Published on 22 January 2021

The simple technique could ward-off complications of diabetes and prolong life.

Researchers at Liverpool Hope University have developed an exercise warm-up routine that can assist people living with type 1 diabetes to exercise for longer while reducing the risk of additional complications.

People with type 1 diabetes are at an increased risk of cardiovascular disease and are encouraged to take regular exercise.

But that is often not as easy as it sounds - with many people living with the condition struggling to tolerate any sort of significant fitness regime.

A team led by researchers at Liverpool Hope University has discovered for the first time how 'VO2 kinetics’ - the time it takes for the body to glean the additional energy needed for exercise - is much slower in people living with type 1 diabetes compared with people who do not have the condition.

The sport scientists discovered how a short ‘priming’ warm-up exercise - which involved a 6 minute burst of hard pedalling on an exercise bike - just before a training session could speed up the VO2 kinetics, making it much easier for them to get the energy they needed.

The results of studies found that ‘critical power’ - the highest intensity before the onset of fatigue – was boosted in diabetes patients by around 8%.

Researchers said that could help people living with type 1 diabetes exercise at higher intensities and for longer, in addition to potentially warding off heart disease.

Researchers said the results, recently published in the Journal of Applied Physiology, “have important implications for the development of interventions to enhance aerobic fitness in this patient group”.

Lead author Dr Simon Marwood, Associate Professor in Physiology of Hope’s School of Health Sciences, says: "This is the first evidence in this patient group that a simple warm up exercise can enhance subsequent exercise performance. 

“It could therefore be used as an aid to improve training intensity, or simply to overcome the barriers in the capacity to undertake exercise at all.”  

Dr Marwood, along with co-authors Dr Richie Goulding and Associate Professor Associate Denise Roche, performed the study in two phases.

Phase one saw 17 males with type 1 diabetes, and 17 healthy males without type 1 diabetes - with an average age in their early to late 30s - put through their paces on a laboratory exercise bike.

Various measurements were taken, including VO2 peak - the point at which oxygen uptake no longer increases with an increase in workload - and blood glucose levels, while being pushed to exhaustion.

Dr Marwood found oxygen uptake kinetics - and general aerobic fitness - were significantly compromised in the group with diabetes - equivalent to around 30 years plus of ageing - compared with healthy individuals.

Dr Marwood said: “Aerobic fitness is an important determinant of cardiovascular risk and cardiovascular risk is already substantially higher in individuals with type 1 diabetes compared to individuals without diabetes.

“The findings from Part 1 are therefore clinically relevant to individuals living with type 1 diabetes, suggesting that interventions aimed at mitigating cardiovascular risk and improving life expectancy in type 1 diabetes necessitate a strong focus on improvement of aerobic fitness.”

Exercise Bikes Being Used

Part two of the trial focused on seven participants with type 1 diabetes.

During a series of tests, they were asked to exercise to failure in order to establish their ‘critical power’.

These bursts of activity were performed both with and without an initial ‘priming’ exercise.

This priming consisted of 3 minutes of gentle ‘baseline’ pedalling, before a sharp ramp up for 6 minutes, followed by a rest of 7 minutes before the main test began. 

Scientists found that the priming exercise ‘resulted in faster VO2 kinetics and a greater critical power when compared to the control condition’ with an ‘increase in critical power of 8% compared to the control condition’.

Dr Marwood added: “Patients with type 1 diabetes demonstrated slower VO2 kinetics when compared to healthy controls. 

“Furthermore, a prior bout of high-intensity exercise speeded oxygen uptake kinetics and increased critical power in people with type 1 diabetes. 

“These findings highlight the potential for other interventions, perhaps nutritional or pharmacological, that also speed VO2 kinetics for enhancing exercise tolerance in this condition.”

In addition, the team of researchers made another surprising finding. 

Contrary to expectations, they found that the issue was not about how oxygen is delivered to the body - but about how muscles are able to utilise it on a cellular level, with people with type 1 diabetes compromised in this respect.

Dr Marwood said: “In type 1 diabetes, therefore, our data strongly suggest that VO2 kinetics, and in turn critical power and exercise tolerance, are primarily limited by an impaired ability to use oxygen in the muscle cell, rather than impairments in the delivery of oxygen.

“Furthermore, these derangements to cellular metabolism can, at least partially, be reversed via a prior bout of priming exercise.”

The research concluded: “This is the first assessment of VO2 kinetics in adults with type 1 diabetes, and we demonstrate a profound slowing of the VO2 kinetics in the type 1 diabetes group relative to the control group.

“The injurious effects of type 1 diabetes on the aerobic phenotype noted herein are likely to contribute to the burden associated with the disease and its secondary complications.”

Addressing the priming exercise, Dr Marwood said: “Our finding of impairments in each of the most important parameters of aerobic function in type 1 diabetes supports recent suggestions that the current physical activity recommendations may be insufficient to offset the deleterious effects of this disorder on aerobic function.

“Moreover, our data suggest that interventions that can specifically improve the speed of the VO2 kinetics will enhance exercise tolerance in this population.”

Type 1 diabetes, sometimes known as juvenile diabetes or insulin-dependent diabetes, is a condition in which the pancreas produces little or no insulin - with insulin being a hormone required to allow sugar to enter cells to produce energy.

The benefits of ‘priming’ exercises were first established in the early 2000’s by Dr Mark Burnley, of the University of Kent, and Andy Jones, Professor of Applied Physiology at the University of Exeter. Professor Jones has made global headlines in recent years as scientist and external advisor for Nike's mission to break the two-hour barrier for the marathon.

Read the report in Journal of Applied Physiology
Read the DRWF leaflet Exercise and diabetes

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Sarah Tutton, Chief Executive of DRWF, said: “Research is the only way to find new treatments and a cure for diabetes. We have multi-year grant awards in place right now which we must do our utmost to honour and we must be able to react to ongoing applications that we receive for research work that could truly make a difference to the lives of people with diabetes. 

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Read Lockdown guidance for staying home and safe for people living with diabetes during Covid-19 pandemic
Read How people with diabetes could become more ill if diagnosed with Covid-19
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