Continuous exercise (CON) and high-intensity interval exercise (HIIE) can be safely performed with type 1 diabetes mellitus (T1DM). Additionally, continuous glucose monitoring (CGM) systems may serve as a tool to reduce the risk of exercise-induced hypoglycemia. It is unclear if CGM is accurate during CON and HIIE at different mean workloads. Seven T1DM patients performed CON and HIIE at 5% below (L) and above (M) the first lactate turn point (LTP₁), and 5% below the second lactate turn point (LTP₂) (H) on a cycle ergometer. Glucose was measured via CGM and in capillary blood (BG). Differences were found in comparison of CGM vs. BG in three out of the six tests (p < 0.05). In CON, bias and levels of agreement for L, M, and H were found at: 0.85 (−3.44, 5.15) mmol·L⁻¹, −0.45 (−3.95, 3.05) mmol·L⁻¹, −0.31 (−8.83, 8.20) mmol·L⁻¹ and at 1.17 (−2.06, 4.40) mmol·L⁻¹, 0.11 (−5.79, 6.01) mmol·L⁻¹, 1.48 (−2.60, 5.57) mmol·L⁻¹ in HIIE for the same intensities. Clinically-acceptable results (except for CON H) were found. CGM estimated BG to be clinically acceptable, except for CON H. Additionally, using CGM may increase avoidance of exercise-induced hypoglycemia, but usual BG control should be performed during intense exercise.

The aim of the study was to assess the amount of orally administered carbohydrates needed to maintain euglycemia during moderate-intensity exercise in individuals with type 1 diabetes. Nine participants with type 1 diabetes (four women, age 32.1 ± 9.0 years, BMI 25.5 ± 3.9 kg/m², HbA_1c 55 ± 7 mmol/mol (7.2 ± 0.6%)) on insulin Degludec were randomized to cycle for 55 min at moderate intensity (63 ± 7% VO_2peak) for five consecutive days on either 75% or 100% of their regular basal insulin dose. The impact of pre-exercise blood glucose concentration on the carbohydrate requirement was analyzed by one-way ANOVA stratified for pre-exercise blood glucose quartiles. The effect of the basal insulin dose on the amount of orally administered carbohydrates was evaluated by Wilcoxon matched-pairs signed-rank test. The amount of orally administered carbohydrates during the continuous exercise sessions was similar for both trial arms (75% or 100% basal insulin) with median [IQR] of 36 g (9–62 g) and 36 g (9–66 g) (p = 0.78). The amount of orally administered carbohydrates was determined by pre-exercise blood glucose concentration for both trial arms (p = 0.03). Our study elucidated the importance of pre-exercise glucose concentration related orally administered carbohydrates to maintain euglycemia during exercise in individuals with type 1 diabetes.

Estimation of the intensity of physical activity (PA) based on absolute accelerometer cut points (Cp) likely over- or underestimates intensity for a specific individual. The purpose of this study was to investigate the relationship between absolute moderate intensity Cp and the first ventilatory threshold (VT₁). A group of 24 pregnant and 15 nonpregnant women who performed a submaximal incremental walking test with measures of ventilatory parameters and accelerations from three different accelerometers on the wrist (ActiGraph wGT3X-BT, GENEActiv, Axivity AX3) and one on the hip (Actigraph wGT3X-BT) were analyzed. Cp were determined corresponding to 3 metabolic equivalents of task (MET), using the conventional MET definition (Cp_3.5) (3.5 mL/kg×min) and individual resting metabolic rate (Cp_ind). The ventilatory equivalent (VE/VO₂) was used to determine VT₁. Accelerations at VT₁ were significantly higher (p < 0.01) compared to Cp_3.5 and Cp_ind in both groups. Cp_3.5 and Cp_ind were significantly different in nonpregnant (p < 0.01) but not in pregnant women. Walking speed at VT₁ (5.7 ± 0.5/6.2 ± 0.8 km/h) was significantly lower (p < 0.01) in pregnant compared to nonpregnant women and correspondent to 3.8 ± 0.7/4.9 ± 1.4 conventional METs. Intensity at absolute Cp was lower compared to the intensity at VT₁ independent of the device or placement in pregnant and nonpregnant women. Therefore, we recommend individually tailored cut points such as the VT₁ to better assess the effect of the intensity of PA.

The aim of our study is to determine the first (LTP₁) and the second (LTP₂) lactate turn points during an incremental bicep curl test and to verify these turn points by ventilatory turn points (VT₁ and VT₂) and constant-load exercise tests. Twelve subjects performed a one-arm incremental bicep curl exercise (IET) after a one repetition maximum (1RM) test to calculate the step rate for the incremental exercise (1RM/45). Workload was increased every min at a rate of 30 reps/min until maximum. To verify LTPs, VT₁ and VT₂ were determined from spirometric data, and 30 min constant-load tests (CL) were performed at 5% P_max below and above turn points. Peak load in IET was 5.3 ± 0.9 kg (La_max: 2.20 ± 0.40 mmol·L⁻¹; HR_max: 135 ± 15 b·min⁻¹; VO_2max: 1.15 ± 0.30 L·min⁻¹). LTP₁ was detected at 1.9 ± 0.6 kg (La: 0.86 ± 0.36 mmol·L⁻¹; HR 90 ± 13 b·min⁻¹; VO₂: 0.50 ± 0.05 L·min⁻¹) and LTP₂ at 3.8 ± 0.7 kg (La: 1.38 ± 0.37 mmol·L⁻¹; 106 ± 10 b·min⁻¹; VO₂: 0.62 ± 0.11 L·min⁻¹). Constant-load tests showed a lactate steady-state in all tests except above LTP₂, with early termination after 16.5 ± 9.1 min. LTP₁ and LTP₂ could be determined in IET, which were not significantly different from VT₁/VT₂. Constant-load exercise validated the three-phase concept, and a steady-state was found at resting values below VT₁ and in all other tests except above LTP₂. It is suggested that the three-phase model is also applicable to small muscle group exercise.

Therapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case of a man with long-lasting type 1 diabetes in whom no blood glucose decrease during different types of exercise with varying exercise intensities and modes was found, despite physiological hormone responses. A Caucasian man diagnosed with type 1 diabetes for 24 years performed three different continuous high-intensity interval cycle ergometer exercises as part of a clinical trial (ClinicalTrials.gov identifier NCT02075567). Intensities for both modes of exercises were set at 5% below and 5% above the first lactate turn point and 5% below the second lactate turn point. Short-acting insulin doses were reduced by 25%, 50%, and 75%, respectively. Measurements taken included blood glucose, blood lactate, gas exchange, heart rate, adrenaline, noradrenaline, cortisol, glucagon, and insulin-like growth factor-1. Unexpectedly, no significant blood glucose decreases were observed during all exercise sessions (start versus end, 12.97 ± 2.12 versus 12.61 ± 2.66 mmol L−1, p = 0.259). All hormones showed the expected response, dependent on the different intensities and modes of exercises. People with type 1 diabetes typically experience a decrease in blood glucose levels, particularly during low- and moderate-intensity exercises. In our patient, we clearly found no decline in blood glucose, despite a normal hormone response and no history of any insulin insensitivity. This report indicates that there might be patients for whom the recommended preexercise therapy adaptation to avoid exercise-induced hypoglycemia needs to be questioned because this could increase the risk of severe hyperglycemia and ketosis.

Pre-competitive conditioning has become a substantial part of successful performance. In addition to temperature changes, a metabolic conditioning can have a significant effect on the outcome, although the right dosage of such a method remains unclear. The main goal of the investigation was to measure how a lower body high-intensity anaerobic cycling pre-load exercise (HIE) of 25 s affects cardiorespiratory and metabolic responses in subsequent upper body performance. Thirteen well-trained college-level male cross-country skiers (18.1 ± 2.9 years; 70.8 ± 7.6 kg; 180.6 ± 4.7 cm; 15.5 ± 3.5% body fat) participated in the study. The athletes performed a 1000-m maximal double-poling upper body ergometer time trial performance test (TT) twice. One TT was preceded by a conventional low intensity warm-up (TT_low) while additional HIE cycling was performed 9 min before the other TT (TT_high). Maximal double-poling performance after the TT_low (225.1 ± 17.6 s) was similar (p > 0.05) to the TT_high (226.1 ± 15.7 s). Net blood lactate (La) increase (delta from end of TT minus start) from the start to the end of the TT_low was 10.5 ± 2.2 mmol L⁻¹ and 6.5 ± 3.4 mmol L⁻¹ in TT_high (p < 0.05). La net changes during recovery were similar for both protocols, remaining 13.5% higher in TT_high group even 6 min after the maximal test. VCO₂ was lower (p < 0.05) during the last 400-m split in TT_high, however during the other splits no differences were found (p < 0.05). Respiratory exchange ratio (RER) was significantly lower in TT_high in the third, fourth and the fifth 200 m split. Participants individual pacing strategies showed high relation (p < 0.05) between slower start and faster performance. In conclusion, anaerobic metabolic pre-conditioning leg exercise significantly reduced net-La increase, but all-out upper body performance was similar in both conditions. The pre-conditioning method may have some potential but needs to be combined with a pacing strategy different from the usual warm-up procedure.