Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun;123(6):1147-1165.
doi: 10.1007/s00421-023-05135-1. Epub 2023 Jan 23.

The role of exercise and hypoxia on glucose transport and regulation

Affiliations
Review

The role of exercise and hypoxia on glucose transport and regulation

J Soo et al. Eur J Appl Physiol. 2023 Jun.

Abstract

Muscle glucose transport activity increases with an acute bout of exercise, a process that is accomplished by the translocation of glucose transporters to the plasma membrane. This process remains intact in the skeletal muscle of individuals with insulin resistance and type 2 diabetes mellitus (T2DM). Exercise training is, therefore, an important cornerstone in the management of individuals with T2DM. However, the acute systemic glucose responses to carbohydrate ingestion are often augmented during the early recovery period from exercise, despite increased glucose uptake into skeletal muscle. Accordingly, the first aim of this review is to summarize the knowledge associated with insulin action and glucose uptake in skeletal muscle and apply these to explain the disparate responses between systemic and localized glucose responses post-exercise. Herein, the importance of muscle glycogen depletion and the key glucoregulatory hormones will be discussed. Glucose uptake can also be stimulated independently by hypoxia; therefore, hypoxic training presents as an emerging method for enhancing the effects of exercise on glucose regulation. Thus, the second aim of this review is to discuss the potential for systemic hypoxia to enhance the effects of exercise on glucose regulation.

Keywords: Exercise; Glucose; Glucose metabolism; Hypoxia; Insulin resistance.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Proposed pathways mediating translocation of GLUT-4 to the cell membrane of skeletal myocyte in response to insulin and exercise/contraction with and without additional hypoxic stimulus. Upon insulin binding, the activated insulin receptor initiates downstream metabolic signalling that recruits diverse substrates, which ultimately leads to the translocation and fusion of the glucose transporter storage vesicle to the cell membrane and insertion of GLUT-4. Exercise and muscle contraction stimulate GLUT-4 translocation and glucose uptake through a distinct mechanism independent of insulin. This mechanism involves changes in cellular energy status, intracellular Ca2+ concentration, reactive oxygen species (ROS) and nitric oxide (NO). Hypoxia activates GLUT-4 translocation via similar or overlapping pathways to that of contraction-mediated glucose uptake. The (+) indicates the proposed potentiation of the hypoxia stimulus
Fig. 2
Fig. 2
Glucoregulatory effects of key hormones controlling plasma glucose concentration. Effect of insulin on the liver, adipose tissue and skeletal muscle pathways are demonstrated, along with counter-regulatory effects of epinephrine and norepinephrine, growth hormone and glucagon

Similar articles

Cited by

References

    1. Azevedo JL, Carey JO, Pories WJ, Morris PG, Dohm GL. Hypoxia stimulates glucose transport in insulin-resistant human skeletal muscle. Diabetes. 1995;44(6):695–698. doi: 10.2337/diab.44.6.695. - DOI - PubMed
    1. Babraj J, Vollaard N, Keast C, Guppy F, Cottrell G, Timmons J. Extremely short duration high intensity interval training substantially improves insulin action in young healthy males. BMC Endocr Disord. 2009;9(1):3. doi: 10.1186/1472-6823-9-3. - DOI - PMC - PubMed
    1. Bailey DP, Smith LR, Chrismas BC, Taylor L, Stensel DJ, Deighton K, Douglas JA, Kerr CJ. Appetite and gut hormone responses to moderate-intensity continuous exercise versus high-intensity interval exercise, in normoxic and hypoxic conditions. Appetite. 2015;89:237–245. doi: 10.1016/j.appet.2015.02.019. - DOI - PubMed
    1. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol. 2005;99(3):1193–1204. doi: 10.1152/japplphysiol.00160.2005. - DOI - PubMed
    1. Belhaj MR, Lawler NG, Hoffman NJ. Metabolomics and lipidomics: expanding the molecular landscape of exercise biology. Metabolites. 2021;11(3):151. doi: 10.3390/metabo11030151. - DOI - PMC - PubMed