Regulation of Glycemic Control by Physical Activity: A Role for Mitochondria?

  1. Kevin R. Short
  1. Section of Diabetes/Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
  1. Corresponding author: Kevin R. Short, kevin-short{at}

Hippocrates is attributed with stating that “... eating alone will not keep a man well; he must also take exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health” (1). Those words of wisdom highlight that the benefits of physical activity for maintenance of good health, in conjunction with appropriate diet, have long been recognized. As we try to manage the worldwide increase of diabetes, it is useful to remind ourselves of the value of exercise for preventing and treating insulin resistance. For adults with type 2 diabetes, both endurance and resistive exercise can lower glycated hemoglobin levels within 3–6 months (2) and moderate-intensity walking can reduce the amplitude of postprandial glucose excursions within 5–7 days (3). In the Diabetes Prevention Program, adults at risk for developing type 2 diabetes who were placed in a weight loss plus exercise program for ∼3 years had significantly lower incidence of diabetes for up to 10 years after enrollment compared with those who received either standard of care or metformin (4). In the lifestyle intervention group, weight loss was the major determinant of diabetes prevention during the first year, but physical activity predicted weight maintenance and diabetes prevention in subsequent years (5). Thus, although there have been steady improvements in pharmaceutical treatments to improve glycemic control in individuals who are obese and/or diabetic, physical activity remains an important first-line therapeutic approach.

Exercise improves glucose control by increasing insulin sensitivity and non–insulin-dependent glucose uptake in skeletal muscle (6). There is also evidence that energy turnover (i.e., the oxidation of glucose and fatty acids) during muscle contraction is important for preventing the …

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