title: Metabolic training: new paradigms of exercise training for metabolic diseases with exercise calorimetry targeting individuals.
abstract: For patients with metabolic diseases, as with other diseases, exercise training is a fully recognized therapy. Such training helps obese patients stabilize weight after slimming. For patients with type 2 diabetics, it is both a prevention and a glucose-lowering treatment and reduces health care costs. We propose a targeted training for individuals at the level of maximal lipid oxidation (LIPOXmax) with a protocol of exercise calorimetry (four 6-min workloads) based on Brooks and Mercier's crossover concept. Calorimetric interpretation of gas exchange at the fifth and sixth minutes of each stage shows a bell-shaped curve for lipid oxidation that peaks at LIPOXmax, a point that varies considerably among individuals. As well, glucose oxidation is a linear function of power (carbohydrate cost of the watt). Such a calculation predicts fairly actual lipid oxidation over 45 min at the same level. Other protocols, with 3-min workloads used in sports medicine, are not reliable for patients with metabolic diseases. For obese adults and teenagers, as well as those with type 2 diabetes, 2 months' training at the LIPOXmax (three sessions at 45 min per week) results in a net loss of fat mass, with preserved fat-free mass, and increased ability to oxidize lipids. At the end of this period, training can be "re-targeted" to be more effective and, possibly, associated with other strategies with stronger exercise intensities. Therefore, metabolic training is a viable option for patients with metabolic diseases, but the full concept is still evolving. However, the major challenge remains to transform inactive individuals into active ones.
authors.affiliation: Inserm ERI 25 Muscle et Pathologies, laboratoire de physiologie des interactions, UFR de médecine, institut de biologie de Montpellier, université Montpellier-I, boulevard Henri-IV, 34062 Montpellier, France. j-brun@chu-montpellier.fr
authors.forename: J-F
authors.initials: JF
authors.lastname: Brun
authors.forename: E
authors.initials: E
authors.lastname: Jean
authors.forename: E
authors.initials: E
authors.lastname: Ghanassia
authors.forename: S
authors.initials: S
authors.lastname: Flavier
authors.forename: J
authors.initials: J
authors.lastname: Mercier
mesh_terms: D002151:Calorimetry; D005081:Exercise Therapy; D006801:Humans; D008659:Metabolic Diseases / Q000378:metabolism / Q000628:therapy*