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The effect of exercise timing on glycemic control: a randomized clinical trial
Teo SYM, Kanaley JA, Guelfi KJ, Marston KJ, Fairchild TJ
Medicine and Science in Sports and Exercise 2020 Feb;52(2):323-334
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Despite the acknowledgment of exercise as a cornerstone in the management of type 2 diabetes (T2D), the importance of exercise timing has only recently been considered. PURPOSE: This study sought to determine the effect of diurnal exercise timing on glycemic control in individuals enrolled in a 12-wk supervised multimodal exercise training program. A secondary aim was to determine the effect of diurnal exercise timing on the circadian rhythm of wrist skin temperature. METHODS: Forty sedentary, overweight adults (mean +/- SD age 51 +/- 13 yr; body mass index 30.9 +/- 4.2 kg/m2; women, n = 23) with and without (n = 20) T2D diagnosis were randomly allocated to either a morning (amEX) or an evening (pmEX) exercise training group. The supervised 12-wk (3 d/wk) program, comprised 30 min of moderate-intensity walking and 4 resistance-based exercises (3 sets, 12 to 18 repetitions each). Glycemic outcomes (glycated hemoglobin, fasting glucose, postprandial glucose) and wrist skin temperature were assessed at baseline and postintervention. RESULTS: Exercise training improved (main effect of time, all p < 0.01) all glycemic outcomes; however, this was independent of allocation to either the amEX (Hedge's g, 0.23 to 0.90) or the pmEX (Hedge's g 0.16 to 0.90) group. Accordingly, the adopted exercise training program did not alter the circadian rhythm of skin temperature. When only T2D individuals were compared, amEX demonstrated greater effects (all Hedge's g) on glycated hemoglobin (amEX 0.57; pmEX 0.32), fasting glucose (amEX 0.91; pmEX 0.53), and postprandial glucose (amEX 1.12; pmEX 0.71) but was not statistically different. CONCLUSIONS: Twelve weeks of multimodal exercise training improved glycemic control and postprandial glycemic responses in overweight non-T2D and T2D individuals. However, no distinct glycemic benefits or alterations in circadian rhythm were associated with morning versus evening exercise, when performed three times per week in this cohort.

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