle Ricerche) Gran~ No. 73.00575.04. Received: April 8, 1978. Acta diabe~, lat. i6, 19, 1979.
19
METABOLIC AND HORMONAL CHANGES DURING EXERCISE IN HEALTHY, DIABETIC AND OBESE SUBJECTS
blATERIALS AND METHODS Five HS, aged 23 +--- 1 years and weighing 61.8 -+- 6.t kg (96 --+ 4% ideal body weight), 5 IDD in good metabolic control (age 28 -+- 6 years; weight 63 ----- 3.7 kg; 101 ± 4% ideal body weight) and 5 0 S (age 30 ± 2 years; weight 90 ± 6.1 kg; 135 -+- 11% ideal body weight) were submitted to the test between 0830 and 0900 after an overnight fast. IDD had received three regular insulin injections before meals on the previous day; insulin was discontinued on the morning of the test. After 30-rain rest in a recumbent position, an indwelling polyethylene cannula was inserted in an antecubital vein. Two basal samples were obtained, after which each subject mounted the tapis-roulant, the speed and slope of which were gradually brought to 4.8 kgm and 10% in 2 min; exercise was continued for 30 min. The subjects then lay down for 1 h. The test lasted a total of 135 min. Blood samples. taken before, during and after exercise at -15, 0, 5, 10, 15, 20, 30, 45, 60 and 90 rain, were immediately chilled in ice water and collected in two series of chilled tubes with EDTA + Trasylol (500 KIE//ml of blood) for glucagon assay and with EDTA alone for other analyses. The tubes were centrifuged at 4 "C and the plasma stored at -20 "C until required. All measurements, hormones and substrates, were performed on plasma samples. FFA determination was performed on the day of the test. Plasma glucose was determined according to the glucose-oxidase method (GOD-Perid, Biochemia); glycerol was determined enzymatically (Biochemia); FFA were determined colorimetrically (Carlo Erba); insulin (IRI) was measured by a single antibody method (Richter): glucagon (IRG) was measured by a single antibody method t6; growth hormone (GH) was determined by the double antibody method (Richter); cortisol (CS) was measured by a binding competition method (Sorin).
RESULTS HS and IDD had much the same body weight and hence sustained about the same exercise load (870 +--t5 and 878 ± 52 kgm/min, respectively), whereas OS undertook a heavier load (1,258 m 84 k g m / m i n ) ( p < 0 . 0 1 ) Plasma glucose changes were no more than slightly significant in I-IS with a decrease at 45 min only. There was no significant increase between 5 and 30 rain in the IDD. The initial increase in glycerol was poorly significant in HS and IDD, and highly significant in OS. Values returned to the baseline at 90 rain in HS and IDD, but remained high in OS. FFA were higher in OS and IDD under basal conditions and after exercise. Means and SEM are shown in tab. 1. Significance was calculated between basal and individual values with the non-paired t-test; analysis of variance was performed in the three groups of data and Scheffd's test 2 was applied between HS and patient (IDD and OS) means of values at each time. in HS, IRI fell slightly at the start, returned to the baseline at 20 rain, and then increased to reach a plateau at 45-90 min; IDD displayed no plasma insulin response, while OS presented an initial decrease, followed by a marked increase to a peak at 45 min, and a final decrease at 90 rain. IRG showed no significant change; fluctuations with a maximum at 15 min were noted in HS; IDD displayed a maximum increase at 45 rain, followed by a fall; an initial tendency to decrease appeared in 20
I',o
-260 ± 31 ---
t{S IDD US
}IS US
plasma F F A (ttEq/1)
plasma [ R I (~J~U/ml)
HS IDD US
plasma corlisol ( n g / m l )
98 ± 29 196±,49 103 ± 25 2.62
0,7 ± 0.1 4,1±0.9 1.3 -+- 0.3 8~68"
230 + 32 110 ± 17 108±10 0,29
-203±48 124 ± 23 1.57
0,8 -+ 0.I 5,7±1,7 ° 0.9 ± 0.2 7.67*
130 -+ 12 122 -~- 20 97±11 1,29
4.6 ± 0.8 8,0+1.9 1.02
326 ± 83 286 -~ 38 426 ± 12 0.67
0.8 ± 0,2 1.1 ± 0.2 0.9±0,1 0.60
88 ± 3.4 201 -~ 39 ° 81 ± 2.7 9.23*
0
5
226 ± 21 145 ± 32 77±6 ° 2.04
142 ± 41 226±63 12l ± 24 1,57
142 :-~:44 258 m 50 153 -± 32 2.17
345 ± 10 352 ± 40 552 ± 43 ° 2.64
0.9±0,1 0.9 ± 0.1 1.9±0.5 ° 3.83*
86 + 2.2 2 1 0 ± ~7° 101 ± 3.3* 11.50"
60
8.2 ~ 3.l* 12.84-2 * 5.2 ± 1.9 2.19
130 ± 23 184 ± 50 103 m 17 1.67
7.2+3.4 8.5±1,6 1.8 ± 0.4 2.47
125 ± 25 139 ~ 2l 105-+-17 1. 00
5.4 ± 1.4 5.4 ± 1,4 3 6 . 5 ± 1 1 °* 2 9 , 5 ± 1 1 °* 7.61" 3.84"
260 ± 47 396 ± 43 682 ± 11 ° 7,72:"
1.2±0.1 1.4 ± 0.2 3 . 3 + 0 . 5 °* 12.18"
78 + 2.t 207 ± : J 7 ° 108 ± 7,3* 11.46"
45
144 ± 36 126 ± 39 131 ± 41 311±50 221±39 175±37 33.5 ± 124 °* 368 ± 128 °* 332 ± 131 2.16 2.18 1.53
8.9±4.3 23.7±5* 23,7 ± 10" 2.52
146 ± 23 149 + 34 102±11 0.84
4,4 ± 2.4 4,0+1.2 1.87
210 ± 53 408 :-~. 109 502 -~- 43 ° 3.00
1,6 ± 0.2 * 2,0 ± 0.1" 3 . 7 ± 0 . 5 °* 10.58"
85 -+ 2,6 200 :~: 42
METABOLIC AND HORMONAL CHANGES DURING EXERCISE IN HEALTHY, DIABETIC AND OBESE SUBJECTS ° GIANFRANCO PAGANO *
MAR[ELLA TROVATI * : ' ¢
ANDREA AIRALDI "'¢ ELISABETTA P I S U ;;-e,-
WALTER MARTINY **r~
GIOVANNA CANTINO :';'; GIANFRANCO LENTI ~:'~'~
A standard physical exercise was performed to compare the metabolic responses of healthy (HS), insulin-dependent diabetic (IDD) and obese (OS) subjects: it was felt more interesting to determine the metabolic reactions of such subjects during their habitual l_~ves (e.g. during a short run or climbing stairs) by exposing them to the same work, as opposed to the previous approach whereby different work was imposed to obtain the same work load in subjects with different weight is. In the situations of ~he former type, each subject faces very different difficulties with respect to his own weight, quite apart from individual work training. Since compliance with the environment rather than the contrary is the usual rule, we used the same tapis-roulant speed and inclination for all subjects, so that the exercise load varied in function of weight. Obese subjects thus faced a significantly heavier work load in overcoming this light obstacle in comparison with HS and IDD whose weights were much the same on average. The object of this study was to compare the metabolic and hormonal changes measured in the peripheral blood in HS and IDD, in the light of direct visceral measurements performed by FELIG a n d WAHREN 7,8.9.28.29,~0,31.32and to see whether OS in fact display smaller hormone responses to exercise, as reported by other authors ~s Key-words: Cor~iso[; Diabetes; Exercise: Glucagon," Growth hormone; Insulin; Obesity. °The work was supported in part by C.N.R. (ConsigIio Nazionale delle Ricerche) Gran~ No. 73.00575.04. Received: April 8, 1978. Acta diabe~, lat. i6, 19, 1979.
19
METABOLIC AND HORMONAL CHANGES DURING EXERCISE IN HEALTHY, DIABETIC AND OBESE SUBJECTS
blATERIALS AND METHODS Five HS, aged 23 +--- 1 years and weighing 61.8 -+- 6.t kg (96 --+ 4% ideal body weight), 5 IDD in good metabolic control (age 28 -+- 6 years; weight 63 ----- 3.7 kg; 101 ± 4% ideal body weight) and 5 0 S (age 30 ± 2 years; weight 90 ± 6.1 kg; 135 -+- 11% ideal body weight) were submitted to the test between 0830 and 0900 after an overnight fast. IDD had received three regular insulin injections before meals on the previous day; insulin was discontinued on the morning of the test. After 30-rain rest in a recumbent position, an indwelling polyethylene cannula was inserted in an antecubital vein. Two basal samples were obtained, after which each subject mounted the tapis-roulant, the speed and slope of which were gradually brought to 4.8 kgm and 10% in 2 min; exercise was continued for 30 min. The subjects then lay down for 1 h. The test lasted a total of 135 min. Blood samples. taken before, during and after exercise at -15, 0, 5, 10, 15, 20, 30, 45, 60 and 90 rain, were immediately chilled in ice water and collected in two series of chilled tubes with EDTA + Trasylol (500 KIE//ml of blood) for glucagon assay and with EDTA alone for other analyses. The tubes were centrifuged at 4 "C and the plasma stored at -20 "C until required. All measurements, hormones and substrates, were performed on plasma samples. FFA determination was performed on the day of the test. Plasma glucose was determined according to the glucose-oxidase method (GOD-Perid, Biochemia); glycerol was determined enzymatically (Biochemia); FFA were determined colorimetrically (Carlo Erba); insulin (IRI) was measured by a single antibody method (Richter): glucagon (IRG) was measured by a single antibody method t6; growth hormone (GH) was determined by the double antibody method (Richter); cortisol (CS) was measured by a binding competition method (Sorin).
RESULTS HS and IDD had much the same body weight and hence sustained about the same exercise load (870 +--t5 and 878 ± 52 kgm/min, respectively), whereas OS undertook a heavier load (1,258 m 84 k g m / m i n ) ( p < 0 . 0 1 ) Plasma glucose changes were no more than slightly significant in I-IS with a decrease at 45 min only. There was no significant increase between 5 and 30 rain in the IDD. The initial increase in glycerol was poorly significant in HS and IDD, and highly significant in OS. Values returned to the baseline at 90 rain in HS and IDD, but remained high in OS. FFA were higher in OS and IDD under basal conditions and after exercise. Means and SEM are shown in tab. 1. Significance was calculated between basal and individual values with the non-paired t-test; analysis of variance was performed in the three groups of data and Scheffd's test 2 was applied between HS and patient (IDD and OS) means of values at each time. in HS, IRI fell slightly at the start, returned to the baseline at 20 rain, and then increased to reach a plateau at 45-90 min; IDD displayed no plasma insulin response, while OS presented an initial decrease, followed by a marked increase to a peak at 45 min, and a final decrease at 90 rain. IRG showed no significant change; fluctuations with a maximum at 15 min were noted in HS; IDD displayed a maximum increase at 45 rain, followed by a fall; an initial tendency to decrease appeared in 20
I',o
-260 ± 31 ---
t{S IDD US
}IS US
plasma F F A (ttEq/1)
plasma [ R I (~J~U/ml)
HS IDD US
plasma corlisol ( n g / m l )
98 ± 29 196±,49 103 ± 25 2.62
0,7 ± 0.1 4,1±0.9 1.3 -+- 0.3 8~68"
230 + 32 110 ± 17 108±10 0,29
-203±48 124 ± 23 1.57
0,8 -+ 0.I 5,7±1,7 ° 0.9 ± 0.2 7.67*
130 -+ 12 122 -~- 20 97±11 1,29
4.6 ± 0.8 8,0+1.9 1.02
326 ± 83 286 -~ 38 426 ± 12 0.67
0.8 ± 0,2 1.1 ± 0.2 0.9±0,1 0.60
88 ± 3.4 201 -~ 39 ° 81 ± 2.7 9.23*
0
5
226 ± 21 145 ± 32 77±6 ° 2.04
142 ± 41 226±63 12l ± 24 1,57
142 :-~:44 258 m 50 153 -± 32 2.17
345 ± 10 352 ± 40 552 ± 43 ° 2.64
0.9±0,1 0.9 ± 0.1 1.9±0.5 ° 3.83*
86 + 2.2 2 1 0 ± ~7° 101 ± 3.3* 11.50"
60
8.2 ~ 3.l* 12.84-2 * 5.2 ± 1.9 2.19
130 ± 23 184 ± 50 103 m 17 1.67
7.2+3.4 8.5±1,6 1.8 ± 0.4 2.47
125 ± 25 139 ~ 2l 105-+-17 1. 00
5.4 ± 1.4 5.4 ± 1,4 3 6 . 5 ± 1 1 °* 2 9 , 5 ± 1 1 °* 7.61" 3.84"
260 ± 47 396 ± 43 682 ± 11 ° 7,72:"
1.2±0.1 1.4 ± 0.2 3 . 3 + 0 . 5 °* 12.18"
78 + 2.t 207 ± : J 7 ° 108 ± 7,3* 11.46"
45
144 ± 36 126 ± 39 131 ± 41 311±50 221±39 175±37 33.5 ± 124 °* 368 ± 128 °* 332 ± 131 2.16 2.18 1.53
8.9±4.3 23.7±5* 23,7 ± 10" 2.52
146 ± 23 149 + 34 102±11 0.84
4,4 ± 2.4 4,0+1.2 1.87
210 ± 53 408 :-~. 109 502 -~- 43 ° 3.00
1,6 ± 0.2 * 2,0 ± 0.1" 3 . 7 ± 0 . 5 °* 10.58"
85 -+ 2,6 200 :~: 42
