Skip to main content

‘Exercise snacks’ before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance



The aim of this study was to investigate whether small doses of intense exercise before each main meal (‘exercise snacks’) would result in better blood glucose control than a single bout of prolonged, continuous, moderate-intensity exercise in individuals with insulin resistance.


Nine individuals completed three exercise interventions in randomised order. Measures were recorded across 3 days with exercise performed on the middle day, as either: (1) traditional continuous exercise (CONT), comprising 30 min moderate-intensity (60% of maximal heart rate [HRmax]) incline walking before dinner; (2) exercise snacking (ES), consisting of 6 × 1 min intense (90% HRmax) incline walking intervals 30 min before each meal; or (3) composite exercise snacking (CES), encompassing 6 × 1 min intervals alternating between walking and resistance-based exercise, 30 min before meals. Meal timing and composition were controlled within participants for exercise interventions.


ES attenuated mean 3 h postprandial glucose concentration following breakfast (by 1.4 ± 1.5 mmol/l, p = 0.02) but not lunch (0.4 ± 1.0 mmol/l, p = 0.22), and was more effective than CONT following dinner (0.7 ± 1.5 mmol/l below CONT; p = 0.04). ES also reduced 24 h mean glucose concentration by 0.7 ± 0.6 mmol/l (p = 0.01) and this reduction persisted for the subsequent 24 h (lower by 0.6 ± 0.4 mmol/l vs CONT, relative to their baselines; p = 0.01). CES was just as effective as ES (p > 0.05 for all glycaemic variables) at improving glycaemic control.


Dosing exercise as brief, intense ‘exercise snacks’ before main meals is a time-efficient and effective approach to improve glycaemic control in individuals with insulin resistance.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7



Cardiovascular disease


Composite exercise snacking


Continuous blood glucose monitoring


Traditional continuous exercise


Exercise snacking protocol


High-intensity interval training


Heart rate

HRmax :

Maximal heart rate


Postprandial glucose


Respiratory exchange ratio


Rating of perceived exertion

\( \dot{V}{\mathrm{O}}_{2 \max } \) :

Maximal oxygen consumption


  1. Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol 8:228–236

    Article  PubMed  Google Scholar 

  2. Hawley JA, Lessard SJ (2008) Exercise training-induced improvements in insulin action. Acta Physiol (Oxf) 192:127–135

    Article  CAS  Google Scholar 

  3. Lindström J, Ilanne-Parikka P, Peltonen M et al (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679

    Article  PubMed  Google Scholar 

  4. Tucker JM, Welk GJ, Beyler NK (2011) Physical activity in US adults: compliance with the physical activity guidelines for Americans. Am J Prev Med 40:454–461

    Article  PubMed  Google Scholar 

  5. Farrell L, Hollingsworth B, Propper C, Shields MA (2013) The socioeconomic gradient in physical inactivity in England. University of Bristol, Bristol

    Google Scholar 

  6. Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001

    Article  PubMed  Google Scholar 

  7. American Diabetes Association (2001) Postprandial blood glucose. Diabetes Care 24:775–778

    Article  Google Scholar 

  8. Brownlee M (2005) The pathobiology of diabetic complications: a unifying mechanism. Diabetes 54:1615–1625

    Article  CAS  PubMed  Google Scholar 

  9. Ceriello A, Bortolotti N, Motz E et al (1998) Meal-generated oxidative stress in type 2 diabetic patients. Diabetes Care 21:1529–1533

    Article  CAS  PubMed  Google Scholar 

  10. Ceriello A, Esposito K, Piconi L et al (2008) Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 57:1349–1354

    Article  CAS  PubMed  Google Scholar 

  11. Da Ros R, Assaloni R, Ceriello A (2005) Postprandial hyperglycemia and diabetic complications. Recenti Prog Med 96:436–444 [article in Italian]

    PubMed  Google Scholar 

  12. de Vegt F, Dekker JM, Jager A et al (2001) Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 285:2109–2113

    Article  PubMed  Google Scholar 

  13. Koopman R, Manders RJF, Zorenc AHG et al (2005) A single session of resistance exercise enhances insulin sensitivity for at least 24 h in healthy men. Eur J Appl Physiol 94:180–187

    Article  CAS  PubMed  Google Scholar 

  14. Larsen J, Dela F, Kjar M, Galbo H (1997) The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients. Diabetologia 40:447–453

    Article  CAS  PubMed  Google Scholar 

  15. Garetto LP, Richter EA, Goodman MN, Ruderman NB (1984) Enhanced muscle glucose metabolism after exercise in the rat: the two phases. Am J Physiol Endocrinol Metab 246:E471–E475

    CAS  Google Scholar 

  16. Ivy J, Holloszy J (1981) Persistent increase in glucose uptake by rat skeletal muscle following exercise. Am J Physiol Cell Physiol 241:C200–C203

    CAS  Google Scholar 

  17. Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ (2012) Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab 14:575–577

    Article  CAS  PubMed  Google Scholar 

  18. Little JP, Gillen JB, Percival M et al (2011) Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol 111:1554–1560

    Article  CAS  PubMed  Google Scholar 

  19. Gibala MJ, Little JP, MacDonald MJ, Hawley JA (2012) Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol 590:1077–1084

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Wisløff U, Støylen A, Loennechen JP et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation 115:3086–3094

    Article  PubMed  Google Scholar 

  21. Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JMD, Guimaraes GV (2010) Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res 33:836–843

    Article  CAS  PubMed  Google Scholar 

  22. World Health Organization (2010) Global recommendations on physical activity for health. World Health Organization, Geneva

    Google Scholar 

  23. Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381

    CAS  PubMed  Google Scholar 

  24. Burgomaster KA, Howarth KR, Phillips SM et al (2008) Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol 586:151–160

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Gibala MJ, Little JP, van Essen M et al (2006) Short-term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance. J Physiol 575:901–911

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. McRae G, Payne A, Zelt JG et al (2012) Extremely low volume, whole-body aerobic–resistance training improves aerobic fitness and muscular endurance in females. Appl Physiol Nutr Metab 37:1124–1131

    Article  PubMed  Google Scholar 

  27. Koshinaka K, Sano A, Howlett KF et al (2008) Effect of high-intensity intermittent swimming on postexercise insulin sensitivity in rat epitrochlearis muscle. Metabolism 57:749–756

    Article  CAS  PubMed  Google Scholar 

  28. Tjønna AE, Lee SJ, Rognmo Ø et al (2008) Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome. Circulation 118:346–354

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hay L, Wilmshurst E, Fulcher G (2003) Unrecognized hypo-and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring. Diabetes Technol Ther 5:19–26

    Article  CAS  PubMed  Google Scholar 

  30. Ceriello A (2005) Postprandial hyperglycemia and diabetes complications. Diabetes 54:1–7

    Article  CAS  PubMed  Google Scholar 

  31. Praet S, Manders R, Meex R et al (2006) Glycaemic instability is an underestimated problem in type II diabetes. Clin Sci (Lond) 111:119–126

    Article  CAS  Google Scholar 

  32. Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36:228–236

    Article  PubMed Central  PubMed  Google Scholar 

  33. Hamilton MT, Healy GN, Dunstan DW, Zderic TW, Owen N (2008) Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardiovasc Risk Rep 2:292–298

    Article  PubMed Central  PubMed  Google Scholar 

  34. Healy GN, Dunstan DW, Salmon J et al (2008) Breaks in sedentary time. Diabetes Care 31:661–666

    Article  PubMed  Google Scholar 

  35. DiPietro L, Gribok A, Stevens MS, Hamm LF, Rumpler W (2013) Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care 36:3262–3268

    Article  CAS  PubMed  Google Scholar 

  36. Nybo L, Sundstrup E, Jakobsen MD et al (2010) High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc 42:1951–1958

    Article  PubMed  Google Scholar 

  37. Takaishi T, Imaeda K, Tanaka T, Moritani T, Hayashi T (2011) A short bout of stair climbing descending exercise attenuates postprandial hyperglycemia in middle-aged males with impaired glucose tolerance. Appl Physiol Nutr Metab 37:193–196

    Article  PubMed  Google Scholar 

  38. Gillen JB, Percival ME, Ludzki A, Tarnopolsky MA, Gibala M (2013) Interval training in the fed or fasted state improves body composition and muscle oxidative capacity in overweight women. Obesity (Silver Spring) 21:2249–2255

    Article  CAS  Google Scholar 

  39. Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56:115–123

    Article  CAS  PubMed  Google Scholar 

  40. Sigal RJ, Kenny GP, Boula NG et al (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med 147:357–369

    Article  PubMed  Google Scholar 

  41. Rognmo Ø, Moholdt T, Bakken H et al (2012) Cardiovascular risk of high-versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 126:1436–1440

    Article  PubMed  Google Scholar 

Download references


We would like to acknowledge the dedication and commitment of our participants, and thank L. Hughes (School of Physical Education, Sport and Exercise Sciences, University of Otago) for technical assistance.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

MEF and JDC conceived the study, with guidance and knowledge on design from PJM, JCB, MJAW, SJEL and JAH. MEF performed the data collection with help from JCB and MJAW for cardiovascular screening. MEF and JDC contributed to the data analysis. MEF drafted the manuscript and all other authors contributed critically to revisions. All authors declare that they read and approved the final version of the manuscript before submission. JDC is responsible for the integrity of the work as a whole.


This study was supported by the School of Physical Education, Sport and Exercise Sciences and Dunedin School of Medicine, University of Otago.

Author information

Authors and Affiliations


Corresponding author

Correspondence to James D. Cotter.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM Methods

(PDF 142 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Francois, M.E., Baldi, J.C., Manning, P.J. et al. ‘Exercise snacks’ before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. Diabetologia 57, 1437–1445 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Continuous glucose monitoring
  • High-intensity interval exercise
  • Postprandial glucose
  • Type 2 diabetes