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The Effect of a Six-Month Exercise Program on Very Low-Density Lipoprotein Apolipoprotein B Secretion in Type 2 Diabetes

Department of Diabetes, Endocrinology, and Internal Medicine, St. Thomas’ Hospital, Guys, Kings and St. Thomas’ School of Medicine, Kings College, London SE1 7EH, United Kingdom

Address all correspondence and requests for reprints to: Dr. A. M. Umpleby, Department of Diabetes, Endocrinology, and Internal Medicine, 4th Floor, North Wing, St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom. E-mail: margot.umpleby{at}kcl.ac.uk.

The dyslipidemia and insulin resistance of type 2 diabetes can be improved by aerobic exercise. The effect of 6 months supervised exercise on very low-density lipoprotein (VLDL) apolipoprotein B metabolism was investigated in patients with type 2 diabetes. Moderately obese patients (n = 18) were randomized into supervised (n = 9) and unsupervised (n = 9) exercise groups. All patients were given a training session and a personal exercise program and asked to exercise four times per week at 70% maximal oxygen uptake for 6 months. Patients in the supervised group had a weekly session with an exercise trainer. VLDL apolipoprotein (apo)B metabolism was measured with an infusion of 1-¹³C leucine before and after 6 months of the exercise program.

Supervised exercise for 6 months resulted in a significant within-group decrease in percent hemoglobin A1c (P < 0.001), body fat (P < 0.004), nonesterified fatty acid (P < 0.04), and triglycerides (P < 0.05) and an increase in insulin sensitivity (P < 0.01). There was a decrease in VLDL apoB pool size (160.8 ± 42.6 to 84.9 ± 23.2 mg, P < 0.01) and VLDL apoB secretion rate (11.3 ± 2.6 to 5.5 ± 2.0 mg/kg·d, P < 0.05) with no change in fractional catabolic rate. In a between-group comparison, the decrease in VLDL apoB secretion rate in the supervised group did not achieve significance. This study demonstrates that in type 2 diabetes, a supervised exercise program reduces VLDL apoB pool size, which may be due to a decrease in VLDL apoB secretion rate.

This work was supported by a grant from the British Heart Foundation (PG/2000056). S.A. was supported by a grant from the government of Pakistan.

Abbreviations: apoB, Apolipoprotein B; ASR, absolute secretion rate; CV, coefficient of variation; CVD, cardiovascular disease; FCR, fractional catabolic rate; FSR, fractional secretion rate; HbA1c, hemoglobin A1c; HDL, high-density lipoprotein; HDL-C, HDL cholesterol; HOMA_IR, insulin resistance calculated using homeostasis assessment model; -KIC, -ketoisocaproic acid; LDL, low-density lipoprotein; MTP, microsomal transfer protein; NEFA, nonesterified fatty acid; TG, triglyceride VLDL, very LDL; VO_2max, maximal oxygen uptake.

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