Table 1.
Study characteristics of the included randomized controlled crossover studies. Information on participants’ characteristics, meal, and exercise intervention protocols as well as descriptive key results and information on secondary outcomes and statistics are displayed
| References | Participants, number (n) (age in years, height in cm, weight in kg, BMI in kg/m2, HbA1c in percent) [mean, SD], additional characteristics, diabetes medication | Meal details [mean, SD] | Exercise details (type, intensity, duration), [mean, SD] | Protocol details (duration between exercise and meal) | Postprandial glucose Mean values, area under the curve (AUC) or incremental area under the curve (iAUC), duration, (number of participants), [mean, SD] |
Indirect calorimetry Energy expenditure (EE) in kilojoules (kj) or kilocalories (kcal), heart rate (HR) in beats per minute, Respiratory exchange ratio (RER) |
Secondary outcomes | Statistical analysis |
|---|---|---|---|---|---|---|---|---|
| Colberg et al. [18] |
n = 12 (6 female, 6 male) Age = 61.4, 2.7 Height = 171.5, 2.5 Weight = 101.0, 6.9 BMI = 34.5, 2.4 HbA1c = 7.0, 0.3 Type 2 diabetes, oral medication, and diet |
Dinner: one of 4 different frozen meals with similar caloric contents (grilled chicken, turkey, stuffed pasta, or breaded fish), 420.9, 4.8 kcal, 43–54 g carbohydrate, 4–10 g fiber, 9–16 g fat, 19–32 g protein | Treadmill walking, moderate intensity (40.3, 3.7% heart rate reserve, self-selected pace perceived as comfortable), 20 min | Exercise beginning 15–20 min post-dinner | 11.3, 3.7 mmol/L, iAUC, 240 min, (12) | None | Repeated measures analysis of variance, (rmANOVA) | |
| Exercise immediately pre-dinner | 13.7, 2.2 mmol/L, 240 min, iAUC, (12) | |||||||
| Control (dinner) | 11.7, 2.0 mmol/L, iAUC, 240 min, (12) | |||||||
| Heden et al. [17] |
n = 13 (7 female, 5 male) Age = 48.5, 11.9 Height = 167, 11 Weight = 103.2, 22.8 BMI = 36.7, 5.3 HbA1c = 7.2, 1.1 Type 2 diabetes, oral medication, no diet |
Dinner: spaghetti, sauce with beef, garlic bread, lemon-lime flavored soda, 1.5 g of acetaminophen (to assess gastric emptying), 50% carbohydrate, 35% fat, and 15% protein | Resistance exercise (leg press, seated calf raises, seated chest flies, seated back flies, back extensions, shoulder raises, leg curls, and abdominal crunches), vigorous intensity (10 repetition maximum), 46, 1 min | Exercise beginning 45 min post-dinner | 638, 487 mmol/L, iAUC, 240 min, (13) |
EE = 590, 59 kJ HR = 110, 4 RER = 1.00, 0.01 |
Metabolic data during exercise: oxygen consumption (no difference), energy expenditure (no difference), RER (no difference), heart rate (higher in post meal exercise), perceived exertion (no difference) Post-meal data: insulin, insulin secretion and C-peptide (lowering effect of post-meal exercise), insulin clearance (lowering effect of pre- and post-meal exercise), glucagon (lowering effect of pre-meal exercise), free fatty acids (increasing effect of pre meal exercise), triacylglycerol and very low-density lipoprotein-1 (lowering effect of post-meal exercise), chylomicrons, very low density lipoprotein-2 (no effects), glucagon-like peptide 1 (lowering effect of post-meal exercise), glucose-dependent insulinotropic peptide (no effect), subjective well-being (increasing effect of pre- and post-meal exercise) Subsequent meal data: no effect on nocturnal or morning glycemic control, fasting glucose, insulin, C-peptide, insulin clearance, insulin resistance, or triacylglycerol |
rmANOVA |
| Exercise until 20–30 min pre-dinner | 746, 371 mmol/L, iAUC, 240 min, (13) |
EE = 586, 59 kJ HR = 106, 4 RER = 1.00, 0.01 |
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| Control (dinner) | 909, 325 mmol/L, iAUC, 240 min, (13) |
EE = 264, 13 kJ HR n.a RER = 0.83, 0.01 |
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| Nygaard et al. [19] |
n = 12 (4 female, 8 male) Age = 65, 8 Height = 173, 8 Weight = 73.3, 9.7 BMI = 24.5, 1.9 HbA1c = 6.1, 0.6 Elevated fasting glucose, no oral medication, no diet |
Breakfast: 250 mL semi-skimmed milk and cornflakes (1 g carbohydrate per kg bodyweight), 380, 48 kcal, 13, 2 g protein, 3, 1 g fat, 74, 9 g carbohydrate | Treadmill walking, moderate intensity (8% inclination, 12 on a 6–20 perceived exertion scale), 60 min | Exercise beginning 15 min post-breakfast | 1477, 105 mmol * 210 min * l−1, AUC, (12) |
Metabolic data during exercise: heart rate (higher in post-meal exercise), aerobic metabolism (no differences), carbohydrate oxidation (higher in post-meal exercise), fat oxidation (lower in post-meal exercise), blood lactate (higher in post-meal exercise), perceived exertion (higher in post-meal exercise) Subsequent meal data: no effect on postprandial glucose values after the second or third meal after exercise. Significant effect on postprandial glucose after the fourth meal (11 h after breakfast) [post-meal < pre-meal], significant effect on the 10 highest glucose values during the day (post-meal < control, post-meal < pre-meal) |
Linear mixed-model analysis | |
| Exercise until 30 min pre-breakfast | 1549, 188 mmol * 210 min * l−1, AUC, (12) | |||||||
| Control (breakfast) | 1576, 199 mmol * 210 min * l−1, AUC, (12) | |||||||
| Terada et al. [12] |
n = 10 (2 female, 8 male) Age = 60, 6 Height = 172.4, 9.4 Weight = 91.4, 17.1 BMI = 30.8, 5.4 HbA1c = 7.1, 1.0 Type 2 diabetes, oral medication |
Breakfast: healthy breakfast, 600, 57 kcal, 50% carbohydrate, 20% protein, 30% fat | Treadmill walking, moderate intensity (55% VO2peak), 60 min | Exercise beginning 60 min post-breakfast | 240, 183 mmol * 120 min * l−1, AUC, (8) |
EE = 362, 101 kcal RER = 0.85, 0.03 |
Metabolic data during exercise: oxygen uptake relative to maximal uptake (%VO2peak, no difference), oxygen uptake (no difference), RER (sign higher during post-meal exercise), energy expenditure (no difference) | Linear mixed-model analysis |
| Exercise until 60 min pre-breakfast | 198, 189 mmol * 120 min * l−1, AUC, (9) |
EE = 351, 88 kcal RER = 0.82, 0.04 |
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| Control (breakfast) | 355, 66 mmol * 120 min * l−1, AUC, (10) | |||||||
| Treadmill walking, vigorous intensity (15 intervals each 1 min 100% VO2peak + 4 min 40% VO2peak), 60 min | Exercise beginning 60 min post-breakfast | 314, 188 mmol * 120 min * l−1, AUC, (9) |
EE = 371, 94 kcal RER = 0.88, 0.03 |
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| Exercise until 60 min pre-breakfast | 267, 184 mmol * 120 min * l−1, AUC, (10) |
EE = 354, 85 kcal RER = 0.83, 0.04 |
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| Control (breakfast) | 355, 66 mmol * 120 min * l−1, AUC, (10) | |||||||
| Yunarti et al. [21] |
n = 10 (10 female) Age = 40.41, 3.09 Height = 161.40, 3.56 Weight = 86.67, 7.26 BMI = 33.22, 2.20 Obesity |
Breakfast: no information available | Treadmill walking, moderate intensity, 30 min | Exercise post-breakfast, interval between meal and exercise not indicated | 200.2, 4.5 mg/dL, 120 min, (10) | None | n.a | |
| Exercise pre-breakfast, interval between meal and exercise not indicated | 207.6, 4.5 mg/dL, 120 min, (10) | |||||||
| Control (breakfast) | 211.3, 4.3 mg/dL, 120 min, (10) | |||||||
| Yoko et al. [20] |
n = 11 (6 female, 5 male) Age = 42.7, 9.4 Height = 164.8, 5.3 Weight = 62.9, 10.9 BMI = 23.1, 4.1 |
Lunch: 100 g rice and ad libitum intake of protein and fat, ≥ 40 g carbohydrate, no information on the amount of protein and fat intake | Walking, moderate intensity (2 min 4 km/h and 18 min 6 km/h), 20 min | Exercise beginning 20 min post-lunch | 2143, 1245 mg * 120 min * dL−1, iAUC, (11) | None | Wilcoxon signed-rank test | |
| Exercise immediately pre lunch | 3050, 1654 mg * 120 min * dL−1, iAUC, (11) | |||||||
| Control (lunch) for post-lunch exercise | 3393, 1781 mg * 120 min * dL−1, iAUC, (11) | |||||||
| Control (lunch) for pre-lunch exercise | 3599, 2270 mg * 120 min * dL−1, iAUC, (11) | |||||||
| Resistance exercise (pushups, squats, front bridges), moderate intensity (18 min resistance exercise and 2 min stretching), 20 min | Exercise beginning 20 min post-lunch | 2520, 1659 mg * 120 min * dL−1, iAUC, (9) | ||||||
| Exercise immediately pre-lunch | 3230, 2214 mg * 120 min * dL−1, iAUC, (9) | |||||||
| Control (lunch) for post-lunch exercise | 3058, 2283 mg * 120 min * dL−1, iAUC, (9) | |||||||
| Control (lunch) for pre-lunch exercise | 3498, 1964 mg * 120 min * dL−1, iAUC, (9) | |||||||
| Solomon et al. [11] |
n = 16 (5 female, 11 male) Age = 31, 11 Weight = 72.3, 10.6 BMI = 23.5, 2.8 HbA1c = 5.3, 0.3 |
Breakfast: meal replacement drink (Nurishment; Dunns River Brands, Frisco, TX, USA), 500 kcal, 71 g carbohydrate (57% of total kcal), 13 g fat (26% of total kcal), 24 g protein (19% of total kcal) | Standing, light intensity (rating of perceived exertion 6, 1 on a 6–10 scale), 30 min | Exercise (standing) immediately post-breakfast | 663, 63 mg * 120 min * dL−1, AUC, (16) |
EE = 54, 14 kcal RER = 0.87, 0.10 |
rmANOVA | |
| Exercise (standing) beginning 30 min post-breakfast | 683, 51 mg * 120 min * dL−1, AUC, (16) | |||||||
| Exercise (standing) immediately pre-breakfast | 714, 66 mg * 120 min * dL−1, AUC, (16) | |||||||
| Control (breakfast) | 698, 36 mg * 120 min * dL−1, AUC, (16) | |||||||
|
n = 16 (5 female, 11 male) Age = 31, 11 Weight = 72.3, 10.6 BMI = 23.5, 2.8 HbA1c = 5.3, 0.3 |
Treadmill walking, light-to-moderate intensity (3.5, 0.5 miles per hour, rating of perceived exertion 11, 2 on a 6–20 scale), 30 min | Exercise (walking) immediately post-breakfast | 617, 58 mg * 120 min * dL−1, AUC, (16) |
EE = 123, 19 kcal RER = 0.87, 0.06 |
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| Exercise (walking) beginning 30 min post-breakfast | 669, 84 mg * 120 min * dL−1, AUC, (16) | |||||||
| Exercise (walking) immediately pre-breakfast | 675, 686 mg * 120 min * dL−1, AUC, (16) | |||||||
| Control (breakfast) | 673, 96 mg * 120 min * dL−1, AUC, (16) | |||||||
|
n = 16 (11 female, 5 male) Age = 24, 7 Weight = 66.0, 11.3 BMI = 23.0, 3.4 HbA1c = 5.1, 0.4 |
Resistance exercise with bodyweight (3 times: 10 squats, 10 push-ups, 10 sit-ups, 20 alternate leg forward lunges), light-to-moderate intensity (rating of perceived exertion 11, 2 on a 6–20 scale), 7.1, 1.8 min | Exercise (resistance) immediately post-breakfast | 624, 57 mg * 120 min * dL−1, AUC, (16) |
EE = 53, 19 kcal RER = 1.04, 0.09 |
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| Exercise (resistance) beginning 30 min post-breakfast | 655, 99 mg * 120 min * dL−1, AUC, (16) | |||||||
| Exercise (resistance) immediately pre-breakfast | 663, 68 mg * 120 min * dL−1, AUC, (16) | |||||||
| Control (breakfast) | 673, 51 mg * 120 min * dL−1, AUC, (16) | |||||||
| Derave et al. [22] |
n = 7 (male) Age = 45, 11 Weight = 108, 14 BMI = 34, 3 Metabolic syndrome (3 or more of the following: waist circumference > 102 cm, blood pressure > 130/85 mmHg, serum triglycerides > 150 mg/dL, high-density lipoprotein cholesterol < 40 mg/dL, fasting glucose > 110 mg/dL but < 126 mg/dL, or fasting insulin > 15 uU/mL) |
Breakfast: 20 kJ/kg body weight, 82% carbohydrate, 9% protein, 9% fat | Bicycle ergometer, moderate intensity (60% VO2max), 45 min | Exercise immediately post-breakfast | 2970, 1090 mg * min * dL−1, iAUC, (7) |
HR = 138, 17 RER = 0.91, 0.01 |
Metabolic data during exercise: oxygen uptake (post-meal < pre-meal), carbon dioxide production (post-meal > pre-meal), RER (post-meal > pre-meal), carbohydrate oxidation rate (post-meal > pre-meal), fat oxidation rate (post-meal < pre-meal), HR (no effect) Post-meal data: insulin (no effect), triglycerides (no effect) Subsequent meal data: no effect on postprandial glucose, insulin or triglyceride values after the second or third meal after exercise |
rmANOVA |
| Exercise immediately pre-breakfast | 5230, 2690 mg * minutes * dL−1, iAUC, (7) |
HR = 133, 22 RER = 0.87, 0.03 |
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| Control (breakfast) | 3740, 1020 mg * min * dL−1, iAUC, (7) |
BMI body mass index, HbA1c glycated hemoglobin, n.a. not available, SD standard deviation