Introduction: Metabolic adaptations to maximal physical exercise in people with obesity (PwO) are scarcely described. This cross-sectional study evaluates the metabolic response to exercise via the respiratory exchange ratio (RER) in PwO and different degrees of glycemic control. Methods: Eighty-five PwO (body mass index 46.0 [39.0–54.0] kg/m²), that is, 32 normoglycemic (Ob-N), 25 prediabetic (Ob-preDM), and 28 diabetic (Ob-T2DM) subjects and 18 healthy subjects performed an incremental, maximal cardiopulmonary exercise test. The RER was measured at rest (RERrest) and at peak exercise (RERpeak). Results: RERpeak was significantly higher in healthy subjects than that in PwO. Among those, RERpeak was significantly higher in Ob-N than that in Ob-preDM and Ob-T2DM (1.20 [1.15–1.27] vs. 1.18 [1.10–1.22] p = 0.04 and vs. 1.14 [1.10–1.18] p #x3c; 0.001, respectively). Accordingly, ΔRER (RERpeak-RERrest) was lower in Ob-preDM and Ob-T2DM than that in Ob-N (0.32 [0.26–0.39] p = 0.04 and 0.29 [0.24–0.36] p #x3c; 0.001 vs. 0.38 [0.32–0.43], respectively), while no significant difference was found in ΔRER between Ob-preDM and Ob-T2DM and not even between Ob-N and healthy subjects. Moreover, ΔRER in PwO correlated with glucose area under curve (p = 0.002). Conclusions: PwO demonstrate restricted metabolic response during maximal exercise. Particularly, those with prediabetes already show metabolic inflexibility during exercise, similarly to those with type 2 diabetes. These findings also suggest a potential role of cardiopulmonary exercise testing in detecting early metabolic alterations in PwO.
Obes Facts

中文翻译：

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重度肥胖、糖尿病前期和糖尿病患者对次最大和最大运动的代谢反应

简介：几乎没有描述肥胖人群 (PwO) 对最大程度体育锻炼的代谢适应。这项横断面研究通过 PwO 中的呼吸交换比 (RER) 和不同程度的血糖控制来评估对运动的代谢反应。方法： 85 名 PwO（体重指数 46.0 [39.0–54.0] kg/m ²），即 32 名血糖正常 (Ob-N)、25 名糖尿病前期 (Ob-preDM) 和 28 名糖尿病 (Ob-T2DM) 受试者和 18 名健康受试者进行了增量最大心肺运动测试。RER 在休息时 (RERrest) 和运动高峰时 (RERpeak) 测量。结果：健康受试者的 RERpeak 显着高于 PwO。其中，RERpeak 在 Ob-N 中显着高于 Ob-preDM 和 Ob-T2DM（1.20 [1.15–1.27] vs. 1.18 [1.10–1.22] p = 0.04 和 vs. 1.14 [1.10–1.18] p # x3c；分别为 0.001）。因此，Ob-preDM 和 Ob-T2DM 中的 ΔRER（RERpeak-RERrest）低于 Ob-N（0.32 [0.26-0.39] p = 0.04 和 0.29 [0.24-0.36] p #x3c；0.001 与 0.38 [ 0.32–0.43]），而 Ob-preDM 和 Ob-T2DM 之间的 ΔRER 没有显着差异，甚至 Ob-N 和健康受试者之间也没有发现显着差异。此外，PwO 中的 ΔRER 与曲线下的葡萄糖面积相关（p = 0.002）。结论：PwO 在最大运动期间表现出受限的代谢反应。特别是，糖尿病前期患者在运动过程中已经表现出代谢不灵活，类似于 2 型糖尿病患者。这些发现还表明心肺运动测试在检测 PwO 早期代谢改变方面的潜在作用。
肥胖事实