Determinants of VO2peak Responsiveness to Aerobic Exercise Training in Adults with Type 2 Diabetes: The PROTECTION Study
Michielsen M, Gojevic T, Bekhuis Y, Claes J, Machado F, Claessen G, et al.
Summary
In 108 adults with Type 2 diabetes participating in a 26-week supervised cycling programme, GLP-1 receptor agonist use was identified as a negative predictor of VO2peak improvement alongside female sex, smoking, and beta-blocker use. While overall fitness improved by 17%, significant interindividual variability existed, with fat mass and insulin resistance as key baseline determinants of exercise responsiveness.
Clinical Significance
This is one of the first studies to flag GLP-1 RA use as a potential modifier of exercise training adaptation. For clinicians prescribing GLP-1 agonists alongside exercise programmes for T2D patients, this finding suggests that exercise prescription may need adjustment — and that patients on GLP-1 RAs may require different expectations or training intensities for cardiorespiratory gains.
Key Findings:
- 108 T2D adults, 26-week supervised moderate-intensity cycling (3 sessions/week)
- Overall VO2peak improved +3.6 mL/kg/min (+17%), but responses varied widely
- GLP-1 RA use negatively associated with VO2peak improvement change
- Key positive predictors: lung function, muscle strength, hemoglobin
- Key negative predictors: female sex, smoking, fat mass, insulin resistance, beta-blockers, GLP-1 RA
Clinical Takeaway: GLP-1 RA use may attenuate exercise training gains in VO2peak. Clinicians combining GLP-1 RAs with exercise prescriptions should monitor fitness outcomes closely and may need to adjust training volume or intensity.
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