The Impact of a Multidimensional Physical Activity Intervention on Glycemic Control in Type 1 Diabetes: A Preliminary...

Objectives: Type 1 diabetes is characterized by hyperglycemic episodes influenced by diet, sleep quality, chronotype, and physical activity, among others. While aerobic exercise is known to improve glycemic control, its effect on blood glucose regulation remains underexplored. Thus, this case study aimed to evaluate the effects of a prolonged and differentiated indoor and outdoor exercise intervention on glycemic control in an individual with type 1 diabetes. Methods: The participant (age: 23 years; weight: 95 kg; height: 1.90 m; Body Mass Index: 26.3 kg/m²; waist to hip ratio: 0.98; basal metabolic rate: 2015 kcal; Heart Rate Maximum (HRmax): 197 beats·min^-1) completed two outdoor (~3800 m) and two indoor sessions with self-selected speed, in the initial 2 min stage, at a 0% grade slope. The grade increased by 2% at each stage during the uphill phase until reaching volitional fatigue, followed by a 2% decrease at each stage during the downhill phase until returning to a 0% grade. Blood pressure was assessed before and after each session. Daily nutrition intake, insulin intake, and blood glucose were continuously monitored. Dietary adherence (PREvención con DIeta MEDiterránea), sleep quality (Pittsburgh Sleep Quality Index), chronotype (Morningness-Eveningness Questionnaire), and physical activity levels (International Physical Activity Questionnaire) were assessed before each session. The Physical Activity Enjoyment Scale was used to measure enjoyment after each session. Results: The sessions were completed in ~44 and ~39 min with the participant achieving 84% (outdoor) and 96% (indoor) of their theoretical HRmax. The intervention resulted in glycemic improvements, with time spent in hyperglycemia (>250 mg/dL) decreasing from 56.46% to 0%, while time in the normal range (70-180 mg/dL) increased to 63.96%. A 47% reduction in insulin units showed that insulin sensitivity also improved. Conclusions: Despite differences in intensity, indoor and outdoor activities yielded comparable benefits, with outdoor activities being perceived as more enjoyable (outdoor: 28.5 ± 0.7; indoor: 24.0 ± 5.6) and positively impacting glycemic control, thus supporting the need for tailored strategies in diabetes management.