Acute inspiratory muscle exercise effect on glucose levels, glucose variability and autonomic control in patients with type 2 diabetes: A crossover randomized trial

Abstract

Inspiratory muscle exercise (IME) can be an alternative to conventional exercise. We aimed to evaluate the effect of IME on glucose, glucose variability, and autonomic cardiovascular control in type 2 diabetes. Fourteen diabetic subjects were randomly assigned to IME with 2% maximal inspiratory pressure (PImax) or 60% PImax wearing a continuous glucose monitoring system for three days. Glucose variability [glucose variance (VAR), glucose coefficient of variation (CV%), glucose standard deviation (SD), and mean amplitude of glycemic excursions (MAGE)] were evaluated. Glucose reduction was observed in 5 min (60% of PImax 33.2% and 2% of PImax 32.0%), 60 min (60% of PImax 29.6% and 2% of PImax 31.4%) and 120 min (60% of PImax 21.4% and 2% of PImax 24.0%) after IME (vs.1 h before the exercise), with no difference between loads. This reduction in glucose levels was observed in all moments of the IME protocol. Glucose variability was reduced after 12 h and 18 h of the IME (ΔCV: P < 0.001, ΔSD: P < 0.001 and ΔVAR: P < 0.001) for both loads. No difference was found in MAGE (P = 0.594) after IME. Mean arterial pressure and heart rate rose during the exercise session with 60% of PImax. Although sufficiently strong to induce cardiovascular changes, an inspiratory muscle exercise session with 60% of PImax in subjects with type 2 diabetes has failed to induce any significant improvement in glucose, glucose variability and autonomic control, compared to the 2% Plmax exercise session.

Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: a randomized controlled trial

“…In addition, Örün et al (2021) found a significant decrease in cortisol levels after an acute breathing exercise session. Moreover, in line with our findings, Schein et al (Schein et al, 2020) concluded that breathing exercise significantly decreased FBG in T2DM patients. Likewise, Hedge et al (2012) noted that breathing exercises could be incorporated in standard care as an add-on therapy to improve the glycemic parameters in T2DM patients.…”

Effects of Inspiratory Muscle Training in Type 2 Diabetes: A Systematic Review

“…IMT protocol acute showed a reduction in the normalized high frequency (or HFn) component in one session, with a MIP training session at 60% [ 36 ] , i.e. , there was a greater predominance of the sympathetic component during one training session with that load.…”

“…This is due to the increase in vagal modulation after controlled exercises, since a stimulus to the hepatic vagus nerve has reduced blood glucose in rats [ 44 ] . In an acute way, IMT has already shown interference on glycemic levels, demonstrating a reduction in values [ 18 , 36 ] .…”

Neuromuscular electrical stimulation changes glucose, but not its variability in type 2 diabetes: a randomized clinical trial

“…Glucose variability analyses comprised SD, CV% and MAGE (Hill et al 2011). These indices, except for MAGE, were calculated within a 6-h timeframe (Fofonka et al 2018, Schein et al 2020. MAGE index was calculated 24h after An Acad Bras Cienc (2024) 96(1) e20220282 4 | 13 intervention based on differences between peak and nadir points higher than 1SD (Hill et al 2011).…”

“…Alternative exercise interventions, such as inspiratory muscle exercises, were capable of acutely reducing glucose levels (Schein et al 2020) and after 8-week training (Pinto et al 2020). Neuromuscular electrical stimulation (NMES) can also be an alternative method to conventional exercising, since it helps increase muscle strength, endurance, cardiorespiratory fitness, and quality of life (Gomes Neto et al 2016).…”