.-Physical inactivity likely plays a role in the development of insulin resistance and obesity; however, direct evidence is minimal and mechanisms of action remain unknown. Studying metabolic outcomes that occur after transitioning from higher to lower levels of physical activity is the best tool to answer these questions. Previous studies have successfully used more extreme models of inactivity, including bed rest, or the cessation of exercise in highly trained endurance athletes, to provide novel findings. However, these models do not accurately reflect the type of inactivity experienced by a large majority of the population. Recent studies have used a more applicable model in which active (ϳ10,000 steps/day), healthy young controls are asked to transition to an inactive lifestyle (ϳ1,500 steps/day) for a 14-day period. The transition to inactivity resulted in reduced insulin sensitivity and increased central adiposity. This review will discuss the outcomes of these studies, their implications for the cause/effect relationship between central adiposity and insulin resistance, and provide rationale for why inactivity induces these factors. In addition, the experimental challenges of directly linking acute responses to inactivity to chronic disease will also be discussed. inactivity; skeletal muscle; insulin sensitivity; obesity
TYPE 2 DIABETES AND CENTRAL OBESITYOBESITY and obesity-associated metabolic diseases are increasing at epidemic rates. The World Health Organization's (WHO) latest estimates indicate that ϳ400 million adults were obese (body mass index Ͼ 30 kg/m 2 ) globally in 2006 and predict that these numbers will rise to 700 million by the year 2015. This increase in obesity parallels a dramatic increase in the number of persons diagnosed with Type 2 diabetes (T2D). In 2009, WHO estimated that more than 200 million people worldwide have T2D, and it is estimated that worldwide T2D rates will double between the year 2000 and 2030 (46). Although excess adiposity in all regions can cause metabolic consequences, excess central adiposity (visceral adiposity) is most tightly linked to the development of T2D (1,3,9,12,13). The current dogma implies that central adiposity first develops, leading to inflammation and/or an increased storage of ectopic lipids in skeletal muscle and liver, which induces insulin resistance and ultimately leads to T2D (31), but this order of events has never been proven (33). The causes of both increased central obesity and type 2 diabetes are undoubtedly multifactorial and complex; however, we (5, 43) and others (15, 23) believe that a lack of regular exercise, or physical inactivity, plays a fundamental role. This hypothesis is backed by epidemiological evidence suggesting that physical inactivity plays a causal role in the development of T2D (20, 21) and obesity (10) while regular physical activity significantly lowers risk (2, 23, 24) for both conditions. While these studies strongly associate inactivity to T2D and obesity, historically, there have been a limited number of stu...