**2. Influence of dynamic physical training on metabolic, hormonal and clinical parameters in adolescents and men with Type 1 diabetes mellitus (1978 to 1982)**

A prospective single-centre study with 19 PWD1 males (age 15–35 years, diabetes duration from 2 months to 20 years (mean 6,8 years) improved insights on the effects of physical training [62]. The study protocol was based on several previous studies [79–88] At the beginning of the training period, proband was admitted to the hospital for one week. His Physical Working Capacity (PWC 170) was investigated using the bicycle ergometer Zimmermann [89]. At the end of the following outdoor training period (duration 157 43 days), the second and third tests were performed whereas a one-week quiet break between them without any exercise was included into the study schedule (**Figure 1**). Each test was performed one hour after breakfast in the morning. PWC 170 and other parameters at the first, second and third tests were compared (**Figures 2** and **3**).

Here are the effects of the 5–6-month dynamic training (athletics, cycling and swimming) in PWD1:

1. Increase of PWC 170. PWC 170 is the submaximal ergometer load resulting in a heart rate of 170 beats/min which is reached at the 4th step. This load was calculated using linear extrapolation of heart rates at previous steps. Each step lasted 10 min (In future studies maximum oxygen capacity VO2 max. has been used instead of PWC 170).

**Figure 1.**

*Design of the training and quiet (klid) period with three ergometer tests.*

**Figure 2.**

*Schedule of PWC 170 ergometer step test [89] and respective investigations.*

**Figure 3.**

*Amount of injected insulin [IU/d], quotient Q [g Carb/IU] (saccharide relation), Michaelis glycaemic control index GCI [90] estimated energy expenditure [MJ/d], systolic blood pressure (syst TK) at the 3rd step (100 W) of ergometer test and PWC 170 [W] over the study n = 19.*

*Intensive Management of Type 1 Diabetes in Adults: One Centre Experience 1970–2022 DOI: http://dx.doi.org/10.5772/intechopen.108032*

2.An improvement of saccharide (carbohydrate) metabolism was demonstrated by increased insulin effectiveness (quotient Q) without any change in blood glucose control. Quotient Q describes how many grams of consumed carbohydrates are metabolised due to 1 IU of injected insulin. An approximate relation between insulin effectiveness Q and physical working capacity PWC 170 can be calculated using a new formula derived from our observations:

$$\mathbf{Q} \text{ [g Carb./IU]} = \mathbf{0}, \mathbf{0} \text{\(3 PWC 170 [W] - 0,5,} \tag{1}$$

(where PWC 170 reached values 90 W <PWC 170 <295 W).

The increase of PWC 170 depends on the amount of estimated energy expended for the submaximal training. Following training interruption (as it may happen e.g. after admission to the hospital) the insulin effectiveness drops in relation to the decrease of PWC 170 due to reduced physical exercise (**Figure 3**).

The insulin effectiveness Q in this study reached values ranging from 2.5 to 22.4 g Carb./IU. Its evolution appears to be related to the value of the physical working capacity PWC 170 (**Figure 4**).

No influence of training either on venous blood glucose concentration (vBG) at the beginning of ergometer test or on the speed of vBG reduction in the course of tests I, II and III was shown. The reduction of vBG became significant (p < 0,05) as soon as at the end of step 2 (75 W) (**Figure 5**).

An improvement of lipoprotein metabolism was recognised by an increase in HDL cholesterol concentration (1.19 � 0.08 vs 1.86 � 0.22 mmol/l, p < 0.05) (**Figure 6**) and by a decrease in the index of total cholesterol/HDL cholesterol. These significant changes could also be found 7 days after the end of the training [58].

A beneficial influence on some signs of neuropathy [59], on memory, attention and on the general condition of diabetic patients could also be demonstrated [60].

The important results of our study are comprised in the Abstract book (**Figure 7**).

Hence, based on this study, a submaximal dynamic physical training may be recommended as an additive treatment of type 1 diabetic patients with no signs of

**Figure 4.** *Relation of insulin effectiveness QI, QII, QIII and respective PWC 170.*

## **Figure 5.**

*Development of vBG in the course of the bicycle ergometer test I (before training), II (end of training) and III (after 6 days of quiet) n = 19.*

**Figure 6.**

*Increase of serum HDL cholesterol concentration between the start and end of the 6-month training (n = 19).*

catabolism. At the beginning, the insulin should be reduced or the amount of carbohydrates in food increased along with the change of insulin effectiveness. Even in patients with high physical working capacity, it is not possible to replace insulin by physical exercise. Following the training cessation, the amount of injected insulin should be increased or the amount of carbohydrates in food reduced along with the decrease of insulin effectiveness.
