Efectos del ejercicio físico
de alta intensidad y
sobrecarga en parámetros
de salud metabólica en
mujeres sedentarias, pre-
diabéticas con sobrepeso
u obesidad
Effect of sprint interval
training and resistance
exercise on metabolic
markers in overweight
women
Cristian Álvarez1,a, Rodrigo
Ramírez2,b, Marcelo Flores3,4,c, Cecil
Zúñiga5,d, Carlos A. Celis-Morales6,e
1
Centro de Salud Familiar de Los Lagos.
Centro de Promoción de Salud de la
mujer, Región de Los Ríos, Chile.
2
Departamento de Ciencias de la
Actividad Física, Universidad de Los
Lagos, Osorno, Chile.
3
Unidad de Kinesiología, Hospital de
Carabineros de Chile, Santiago, Chile.
4
Departamento de Fisiología,
Universidad de Melbourne, Australia.
5
Departamento de Educación Física,
Universidad San Sebastián, Región de
Los Ríos, Chile.
6
Centro de Investigación en Nutrición
Humana, Instituto de Investigación en
Envejecimiento y Salud. Universidad de
Newcastle. Inglaterra. Reino Unido.
a
Profesor de Educación Física, MSc.
Entrenamiento Deportivo.
b
Profesor de Educación Física, MSc.
Fisiología del Ejercicio.
c
Kinesiólogo, MSc. Fisiología del
Ejercicio.
d
Kinesiólogo, MSc. Educación, ISAK
nivel III.
e
Doctor en Ciencias Cardiovasculares y
Biomédicas (PhD).
Correspondencia a:
Background: Physical activity is
associated with an improvement in
cardiovascular health, however there is
a paucity of information about the
effects of sprint interval training on
individuals with high metabolic
risk. Aim: To determine the effects of
three exercise programs on
anthropometric and metabolic markers
in overweight, sedentary and
prediabetic women. Material and
Methods: Forty three women were
ascribed to four groups matched by
body mass index and body fat: high
intensity intervals (HIT, n = 12),
resistance (R, n = 8), combined group
(HIT +R, n = 10) and control group
(CG, n = 13). Participants completed 12
weeks of exercise intervention. Body
mass index, waist circumference,
percentage of fat mass measured by
impedanciometry, blood pressure,
fasting glucose, insulin and homeostasis
model assessment for insulin resistance
(HOMAlR) and fitness assessed using the
two km walk test were measured at
baseline and after the training
period. Results: No changes in
anthropometric and body composition
variables were observed. However, in
HIT and R groups, significant reductions
were observed on fasting glucose (5.4
and 16.6% respectively), insulin (18.6
and 43.4% respectively) and
HOMAIR (24.1 and 55.4% respectively),
72 hours after the intervention. No
significant changes were found for the
observed values in the combined and
control groups. Conclusions: HIT and
resistance training improve glycemic
control and insulin sensitivity in females
with a high metabolic risk.
(Rev Med Chile 2012; 140:1289-1296).
Key words: Exercise; Insulin
Resistance; Obesity; Sedentary
Lifestyle.

Overweight and obesity are states that are
associated with the development of
insulin resistance (IR), type 2 diabetes
(T2D) and cardiovascular disease (CVD)
1-3. Additionally, sedentary lifestyle has
been pointed out as another relevant
factor in the increase of these
pathologies3-5. In Chile, 93% of women
are sedentary and 64% are overweight or
obese and CVDs are currently the main
cause of death in the country6,7.
Despite the association between the
practice of physical activity (PA) and the
reduction of CVD8, AF levels remain low
in the population9. This has led to the
proposal of new AF recommendations for
the adult population, which reduce the
traditional 150 min of AF per week to 20
min of AF of greater intensity and with
shorter duration (eg 3 times per week)
10,11. This change could be an important
step to increase the levels of FA, since the
lack of time has been identified as one of
the main barriers to the practice of PA in
the adult population12. However, in
relation to the effects of this new practice
of AF in people with metabolic risk is
limited. Taking into account the levels of
sedentary lifestyle, obesity, DT2 and
CVD in Chile, it is necessary to design,
and evaluate other models of FA, that are
feasible to be implemented in local health
services and programs throughout the
country. Therefore, the objective of this
study was to evaluate the impact of 3 AF
programs on anthropometric parameters
and cardiovascular health in sedentary,
pre-diabetic and overweight women.
Material and methods
Participants
Forty-three women participated in the
study (n = 43), who were recruited at the
Family Health Center of Los Lagos
(CESFAM), Los Ríos Region, Chile. The
study design corresponds to an
experimental study with simple random
sampling. The participants were divided
into four groups: interval program (PI),
overload program (PS), mixed program
(PI + PS) and control group (GC). The
allocation of the participants in each
group was matched according to BMI
and% fat mass. The sample size was
estimated using observed changes in
plasma insulin (delta = 2.16 mU / L, SD =
1.38) in a group operated with different
exercise programs13. A total of 9
participants per group gives a power of
80% and an α of 0.05.
The inclusion criteria were: a) sedentary
(exercise <30 min / week), b) BMI> 25.0
kg / m2, c) blood glucose level 100 to
<125 mg / dl14. Exclusion criteria were:
a) history of osteoarticular disease,
ischemic, arrhythmias, tachycardia and /
or chronic obstructive pulmonary disease;
b) with pharmacological treatment for
metabolic alterations. This study was
carried out considering the Declaration of
Helsinki and was approved by the ethics
committees of CESFAM Los Lagos,
Osorno, Chile. All participants gave their
written informed consent prior to the
intervention.
Procedures
Body weight, fat mass (MG) and muscle
mass (MM) were determined, using a
digital scale of bioimpedance of feet and
hands (OMRON®, Model HBF-INT).
The height was measured with a 0.1 cm
precision height rod (Health or Meter®,
USA). BMI was calculated by dividing
body weight by height squared (kg / m2)
and overweight was defined as BMI> 25 Table 1. Description of the
kg / m2. The waist circumference was physical exercise protocols used
measured just above the line of the iliac in the intervention
crest15 with an inextensible tape and
precision of 0.1 cm (Hoechstmass®, West
Germany 1-150 cm).

Blood pressure was determined with a

digital monitor (OMRON, model HEM-
742INT). Each participant remained in a
seated position at least 15 minutes prior to
the measurement, reporting only the
average of three measurements. Fasting
Program of physical exercise of overload
blood samples (4 ml) were obtained
(PS): consisted of performing 5 different
between 8:00 AM and 11:00 AM (Pre-
exercises of overload (squat, flexo-
intervention, 24 h and 72 h Post-
extension of biceps, flexo-extensions of
intervention). Glicemia was determined
ankle, flexo-extension of shoulders and
with an enzymatic method (Trinder,
flexo-extensions of elbow). Each exercise
Genzyme Diagnostics, Canada) and
was performed for 1 minute (reaching
insulin was determined by RIA (DPC,
muscle failure) and repeated 3 times per
Los Angeles, CA). Insulin resistance was
session, with pauses of 2 min of recovery
determined with HOMAIR16.
between each series18 (Table 1).
The UKK test was applied to determine
Program of Combined Physical Exercise
bipedal translation capacity17. Socio-
(PI + PS): consisted of performing both
demographic and health questionnaires
exercise programs on non-consecutive
were applied to determine age, history of
days, making a total of 5 days of physical
pharmacological treatment, family history
exercise per week (Table 1).
of diseases indicated in the inclusion and
exclusion criteria.
Diet, Physical Activity and
Design of intervention programs Adherence

Programs of interval physical exercise All participants were instructed not to

(PI): consisted of performing careers and
recovery pauses in an interval way until
completing a volume of 20 min of AF per
day and twice a week. In each session the
participants completed 7 high-intensity
racing intervals (> 85% of the maximum
heart rate (220-Age), each interval lasted
20 s and increased by 2 s (10%) every 2
weeks, while that the recovery interval of
120 s, decreased by 5 s (~ 4%) every 2
weeks (Table 1).
change their diet and FA patterns during
the course of the intervention. The
adherence presented by the three groups
was PI (85%), PS (95%) and PI + PS
(74%).
Statistics
The data are presented as mean ±
standard deviation. The Shapiro-Wilk test
was applied to determine if the variables
corresponded to a normal distribution.
Differences between Pre and Post
intervention were determined with
Student t test for related samples. To
determine if there were significant
differences in quantitative variables
between the four Pre-intervention groups,
two-way ANOVA analysis was applied
and to determine differences between pre-
test, post-test 24 h and post-test 72 h, one-
way ANOVA was applied, the test
Bonferoni was used to detect where these
differences were. The analyzes were
adjusted for age and adherence to the
intervention program. All analyzes were
performed in SPSS (version 19). The
level of significance accepted was p
<0.05.
Results
Table 2 describes the anthropometric
variables stratified by AF Pre and Post
intervention program. The age and
anthropometric characteristics (weight,
height, BMI, waist circumference
and% fat mass) of the participants did
not show significant differences
between groups prior to the
intervention.
Table 2. Anthropometric and physical
condition characteristics of the
participants Pre and Post intervention
stratified by group
In relation to the metabolic variables
(Table 3), systolic blood pressure
presented differences between the groups
prior to the intervention (p <0.001), being
significantly higher in the PI group
compared to the PI + PS group and the
control group. However, diastolic blood
pressure, cardio-respiratory test UKK,
glycemia, insulinemia and HOMAIR did
not show significant differences between
groups prior to the intervention (Table 2).
Table 3. Metabolic characteristics of
the participants Pre and Post
intervention stratified by group.
After 12 weeks of intervention, the
anthropometric variables did not show
significant changes between the
intervention groups. In the UKK cardio-
respiratory test, the PI and PI + PS groups
significantly reduced the time used to
travel 2 km after the 12 weeks of
intervention (p <0.001), but not the PS
and GC groups.
Systolic blood pressure showed a
significant reduction Post intervention
only in the PI group (p = 0.043). The
metabolic markers of glycemia,
insulinemia and HOMAIR were
measured 24 h and 72 h post intervention.
The glycemia shows a significant
reduction of 6.7% in the PI group (p =
0.011) and 7.4% in the PS group (p =
0.019), but not in the group PI + PS and
GC at 24 h Post intervention . No
significant reductions were found in
insulin and HOMAIR at 24 h Post
intervention in any of the groups.
However, these variables showed a
significant reduction at 72 h Post
intervention in the PI and PS groups, but
not in the PI + PS and GC group. The
magnitude of these reductions were 5.4%
and 6.5% in glycemia levels, 18.6% and
43.4% in insulinemia, 24.1% and 55.4%
in HOMAIR in the PI group and PS,
respectively. The average% of reductions
(delta 24 and 72 h Post intervention) are
presented in Figure.1.
Figure 1. Changes in
glycemia and HOMAir
after 12 weeks of
intervention. Data
presented as mean ±
standard error of the
mean. Graphs a and c
show the levels of
glycemia and insulin
resistance pre-
intervention, 24 h and 72
h post intervention.
Graphs b and d show
the% reduction
(Post72h-Pre) in
glycemia and HOMAIR
post intervention.
Groups are marked as
(PI: Interval Program,
PS: Overload Program,
PI + PS: Combined
Group and GC: Control
Group). Significant
differences between pre,
24 h post and 72 h post
were determined with
one-way ANOVA. The
models were adjusted
for age and program
attendance. Values of
significance are
indicated as * p <0.05,
** p <0.01.
Discussion
The results of this study indicate that the
application of more intense PA programs,
such as the PI and PS programs, are
effective tools for the reduction of IR
levels in sedentary, pre-diabetic and
overweight women. It is also important to
note that the design of shorter AF
programs can be used as a strategy to
increase the practice and adherence to AF
programs in adults with metabolic risk,
which is a necessity considering the
national reality in relation to the high
levels of sedentary lifestyle (~ 93%),
overweight or obesity (~ 64%) and
prevalence of diabetes (~ 9%) in
women6, 7.
The interventions proposed in this
investigation did not produce changes in
BMI, waist circumference and% fat mass
in any of the 3 groups operated on. Our
results agree with previous studies where
similar AF programs in obese women did
not produce significant changes in
adiposity19,20. These results could be
explained by the short intervention
period.
Although no changes were detected in
adiposity markers in our study, the
proposed FA programs significantly
reduced post-intervention glycemia
levels. Glycemic control is an important
factor in the treatment of T2D and is
associated with vascular complications in
diabetic patients21. This study reported
an average reduction of 6.1% and 6.9% in
post-intervention blood glucose levels in
the PI and PS group, respectively. These
changes were lower than those reported
by Little and cols19, who reported a
reduction of 13% after 6 sessions of (PI)
during 2 weeks of intervention. Similar
reductions in glycemia (15.6%) were
reported by Cauza et al22, after an
intervention with PS exercises. This
difference in blood glucose reduction
could be explained by the type of patients
who underwent surgery, since both
studies involved diabetic patients and, as
previously mentioned, the benefits of AF
are greater in people with metabolic risk
(overweight, sedentary and diabetic).
23.24.
The average reductions in insulinemia (PI
~ 16%, PS ~ 27.6) and HOMAIR (PI ~
17%; PS ~ 38), reflect the vascular
benefits associated with the application of
PI and PS exercises in women with
metabolic risk. These reductions have
important clinical implications due to the
association between IR and the increase
in mortality levels attributed to CVD25.
The reduction in insulinemia and
HOMAreported in our study are similar
to the benefits obtained with traditional
training programs, where 150-300 min
per week of aerobic exercise (65% of
VO2MAX) reduces in 22% the levels of
insulinemia and improvement in 32%
insulin sensitivity, after 7 weeks of
training in overweight women and family
history of diabetes26. However, it is
important to note that the greater
reduction in HOMAIR associated with
the PS group compared to the PI group
could be explained by differences in the
volume and training time in our study
(Table 1).
Similarly, the lack of adherence to the
program could be one of the factors that
could explain the non-significant changes
in the PI + PS group. However, it is
important to note that all three programs
have a clear tendency to reduce glycemia
and insulin resistance. The potential
mechanisms through which PI or PS
programs improve glycemic control and
insulin sensitivity are interesting
considering that there were no changes in
the variables of body composition. It has
recently been reported that programs of 4
repetitions interval of 30 s, produce a
minimum energy expenditure of ~ 40-80
kcal but nevertheless, reduce muscle
glycogen between 30% and 45% through
the metabolic pathway of AMPK that
plays a role paramount in the
translocation of GLUT4 and muscle
glucose consumption27. Interestingly, the
level of reduction in muscle glycogen
induced by 4 repetitions of 30 s of PI
exercises is similar to that induced by a
90-min session of moderate intensity
aerobic exercise28. Additionally, another
mechanism that could explain the
reduction in IR is muscle adaptation to
training programs. It has been reported
that diabetic patients or those with
metabolic risk have a reduced capacity for
mitochondrial oxidation, 29 and that
interventions similar to those proposed in
our study increase mitochondrial
oxidation capacity in both healthy
subjects30 and metabolic risk31.
Additionally, changes in systolic blood
pressure (SBP) were detected in the
interval group, this could be explained
because the PI group had higher levels of
SBP than the other Pre-intervention
groups. The mechanisms by which PI
exercises reduce SBP have not been fully
elucidated, but they may be mediated by a
reduction in sympathetic nervous system
vascular control32 and vasodilation
mechanisms associated with an increase
in nitric oxide production by the body.
endothelium33.
It is important to highlight some strengths
of the present study, as it was matched
according to BMI and fat mass levels of
the groups operated on. Additionally, the
design of the exercise programs was
carried out considering protocols of
simple application, and feasible to be
replicated in other CESFAM at a national
level. Finally, standardized techniques for
the measurement of anthropometric and
metabolic parameters were considered.
However, it is important to mention
potential limitations in the design of the
study that should be considered in future
research. Within the limitations is the
control of caloric intake during the
intervention, since the changes detected
in metabolic markers could be affected by
changes in eating patterns, however, the
participants were constantly instructed
not to modify their diet. Similarly,
physical activity levels were not
objectively controlled during the
intervention, however, the non-
performance of physical activity outside
the intervention programs was
emphasized. Another limitation was the
age distribution in the groups, the average
age was higher in the PS group which
could explain why said program shows
greater reductions, however, the age was
adjusted in the statistical models and no
differences were detected in the
magnitude and direction of the results.
Finally, adherence to the intervention
programs is another factor of confusion,
therefore the analyzes were adjusted by
level of assistance.
In conclusion, the PI and PS programs are
effective alternatives for the reduction of
insulin resistance in sedentary, pre-
diabetic and overweight women. The total
exercise time required per week to
produce metabolic benefits was 60 min in
the PI group and 90 min in the PS group,
representing 40% and 60%, respectively,
of the traditional AF recommendations
(150 min x week) 10. Considering that
the lack of time has been one of the main
justifications for the non-practice of
physical activity, we believe that this
strategy of reducing exercise time could
be a viable alternative to increase
adherence to intervention programs. The
exercise programs presented in this
research show that implementing shorter
programs in Family Health Centers at the
national level is an alternative
prescription tool, easy to implement and
effective in reducing cardiovascular risk
associated with insulin resistance in
patients with metabolic risk.
Acknowledgments: To all the
participants, for their commitment to
the program. Carmen Gloria Flores,
Director of CESFAM Los Lagos and
Leslie Ruiz, Coordinator of the Health
Promotion Program, of CESFAM, for
their administrative management of the
project.
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