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Effects of an outdoor bicycle-based intervention in healthy rural Indian men with normal and low birth weight

  • C. Madsen (a1), P. Mogensen (a1), N. Thomas (a2), D. L. Christensen (a3), I. C. Bygbjerg (a3), V. Mohan (a4), M. Inbakumari (a2), S. V. Nadig (a2), R. Alex (a4), F. S. Geetanjali (a5), K. Westgate (a6), S. Brage (a6), A. Vaag (a1) and L. G. Grunnet (a1)...


Physical inactivity and low birth weight (LBW) may lead to an increased risk for developing type 2 diabetes. The extent to which LBW individuals may benefit from physical exercise training when compared with those with normal birth weight (NBW) controls is uncertain. We assessed the impact of an outdoor exercise intervention on body composition, insulin secretion and action in young men born with LBW and NBW in rural India. A total of 61 LBW and 56 NBW healthy young men were recruited into the study. The individuals were instructed to perform outdoor bicycle exercise training for 45 min every day. Fasting blood samples, intravenous glucose tolerance tests and bioimpedance body composition assessment were carried out. Physical activity was measured using combined accelerometry and heart rate monitoring during the first and the last week of the intervention. Following the exercise intervention, the LBW group displayed an increase in physical fitness [55.0 ml (O2)/kg min (52.0−58.0)−57.5 ml (O2)/kg min (54.4−60.5)] level and total fat-free mass [10.9% (8.0−13.4)−11.4% (8.0−14.6)], as well as a corresponding decline in the ratio of total fat mass/fat-free mass. In contrast, an increase in total fat percentage as well as total fat mass was observed in the NBW group. After intervention, fasting plasma insulin levels, homoeostasis model assessments (HOMA) of insulin resistance (HOMA-IR) and insulin secretion (HOMA-IS), improved to the same extent in both the groups. In summary, young men born with LBW in rural India benefit metabolically from exercise training to an extent comparable with NBW controls.


Corresponding author

*Address for correspondence: Prof. N. Thomas, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Ida Scudder Road, Vellore-632004, India. (Email


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1.Shaw, JE, Sicree, RA, Zimmet, PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87, 414.
2.Yajnik, CS. The insulin resistance epidemic in India: fetal origins, later lifestyle, or both? Nutr Rev. 2001; 59, 19.
3.Jayawardena, R, Ranasinghe, P, Byrne, NM, Soares, MJ, Katulanda, P, Hills, AP. Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis. BMC Public Health. 2012; 12, 380.
4.Misra, A, Khurana, L. The metabolic syndrome in South Asians: epidemiology, determinants, and prevention. Metab Syndr Relat Disord. 2009; 7, 497514.
5.LaMonte, MJ, Blair, SN, Church, TS. Physical activity and diabetes prevention. J Appl Physiol (1985). 2005; 99, 12051213.
6.Sieverdes, JC, Sui, X, Lee, D, et al. Physical activity, cardiorespiratory fitness and the incidence of type 2 diabetes in a prospective study of men. Br J Sports Med. 2010; 44, 238244.
7.Wild, S, Roglic, G, Green, A, Sicree, R, King, H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27, 10471053.
8.DeFronzo, RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009; 58, 773795.
9.Seshiah, V, Balaji, V, Balaji, MS, Paneerselvam, A, Kapur, A. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet. 2009; 104(Suppl. 1), S35S38.
10.Yajnik, CS. Nutrient-mediated teratogenesis and fuel-mediated teratogenesis: two pathways of intrauterine programming of diabetes. Int J Gynaecol Obstet. 2009; 104(Suppl. 1), S27S31.
11.Hales, CN, Barker, DJ, Clark, PM, et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ. 1991; 303, 10191022.
12.Liew, C-F, Seah, E-S, Yeo, K-P, Lee, K-O, Wise, SD. Lean, nondiabetic Asian Indians have decreased insulin sensitivity and insulin clearance, and raised leptin compared to Caucasians and Chinese subjects. Int J Obes Relat Metab Disord. 2003; 27, 784789.
13.Banerji, MA, Faridi, N, Atluri, R, Chaiken, RL, Lebovitz, HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999; 84, 137144.
14.Chandalia, M, Lin, P, Seenivasan, T, et al. Insulin resistance and body fat distribution in South Asian men compared to Caucasian men. PloS One. 2007; 2, e812.
15.Chandalia, M, Abate, N, Garg, A, Stray-Gundersen, J, Grundy, SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999; 84, 23292335.
16.Desai, M, Hales, CN. Role of fetal and infant growth in programming metabolism in later life. Biol Rev Camb Philos Soc. 1997; 72, 329348.
17.Hales, CN, Barker, DJ. The thrifty phenotype hypothesis. Br Med Bull. 2001; 60, 520.
18.Jones, RH, Ozanne, SE. Fetal programming of glucose-insulin metabolism. Mol Cell Endocrinol. 2009; 297, 49.
19.Brøns, C, Jacobsen, S, Hiscock, N, et al. Effects of high-fat overfeeding on mitochondrial function, glucose and fat metabolism, and adipokine levels in low-birth-weight subjects. Am J Physiol Endocrinol Metab. 2012; 302, E43E51.
20.Thomas, N, Grunnet, LG, Poulsen, P, et al. Born with low birth weight in rural Southern India: what are the metabolic consequences 20 years later? Eur J Endocrinol. 2012; 166, 647655.
21.Barker, DJ, Hales, CN, Fall, CH, Osmond, C, Phipps, K, Clark, PM. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia. 1993; 36, 6267.
22.Phillips, DI, Barker, DJ, Hales, CN, Hirst, S, Osmond, C. Thinness at birth and insulin resistance in adult life. Diabetologia. 1994; 37, 150154.
23.Borghouts, LB, Keizer, HA. Exercise and insulin sensitivity: a review. Int J Sports Med. 2000; 21, 112.
24.Nishida, Y, Higaki, Y, Tokuyama, K, et al. Effect of mild exercise training on glucose effectiveness in healthy men. Diabetes Care. 2001; 24, 10081013.
25.Krotkiewski, M, Lönnroth, P, Mandroukas, K, et al. The effects of physical training on insulin secretion and effectiveness and on glucose metabolism in obesity and type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1985; 28, 881890.
26.Dela, F, Stallknecht, B. Effect of physical training on insulin secretion and action in skeletal muscle and adipose tissue of first-degree relatives of type 2 diabetic patients. Am J Physiol Endocrinol Metab. 2010; 299, E80E91.
27.Poehlman, ET, Denino, WF, Beckett, T, et al. Effects of endurance and resistance training on total daily energy expenditure in young women: a controlled randomized trial. J Clin Endocrinol Metab. 2002; 87, 10041009.
28.Lo, MS, Lin, LLC, Yao, W-J, Ma, M-C. Training and detraining effects of the resistance vs. endurance program on body composition, body size, and physical performance in young men. J Strength Cond Res. 2011; 25, 22462254.
29.Ortega, FB, Ruiz, JR, Hurtig-Wennlöf, A, et al. Physical activity attenuates the effect of low birth weight on insulin resistance in adolescents: findings from two observational studies. Diabetes. 2011; 60, 22952299.
30.Eriksson, JG, Ylihärsilä, H, Forsén, T, Osmond, C, Barker, DJP. Exercise protects against glucose intolerance in individuals with a small body size at birth. Prev Med. 2004; 39, 164167.
31.Laaksonen, DE, Lakka, H-M, Lynch, J, et al. Cardiorespiratory fitness and vigorous leisure-time physical activity modify the association of small size at birth with the metabolic syndrome. Diabetes Care. 2003; 26, 21562164.
32.Ridgway, CL, Brage, S, Sharp, SJ, et al. Does birth weight influence physical activity in youth? A combined analysis of four studies using objectively measured physical activity. PloS One. 2011; 6, e16125.
33.Kaseva, N, Wehkalampi, K, Strang-Karlsson, S, et al. Lower conditioning leisure-time physical activity in young adults born preterm at very low birth weight. PloS One. 2012; 7, e32430.
34.Salonen, MK, Kajantie, E, Osmond, C, et al. Prenatal and childhood growth and leisure time physical activity in adult life. Eur J Public Health. 2011; 21, 719724.
35.Kajantie, E, Strang-Karlsson, S, Hovi, P, et al. Adults born at very low birth weight exercise less than their peers born at term. J Pediatr. 2010; 157, 610616.
36.Andersen, LG, Angquist, L, Gamborg, M, et al. Birth weight in relation to leisure time physical activity in adolescence and adulthood: meta-analysis of results from 13 nordic cohorts. PloS One. 2009; 4, e8192.
37.Clemm, H, Røksund, O, Thorsen, E, Eide, GE, Markestad, T, Halvorsen, T. Aerobic capacity and exercise performance in young people born extremely preterm. Pediatrics. 2012; 129, e97e105.
38.Craig, CL, Marshall, AL, Sjöström, M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35, 13811395.
39.Faerch, K, Brøns, C, Alibegovic, AC, Vaag, A. The disposition index: adjustment for peripheral vs. hepatic insulin sensitivity? J Physiol. 2010; 588, 759764.
40.Kahn, SE, Prigeon, RL, McCulloch, DK, et al. Quantification of the relationship between insulin sensitivity and beta-cell function in human subjects. Evidence for a hyperbolic function. Diabetes. 1993; 42, 16631672.
41.Wallace, TM, Levy, JC, Matthews, DR. Use and abuse of HOMA modeling. Diabetes Care. 2004; 27, 14871495.
42.Tanaka, H, Monahan, KD, Seals, DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001; 37, 153156.
43.Brage, S, Brage, N, Franks, PW, Ekelund, U, Wareham, NJ. Reliability and validity of the combined heart rate and movement sensor Actiheart. Eur J Clin Nutr. 2005; 59, 561570.
44.Stegle, O, Fallert, SV, MacKay, DJC, Brage, S. Gaussian process robust regression for noisy heart rate data. IEEE Trans Biomed Eng. 2008; 55, 21432151.
45.Ryberg, M, Sandberg, S, Mellberg, C, et al. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. J Intern Med. 2013; 274, 6776.
46.Brage, S, Ekelund, U, Brage, N, et al. Hierarchy of individual calibration levels for heart rate and accelerometry to measure physical activity. J Appl Physiol (1985). 2007; 103, 682692.
47.Brage, S, Brage, N, Franks, PW, et al. Branched equation modeling of simultaneous accelerometry and heart rate monitoring improves estimate of directly measured physical activity energy expenditure. J Appl Physiol (1985). 2004; 96, 343351.
48.Mortensen, B, Hingst, JR, Frederiksen, N, et al. Effect of birth weight and 12 weeks of exercise training on exercise-induced AMPK signalling in human skeletal muscle. Am J Physiol Endocrinol Metab. 2013; 304, E1379E1390.
49.Jensen, CB, Storgaard, H, Dela, F, Holst, JJ, Madsbad, S, Vaag, AA. Early differential defects of insulin secretion and action in 19-year-old caucasian men who had low birth weight. Diabetes. 2002; 51, 12711280.
50.Svedenkrans, J, Henckel, E, Kowalski, J, Norman, M, Bohlin, K. Long-term impact of preterm birth on exercise capacity in healthy young men: a national population-based cohort study. PLoS One. 2013; 8, e80869.
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