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Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study



To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol.


Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring.


Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI − 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from − 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (− 1.56 mmol/L; 95% CI − 2.18, − 0.95, p < 0.001).


Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed.

Trial registration: NCT02834689.

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We are grateful for the support of Noah Schwabe, Micah Medinski, Jasmine Paquin, Camille Genest, Michele Bisson and Larissa Wilhelm for data collection and analysis.


The E-PAraDIGM protocol was developed with funding from a Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant (Application #334972). An investigator-initiated grant awarded to JPL and NGB from Medtronic Canada provided continuous glucose monitors and sensors in-kind and partially supported provision of standardized diets. The authors acknowledge Johnson & Johnson for providing glucometers, test strips and lancets at the Sherbrooke site, as well as Solo GI Nutrition for in-kind provision of SoLo GI bars. JPL is supported by a CIHR New Investigator Salary Award (MSH-141980) and a Michael Smith Foundation for Health Research (MSFHR) Scholar Award (16890). CMP is supported by a CIHR New Investigator Salary Award and the Campus Alberta Research Chair Program. The study sponsors were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; or the decision to submit the report for publication.

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Authors and Affiliations



JLR, CRC, MEF, AMC, AF, NDK, RAD, DRF, GS, KB, FEG and MCD collected the data. JLR, ER, JMM, JEY, RJS, MJG, JSW, CMP, MJ, RM, NGB and JPL provided substantial contributions to the conception or design of the work. JLR, NGB and JPL drafted the article, and all others revised it critically for important intellectual content. TL and JS designed and performed the statistical analyses. All authors provide final approval of the submitted version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Normand G. Boulé or Jonathan P. Little.

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Conflict of interest

JEY has received in-kind research support from Animas Canada, Dexcom Canada and Abbott Nutrition Canada. JPL is a scientific advisor and shareholder with Metabolic Insights Inc., a start-up company developing a noninvasive metabolic monitoring device. JPL is a volunteer chief scientific officer for the not-for-profit Institute for Personalized Therapeutic Nutrition (

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Alberta Health Research Ethics Board: Pro00059779, The University of British Columbia Clinical Research Ethics Board: H1600377, Conjoint Health Research Ethics Board at the University of Calgary: REB16-1049, University of Manitoba Health Research Ethics Board: HS20322, Hamilton Integrated Research Ethics Board: 1695, Comité d’éthique de la recherche du CIUSSS de l’Estrie-CHUS: #MP-31-2017-1601) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. 

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available as participants did not provide consent to this form of data sharing. Aggregated data and additional analyses are available from the corresponding author on reasonable request.

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Rees, J.L., Chang, C.R., François, M.E. et al. Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol 56, 755–765 (2019).

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