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Background: The present study aimed to systematically review the literature on the effects of physical training on neuromuscular parameters in patients with type 1 diabetes mellitus (T1DM)., Methods: The PubMed, Scopus, EMBASE, and COCHRANE databases were accessed in September 2020. Clinical trials that evaluated the effects of physical training on neuromuscular parameters (maximum strength, resistance strength, muscle power, muscle quality, and muscle thickness) of patients with T1DM compared with a control group were considered eligible. The results were presented as the standardized mean difference with 95% confidence intervals. Effect size (ES) calculations were performed using the fixed effect method, with α = .05., Results: Combined training increased the maximum strength levels in individuals with T1DM to a lesser extent than in healthy individuals (ES: 0.363; P = .038). Strength training increased the maximum strength (ES: 1.067; P < .001), as well as combined training (ES: 0.943; P < .001); both compared with aerobic training in patients with T1DM. Strength training increased the maximum strength in a similar magnitude to combined training in patients with T1DM (ES: -0.114; P = .624)., Conclusion: Both combined training and strength training represent effective strategies for improving the maximum strength in individuals with T1DM.

Objective: To investigate physiological responses to cardiopulmonary exercise (CPX) testing in adults with type 1 diabetes compared with age-, sex-, and BMI-matched control participants without type 1 diabetes., Research Design and Methods: We compared results from CPX tests on a cycle ergometer in individuals with type 1 diabetes and control participants without type 1 diabetes. Parameters were peak and threshold variables of VO 2 , heart rate, and power output. Differences between groups were investigated through restricted maximum likelihood modeling and post hoc tests. Differences between groups were explained by stepwise linear regressions ( P < 0.05)., Results: Among 303 individuals with type 1 diabetes (age 33 [interquartile range 22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m 2 , HbA 1c 6.9% [6.2; 7.7%] [52 (44; 61) mmol/mol]), VO 2peak (32.55 [26.49; 38.72] vs. 42.67 ± 10.44 mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191] beats/min), and peak power (216 [171; 253] vs. 245 [200; 300] W) were lower compared with 308 control participants without type 1 diabetes (all P < 0.001). Individuals with type 1 diabetes displayed an impaired degree and direction of the heart rate-to-performance curve compared with control participants without type 1 diabetes (0.07 [-0.75; 1.09] vs. 0.66 [-0.28; 1.45]; P < 0.001). None of the exercise physiological responses were associated with HbA 1c in individuals with type 1 diabetes., Conclusions: Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA 1c . Intriguingly, the participants in our cohort were people with recent-onset type 1 diabetes; heart rate dynamics were altered during CPX testing., (© 2020 by the American Diabetes Association.)

Glycemic fluctuations were compared throughout 10-week high-intensity training protocols in T1DM patients. Differences were compared using the rate of change in glycaemia during exercise (RoC E ). HIIT sessions led to lower RoC E in most weeks than other training protocols. The occurrence of level 1 hypoglycemia along sessions were similar among interventions., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: To investigate the effects of high-intensity interval training (HIIT) and/or strength training (ST) on inflammatory, oxidative stress (OS) and glycemic parameters in type 1 diabetes (T1DM) patients., Methods: After a 4-week control period, volunteers were randomly assigned to 10-week HIIT, ST or ST + HIIT protocol, performed 3×/week. Blood biochemistry, anthropometric, strength and cardiopulmonary fitness variables were assessed. Outcomes were analyzed via generalized estimating equations (GEE), with Bonferroni post hoc analysis., Results: ST, HIIT and ST + HIIT improved glycemic (HbA 1c and fasting glucose) and antioxidant parameters (total antioxidant capacity, catalase and superoxide dismutase activities), but not plasma inflammatory (C-reactive protein, TNF-α and IL-10) or OS markers (thiobarbituric acid-reactive substances, 8-hydroxy-2-deoxyguanosine and oxLDL) levels. Noteworthy, interventions reduced soluble receptors for advanced glycation end products levels. However, intracellular heat shock protein 70 content increased only after HIIT. While daily insulin dosage decreased only in the ST + HIIT group, all training models induced anthropometric and functional benefits., Conclusions: Similar benefits afforded by ST, HIIT or ST + HIIT in T1DM people are associated with enhanced antioxidant systems and glucose-related parameter, even in a few weeks. From a practical clinical perspective, the performance of ST + HIIT may be advised for additional benefits regarding insulin dosage reduction., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This study investigated the influence of performing strength exercises before or after high-intensity interval exercise on glycaemia during and postexercise in T1DM patients. Nine physically active adults with T1DM executed 30 min of strength exercises (SE) (3 sets at 10 RM) before 30 min of high-intensity interval exercise (HIIE) (10 × 60-s bout at ∼90% HR max interspersed with 60 s recovery) (SE + HIIE) or performed the reverse order (HIIE + SE) or rested in this period. Capillary glucose levels were measured each 15 min during and 60 min postexercise recovery. Significant lower glucose levels were observed in SE + HIIE at 60, 75 and 90 min, in comparison with REST. HIIE + SE lowered glycaemia at 30, 45 and 60 min compared with baseline concentrations, while SE + HIIE postponed this glucose decayment to 60 min, when compared with baseline levels. An increased glycaemia at 105 min compared with end-exercise levels were also observed in HIIE + SE. Carbohydrates ingested during exercise to correct hypoglycemia, insulin dosage at same day before and after protocols, and nocturnal hypoglycemia episodes were similar among the three conditions. It is concluded that the performance of HIIE before SE decreases glycaemia already at the end of first exercise modality, while the reverse order postpones it to the end of second exercise, although HIIE + SE improves glycemic stability throughout recovery. T1DM patients who tend to develop exercise-associated hypoglycemia may perform strength exercises before high-intensity interval exercise in a single session., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Type 1 diabetes mellitus (T1DM) is characterized by the loss of insulin secreting cells due to a directed autoimmune process, which is linked to oxidative stress and inflammation. Exercise training is known to induce several benefits by reducing inflammation and improving antioxidant defenses. In this context, exercise training may be considered as an efficient and relatively inexpensive non-pharmacological tool for diabetes treatment, added to the usual insulin administration. Unfortunately, most people with T1DM do not reach the recommended levels of physical activity due to concerns with hypoglycemic episodes. Recent data have demonstrated that exercise sessions composed by strength exercises or high-intensity interval exercise reduce the risk of hypoglycemia during and after the physical effort, when compared with continuous aerobic exercise in insulin-dependent patients. However, no studies have tested the chronic effects of this combination of protocols on health-related markers yet. Herein, we suggest a combination of hypertrophic strength exercises (3 sets at 8-RM) with a high-intensity interval protocol (10×60-s bouts at ∼90% HR max interspersed with 60s recovery) in the same exercise session, three times per week, for T1DM patients free of micro and macrovascular complications. Our hypothesis is that this training protocol may minimize the exercise-associated rapid drop of glucose levels in T1DM, due to glucoregulatory hormones and transient reduction of insulin-mediated glucose uptake. This training is also likely to cover long-term glycaemic, bioenergetic, neuromuscular and cardiorespiratory adaptations, implicating in improved health and decreased risk of micro and macro complications., (Copyright © 2017 Elsevier Ltd. All rights reserved.)