Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2021; 12(4): 331-343
Published online Apr 15, 2021. doi: 10.4239/wjd.v12.i4.331
Exercise intervention under hypoxic condition as a new therapeutic paradigm for type 2 diabetes mellitus: A narrative review
Sung-Woo Kim, Won-Sang Jung, Sochung Chung, Hun-Young Park
Sung-Woo Kim, Won-Sang Jung, Hun-Young Park, Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul 05029, South Korea
Sochung Chung, Department of Pediatrics, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University, School of Medicine, Seoul 05029, South Korea
Hun-Young Park, Department of Sports Science and Medicine, Konkuk University, Seoul 05029, South Korea
Author contributions: Park HY designed the framework and supervised the preparation of the manuscript; Kim SW collected all references, wrote the manuscript, prepared the figure and table; Kim SW, Jung WS, Chung S and Park HY contributed to thorough revision of the manuscript; all authors have read and approved the final manuscript.
Supported by Ministry of Education of the Republic of Korea and the National Research Foundation of Korea, No. NRF-2019S1A5A2A03034583.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hun-Young Park, PhD, Associate Professor, Department of Sports Science and Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea.
Received: January 9, 2021
Peer-review started: January 9, 2021
First decision: January 25, 2021
Revised: January 25, 2021
Accepted: March 8, 2021
Article in press: March 8, 2021
Published online: April 15, 2021

This review aims to summarize the health benefits of exposure to hypoxic conditions during exercise in patients with type 2 diabetes mellitus (T2DM). Exposure to hypoxic conditions during exercise training positively changes the physiological response in healthy subjects. Exposure to hypoxic conditions during exercise could markedly increase skeletal muscle glucose uptake compared to that in normoxic conditions. Furthermore, post-exercise insulin sensitivity of T2DM patients increases more when exercising under hypoxic than under normoxic conditions. Regular exercise under short-term hypoxic conditions can improve blood glucose control at lower workloads than in normoxic conditions. Additionally, exercise training under short-term hypoxic conditions can maximize weight loss in overweight and obese patients. Previous studies on healthy subjects have reported that regular exercise under hypoxic conditions had a more positive effect on vascular health than exercising under normoxic conditions. However, currently, evidence indicating that exposure to hypoxic conditions could positively affect T2DM patients in the long-term is lacking. Therefore, further evaluations of the beneficial effects of exercise under hypoxic conditions on the human body, considering different cycle lengths, duration of exposures, sessions per day, and the number of days, are necessary. In this review, we conclude that there is evidence that exercise under hypoxic conditions can yield health benefits, which is potentially valuable in terms of clinical care as a new intervention for T2DM patients.

Keywords: Exercise, Hypoxia, Insulin-resistance, Metabolism, Type 2 diabetes mellitus, Weight loss

Core Tip: Current research shows that exercise interventions performed under hypoxic conditions have positive effects on healthy subjects and athletes. Exercise intervention under hypoxic conditions can be beneficial as a new treatment for patients, including those with diabetes. This review summarizes recent studies on the potential cause‒effect relationship for exercise interventions under hypoxic conditions in type 2 diabetes mellitus patients and discusses health benefits and risk factors.