Improved carbohydrate metabolism after physical training and dietary intervention in individuals with the ‘atherothrombogenic syndrome’. Oslo Diet and Exercise Study (ODES). A randomized trial

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Abstract
Objectives. To compare the single and joint effect of 1‐year diet and exercise intervention on carbohydrate metabolism and associated coronary risk variables. Design. Unmasked, randomized, 2×2 factorial intervention trial with 1‐year duration for each participant. Setting. The participants were recruited from a screening examination of 40‐year‐old persons in Oslo, Norway. Subjects. Two hundred and nineteen sedentary men and women, with diastolic blood pressure 86–99 mmHg, HDL cholesterol 1.4 mmol L‐1, total cholesterol 5.20–7.74 mmol L‐1 and BMI>24. Participants were randomly allocated to control (n=43), diet (n= 55), exercise (n=54) and diet+exercise (n=67). Interventions. Exercise: supervised endurance exercise three times a week. Diet: reduce weight, increase the intake of fish and reduce total fat intake. Main outcome measures. One‐year changes in insulin and glucose before and after a standardized glucose load. Results. As compared with controls fasting insulin in pmol L‐1 decreased significantly in the combined diet and exercise group (3.9±6.2 versus ‐22.6±4.7 respectively, P=0.003). Insulin in pmol L‐1 after glucose load decreased significantly in all intervention groups compared to controls (diet: ‐82.2± 49.9 P=0.02; exercise: ‐92.4±60.1 P=0.03; diet+exercise: ‐179.6±45.1 P=0.0004). Fasting glucose in mmol L‐1 decreased significantly in the diet alone group (0.21±0.07 P=0.006) and in the diet+exercise group (‐0.26±0.08 P=0.005). In a subgroup analysis of the good responders, the observed changes with respect to total cholesterol (‐0.76 mmol L‐1), HDL cholesterol (0.16 mmol L‐1), triglycerides (‐0.72 mmol L‐1), systolic and diastolic blood pressure (‐8.5/‐6.8 mmHg) were all statistically significant compared to the control with PConclusions. Exercise and diet intervention and in particular the combination of the two, were effective in improving carbohydrate metabolism. Associated risk factors were also affected in a beneficial direction.

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