Intermittent exercise with and without hypoxia improves insulin sensitivity in individuals with type 2 diabetes

R Mackenzie, N Maxwell, P Castle, B Elliott, G Brickley, P Watt

Research output: Contribution to journalArticlepeer-review


CONTEXT: Hypoxia and muscle contraction stimulate glucose transport activity in vitro. Exercise and hypoxia have additive effects on insulin sensitivity in type 2 diabetics (T2D).

OBJECTIVE: The objective of the study was to examine the effectiveness of intermittent exercise with and without hypoxia on acute- and moderate-term glucose kinetics and insulin sensitivity in T2D.

SETTING: The study was conducted at a university research center.

DESIGN, PARTICIPANTS, AND INTERVENTIONS: Eight male T2D patients completed the following: 1) 60 min of continuous exercise at 90% lactate threshold in hypoxia (HyEx60); 2) intermittent exercise at 120% lactate threshold, separated by periods of passive recovery (5:5 min) in hypoxia [Hy5:5; O₂ ∼ 14.7 (0.2)%]; and 3) intermittent exercise (5:5 min) at 120% lactate threshold in normoxia (O₂ ∼ 20.93%).

MAIN OUTCOME MEASURES: Glucose appearance and glucose disappearance, using an adapted non-steady-state one-compartment model were measured. Homeostasis models of insulin resistance (HOMA(IR)), fasting insulin resistance index (FIRI), and β-cell function were calculated 24 and 48 h after exercise conditions.

RESULTS: Glucose disappearance increased from baseline (1.85 mg/kg · min⁻¹) compared with 24 h (2.01 min/kg · min⁻¹) after HyEx60 (P = 0.031). No difference was noted for both Hy5:5 (P = 0.064) and normoxia (P = 0.385). Hy5:5 demonstrated improvements in HOMA(IR) from baseline [d 1, 6.20 (0.40)] when comparisons were made with d 2 [4.83 (0.41)] (P = 0.0013). HOMA(IR) and FIRI improved in the 24 h (HOMA(IR), P = 0.002; FIRI, P = 0.003), remaining reduced 48 h after HyEx60 (HOMA(IR), P = 0.028; and FIRI, P = 0.034).

CONCLUSION: HyEx60 offered the greatest improvements in acute and moderate-term glucose control in T2D. Intermittent exercise stimulated glucose disposal and improved post-exercise insulin resistance, which was enhanced when exercise was combined with hypoxia (Hy5:5). The data suggest a use of hypoxic exercise in treatment of T2D.

Original languageEnglish
Pages (from-to)E546-55
JournalThe Journal of clinical endocrinology and metabolism
Issue number4
Publication statusPublished - Apr 2012


  • Algorithms
  • Blood Glucose
  • Cross-Over Studies
  • Deuterium
  • Diabetes Mellitus, Type 2
  • Exercise
  • Glucose
  • Humans
  • Hyperglycemia
  • Hyperinsulinism
  • Hypoxia
  • Insulin Resistance
  • Insulin-Secreting Cells
  • Kinetics
  • Lactic Acid
  • Male
  • Middle Aged
  • Models, Biological
  • Oxygen
  • Sedentary Lifestyle

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