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Physical activity intensity and type 2 diabetes risk in overweight youth: a randomized trial

International Journal of Obesity volume 40, pages 607–614 (2016)Cite this article

Subjects

Abstract

Background:

The chronic effects of high-intensity endurance training on metabolic health outcomes in overweight adolescents remains poorly understood.

Objective:

To test the hypothesis that high-intensity endurance training (ET) is superior to moderate-intensity ET for improving risk factors for type 2 diabetes in overweight adolescents.

Design and methods:

In this randomized trial, 106 overweight and obese adolescents (15.2 years; 76% female; 62% Caucasian) were randomly assigned to high-intensity ET (70–85% of heart rate reserve, n=38), moderate-intensity ET (40–55% heart rate reserve; n=32) or control for 6 months (n=36). The primary and secondary outcome measures were insulin sensitivity assessed using a frequently sampled intravenous glucose tolerance test and hepatic triglyceride content with magnetic resonance spectroscopy. Exploratory outcomes were cardiorespiratory fitness, physical activity and MRI and dual x-ray absorptiometry-derived measures of adiposity.

Results:

The study had 96% retention and attendance was 61±21% and 55±24% in the high- and moderate-intensity ET arms. Intention-to-treat analyses revealed that, at follow-up, insulin sensitivity was not different between high-intensity (−1.0 mU kg−1 min−1; 95% confidence interval (CI): −1.6, +1.4 mU kg−1 min−1) and moderate-intensity (+0.26 mU kg−1 min−1; 95% CI: −1.3, +1.8 mU kg−1 min−1) ET arms compared with controls (interaction, P=0.97). Similarly, hepatic triglyceride at follow-up was not different in high-intensity (−1.7% fat/water (F/W); 95% CI: −7.0, +3.6% F/W) and moderate-intensity (−0.40% FW; 95% CI: −6.0, +5.3% F/W) ET compared with controls. Both high intensity (+4.4 ml per kg-FFM (fat-free mass) per minute; 95% CI: 1.7, 7.1 ml kg-FFM−1 min−1) and moderate intensity (+4.4 ml kg-FFM−1 min−1; 95% CI: 1.6, 7.3 ml kg-FFM−1 min−1) increased cardiorespiratory fitness, relative to controls (interaction P<0.001).

Conclusions:

ET improves cardiorespiratory fitness among obese adolescents; however, owing to lack of compliance, the influence of exercise intensity on insulin sensitivity and hepatic triglycerides remains unclear.

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Acknowledgements

This study was supported by grants from the Canadian Institutes of Health Research, the Lawson Foundation, the Cosmopolitan Foundation and the Children’s Hospital Foundation of Manitoba. Salary support for the project was provided by The Manitoba Health Research Council (JH, BW) and Manitoba Institute of Child Health (JH), the Canadian Diabetes Association (JM) and the Canadian Institutes of Health Research (JM, KW). The funding agencies had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Author contributions

JM conceptualized and designed the research project, collected data carried out analyses and wrote the manuscript. JH collected data, carried out analyses, reviewed and revised the manuscript. KW and BW conceptualized and designed the study, collected data, reviewed and revised the manuscript. AM, TD and LB collected data, reviewed and revised the manuscript. ES, HD and ER participated in the study design, reviewed and revised the manuscript. DK and PG participated in the study design, reviewed and revised the manuscript. We are indebted and extremely grateful to the adolescents that participated in the POWER trial and their parents for supporting them. We also acknowledge the help and support of the following individuals, without whom the project could not have been completed: Mr Paul McArthur, Ms Catherine MacDonald, Maureen McKay RN, Ms Jackie Dumontet, Ms Angella Griffith, Dr Lawrence Ryner, Dr Patricia Gervai, Ms Quan Van Uytven and the nurses of both the Clinical Research Unit of the Manitoba Institute of Child Health and the Diabetes Research Group for their contributions towards data collection and delivery of the intervention. JM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Author notes

  1. J Hay and K Wittmeier: These authors contributed equally to this work.

Authors and Affiliations

  1. Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada

    J Hay, K Wittmeier, A MacIntosh, B Wicklow, E Sellers, H Dean & J McGavock

  2. Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    J Hay, K Wittmeier, B Wicklow, E Sellers, H Dean & J McGavock

  3. Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada

    J Hay, T Duhamel, E Ready, P Gardiner & J McGavock

  4. Health, Leisure and Human Performance Research Institute, Winnipeg, Manitoba, Canada

    T Duhamel, E Ready & P Gardiner

  5. Department of Physiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    T Duhamel, P Gardiner & J McGavock

  6. Institute of Cardiovascular Sciences, St. Boniface Research Centre, Winnipeg, Manitoba, Canada

    T Duhamel

  7. Diabetes Research Group, Health Sciences Centre of Winnipeg, Winnipeg, Manitoba, Canada

    L Berard & G X Shen

  8. Faculty of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada

    D Kriellaars

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Appendix

Appendix

Table a1 Efficacy analysis for youth that completed 70% of prescribed training
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Hay, J., Wittmeier, K., MacIntosh, A. et al. Physical activity intensity and type 2 diabetes risk in overweight youth: a randomized trial. Int J Obes 40, 607–614 (2016). https://doi.org/10.1038/ijo.2015.241

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