Question

Helio is a 48-year-old sedentary male diagnosed with prediabetes who is 250 lbs and 5’7”. Helio’s VO2max is 26 ml/kg/min. His total daily energy expenditure is 1700 kcal/d and his diet log indicates he eats ~1900 kcal/d (48% CHO, 17% protein, and 35% fat). His doctor prescribes the drug metformin to control his blood glucose and also recommends he see an exercise physiologist and nutritionist to prescribe a lifestyle program to control his weight and prevent the progression to type 2 diabetes. What type of exercise training program would you prescribe for Helio and why? Before exercise training, what substrate would be predominantly oxidized at rest? What fiber type would be most prevalent in his vastus lateralis if a muscle biopsy was performed? How would you expect your specific exercise training program to alter his fiber type and substrate oxidation? How would you measure Helio’s body composition before and after his intervention (justify your choice of measurement)? How would you expect his body composition to change? Describe 2 additional (choose from: neural, respiratory, endocrine or cardiovascular) changes that would occur in response to your specific exercise training program and their time course for adaptation.

Helio complains that he does not like doing structured exercise. Can increasing physical activity without exercise training improve Helio’s health and reduce his risk of developing type 2 diabetes? Are lifestyle and pharmacologic effects of metformin additive in terms of blood glucose control? Incorporate what you have learned throughout the semester into this case study.

Answer 1

The patient Helio is a is a 48-year-old sedentary male diagnosed with prediabetes who is 250 lbs and 5’7”. From this we can identify that he is obese. And his VO2 max is VO2max is 26 ml/kg/min. This indicates a need of cardiovascular fitness also.The average sedentary male will achieve a VO2 max of approximately 35 to 40 mL/kg/min.

Decreased VO2max is correlated with impaired insulin sensitivity and was the most prevalent abnormality in a person at risk for T2DM.This raises the possibility that decreased VO2 max is among the earliest indicators of T2DM therefore, an important risk factor for disease progression.Exercise capacity (VO2max) is strongly correlated with insulin sensitivity and endothelial dysfunction.

Increasing evidence that interventions involving changes in diet and physical activity or pharmacological treatment can prevent/delay type 2 diabetes provides an impetus for wider implementation of preventive approaches.

Exercise intervention, whether aerobic, resistance, or the combination, can improve cardiorespiratory fitness in those with T2D.

Before exercise training, the substrate would be predominantly oxidized at rest is Fat.

Exercise can lower plasma glucose concentrations in type 2 diabetes patients. This can be attributed to a blunted increase in hepatic glucose output and/or an increase in whole-body glucose uptake rate . The latter has been shown to result in greater carbohydrate oxidation rates during exercise in type 2 diabetes patients.

Type 1 and Type 2 muscle fibres were seen in his vastus lateralis in muscle biopsy.No significant net changes in type I or type II intramyocellular lipid content were observed following exercise in the patient.