Exercise Timing for Type 2 Diabetes

Recruiting at 2 trial locations

Overseen By Jaclyn K Dosik

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rutgers, The State University of New Jersey

Must be taking: Heart rate medications

Must not be taking: Weight suppression medications

Disqualifiers: Morbid obesity, Insulin therapy, Smoking, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 2 weeks

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how the timing of exercise, combined with a mobile app called Noom, affects individuals with type 2 diabetes. Researchers aim to determine whether exercising in the morning or afternoon, along with dietary advice via the app, improves weight loss, blood sugar control, and heart health. The study includes participants with type 2 diabetes, a body mass index (BMI) between 28 and 45, and those taking certain heart medications. Participants should not have been recently active or experienced major weight changes. This trial could identify better ways to manage diabetes through exercise and diet. As an unphased trial, it offers participants the chance to contribute to innovative research that may lead to improved diabetes management strategies.

Do I have to stop taking my current medications for the trial?

The trial does not specify if you need to stop taking your current medications. However, if you are taking active weight suppression medication, you cannot participate in the trial.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Studies have shown that exercise is generally safe for people with type 2 diabetes. Research indicates that exercising in the morning or afternoon can improve strength, blood pressure, and blood sugar control. Recent findings suggest that morning exercise, when done before eating, may help manage blood sugar levels. Afternoon exercise has also been linked to better blood sugar levels and overall health benefits. Evidence well supports the safety of exercising at different times of the day, with no major negative effects reported in the studies. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Exercise Timing for Type 2 Diabetes trial because it explores how the timing of exercise might impact blood sugar control, offering a potential new angle on managing this condition. Unlike typical diabetes treatments that focus on medication or diet changes, this trial investigates whether exercising in the morning versus the afternoon can make a difference in managing type 2 diabetes. The unique aspect here is the focus on when exercise is done, rather than just encouraging physical activity in general. This could unlock new strategies for patients to optimize their exercise routines for better blood sugar management, possibly alongside existing treatments like medications and diet adjustments.

What evidence suggests that this trial's treatments could be effective for type 2 diabetes?

This trial will compare the effects of morning and afternoon exercise on blood sugar control in people with type 2 diabetes. Research has shown that afternoon exercise might better control blood sugar than morning workouts. One study found that afternoon exercise led to greater improvements in blood sugar levels compared to morning exercise. Other studies agree, showing that activity after meals can lower blood sugar and reduce insulin resistance. Conversely, some research suggests that morning exercise before eating might also be beneficial, but afternoon workouts seem to offer more advantages. Overall, both morning and afternoon exercises are beneficial, but afternoon sessions might manage diabetes more effectively. Participants in this trial will be assigned to either morning or afternoon exercise groups to further explore these findings. ^{2 3 4 6 7}

Who Is on the Research Team?

Steven K Malin, PhD

Principal Investigator

Rutgers University - New Brunswick

Are You a Good Fit for This Trial?

Adults aged 30-70 with type 2 diabetes, a BMI between 28 and 45, not currently on weight loss meds or insulin therapy. Mustn't have significant heart, liver, kidney diseases or cancer. Non-smokers only (or those who quit over a year ago), not pregnant/nursing, and haven't been exercising regularly.

Inclusion Criteria

I am currently on medication that affects my heart rate or rhythm.

I am between 30 and 70 years old.

I have been diagnosed with type 2 diabetes.

Exclusion Criteria

I have type 1 diabetes and need insulin.

You are allergic to perflutren, which is in the study drug Definity.

My BMI is either above 46 or below 27.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in exercise training either in the morning or afternoon for 2 weeks, supervised and at moderate to hard intensity

2 weeks

Follow-up

Participants are monitored for changes in body weight, glucose tolerance, and flow-mediated dilation

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Exercise Afternoon
• Exercise and nutrition
• Exercise Morning
• Noom mobile application

Trial Overview The trial is testing the effectiveness of Noom for improving diet adherence during exercise in the morning vs. afternoon for better weight loss and heart health in type 2 diabetics. It's checking if this leads to better blood sugar control and blood pressure.

How Is the Trial Designed?

Group I: Morning Exercise Experimental Treatment 1 Intervention

If subjects are randomly assigned to this group, they will participate in exercise training in the morning at a moderate to hard intensity. Subjects will be asked to regularly engage in morning exercise while supervised for about 2 weeks.

Group II: Afternoon Exercise Active Control 1 Intervention

If subjects are assigned to this group, they will participate in the same exercise program but after in the afternoon.

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials

471

Recruited

81,700+

Noom Inc.

Industry Sponsor

Trials

17

Recruited

2,800+

Published Research Related to This Trial

A pilot study involving non-diabetic individuals and a subject with Insulin Dependent Diabetes Mellitus (IDDM) showed that exercising in the morning led to a rapid decrease in blood glucose levels for non-diabetics, while evening exercise resulted in less decline and quicker recovery.

For the diabetic subject, morning exercise did not lower glucose levels and instead caused an increase after 40 minutes, suggesting that the timing of exercise may significantly impact glucose control in individuals with diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronobiology of exercise: the influence of scheduling upon glycemic responses of control and of subjects with diabetes mellitus. Cardoso, SS., Feuers, RJ., Tsai, TH., et al.[2011]

Patients with type 2 diabetes are advised to engage in at least 150 minutes of moderate exercise each week, along with resistance training two to three times a week, to improve their health outcomes.

The article emphasizes the importance of preparticipation cardiovascular screening for patients with diabetes and other health conditions before starting an exercise program, ensuring safety during physical activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise recommendations for patients with type 2 diabetes. Dugan, JA.[2017]

In a study involving 50 overweight women, exercising in the morning resulted in significantly higher levels of satiety compared to exercising in the afternoon, suggesting that morning workouts may help control hunger better.

Overall, the timing of moderate-intensity exercise did not significantly affect appetite or energy intake patterns over the following 24 hours, indicating that the benefits of exercise on weight management may not depend on when it is performed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute Effect of Morning and Afternoon Aerobic Exercise on Appetite of Overweight Women. Alizadeh, Z., Mostafaee, M., Mazaheri, R., et al.[2020]

In a study involving 15 inactive patients with type 2 diabetes, moderate exercise 60 minutes after dinner was found to significantly lower 2-hour postprandial glucose levels compared to exercising 30 minutes after dinner.

Both exercise timings were safe, with no incidents of nocturnal hypoglycemia reported, suggesting that while 60 minutes post-dinner may be more effective for glycemic control, 30 minutes post-dinner could be a safer option for those at risk of low blood sugar.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Effect of moderate exercise for 30 min at 30 min versus 60 min after dinner on glycemic control in patients with type 2 diabetes: a randomized, crossover, self-controlled study]. Li, Z., Hu, Y., Ma, J.[2022]

An exercise program is crucial for managing obesity, as it not only burns calories but also boosts metabolism and helps regulate appetite, potentially leading to reduced caloric intake.

Combining regular exercise with a nutritious diet can help preserve lean body weight and lower the risk of serious health complications associated with obesity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of physical activity in the control of obesity. Allen, DW., Quigley, BM.[2021]

In a study involving 64 patients with type 2 diabetes, post-meal exercise significantly improved blood glucose levels and HbA1c compared to one-time daily exercise, highlighting its effectiveness for glycemic control.

No hypoglycemic events were reported during the study, indicating that post-meal exercise is a safe intervention for managing blood sugar levels in T2DM patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of post-meal and one-time daily exercise in patient with type 2 diabetes mellitus: a randomized crossover study. Pahra, D., Sharma, N., Ghai, S., et al.[2020]

Exercise is a popular strategy for weight loss among adults, but its effectiveness can vary, potentially influenced by the time of day it is performed, with some studies suggesting morning exercise may lead to better weight and fat loss, while others indicate evening exercise could be more effective.

Understanding the impact of exercise timing on weight management could help tailor personalized treatment plans, as it may affect related behaviors like physical activity levels, energy intake, and sleep patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining the Role of Exercise Timing in Weight Management: A Review. Blankenship, JM., Rosenberg, RC., Rynders, CA., et al.[2022]

A systematic review of 19 randomized controlled trials involving 346 participants suggests that exercising 30 minutes after meals may lead to better glycemic control in individuals with type 2 diabetes compared to exercising before meals.

Despite the promising findings, the evidence is primarily based on indirect comparisons, and only two studies directly examined the impact of exercise timing, indicating a need for more consistent and low-risk research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise Timing in Type 2 Diabetes Mellitus: A Systematic Review. Teo, SYM., Kanaley, JA., Guelfi, KJ., et al.[2019]

A randomized controlled trial involving 70 individuals with type 2 diabetes will investigate whether exercising at the time of peak blood sugar levels can improve glycaemic control, specifically by measuring changes in HbA1c over a 5-month period.

The study will also assess secondary outcomes related to cardiovascular health, such as vascular function and body composition, to determine the broader benefits of timing exercise for individuals with type 2 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Personalising activity to target peak hyperglycaemia and improve cardiometabolic health in people with type 2 diabetes: protocol for a randomised controlled trial. Chang, CR., Astell-Burt, T., Russell, BM., et al.[2022]

In a study of 26 sedentary individuals with Type 2 diabetes, those who received personalized exercise consultations showed a significant increase in their exercise behavior stage (82% vs. 33% in the control group), indicating that tailored support can effectively motivate physical activity.

Participants who received exercise consultations also experienced a 4% increase in physical activity levels, while the control group saw a 9% decrease, highlighting the positive impact of personalized guidance on promoting exercise and improving quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study. Kirk, AF., Higgins, LA., Hughes, AR., et al.[2022]

In a 12-week exercise program involving 32 adult males at risk for type 2 diabetes, afternoon exercise training resulted in significantly better improvements in insulin sensitivity and metabolic health compared to morning training.

Participants who exercised in the afternoon showed greater reductions in fasting plasma glucose levels, fat mass, and improved exercise performance, suggesting that the timing of exercise can influence its effectiveness for metabolic health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise training elicits superior metabolic effects when performed in the afternoon compared to morning in metabolically compromised humans. Mancilla, R., Brouwers, B., Schrauwen-Hinderling, VB., et al.[2021]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/30426166/

Afternoon exercise is more efficacious than morning ... Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial.

2. joslin.org joslin.org/news-stories/all-news-stories/news/2023/05/afternoon-exercise-linked-greater-improvements-blood-sugar-levels-patients-type-2

Afternoon Exercise Linked with Greater Improvements in ... Joslin Diabetes Center's new study shows afternoon exercise yields improved glucose control in adults with Type 2 Diabetes. Learn more.

3. sciencedirect.com sciencedirect.com/science/article/pii/S2667036423000018

The importance of exercise for glycemic control in type 2 ... Movement throughout the day by breaking up sitting time benefits blood glucose and insulin. Physical activity after meals reduces blood glucose.

4. diabetologia-journal.org diabetologia-journal.org/2022/11/02/new-study-reveals-that-physical-activity-in-the-afternoon-or-evening-is-linked-to-reduced-insulin-resistance-and-thus-better-control-of-blood-sugar/

New study reveals that physical activity in the afternoon or ... Afternoon or evening physical activity is associated with reduced insulin resistance (and thus better blood sugar control) when compared with an even ...

5. diabetesjournals.org diabetesjournals.org/spectrum/article/36/2/146/148865/Is-There-an-Optimal-Time-of-Day-for-Exercise-A

Is There an Optimal Time of Day for Exercise? A Commentary ... On the other hand, different studies have observed improvements in overall health and glycemia from afternoon exercise compared with morning ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8802999/

Exercise/Physical Activity in Individuals with Type 2 Diabetes Resistance exercise training in adults with T2D typically results in 10-15% improvements in strength, bone mineral density, blood pressure, lipid profiles, ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12021934/

Associations between the timing of 24 h physical activity ... Results. Physical activity levels in late morning and late afternoon were associated with lower adjusted odds of diabetes.