Editors' ChoiceMicrobiome

A gut reaction to exercise

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Science Translational Medicine  11 Dec 2019:
Vol. 11, Issue 522, eaaz9765
DOI: 10.1126/scitranslmed.aaz9765


Alterations in gut microbiome composition and function predict those who respond favorably to exercise in metabolic control.

Many of us have heard the expression “exercise is medicine.” Exercise can improve insulin sensitivity and glycemic control, and it is considered a cost-effective lifestyle intervention for the treatment of obesity and type 2 diabetes (T2D). However, clinical implementation of exercise for these conditions has not occurred fully, as individual response to excercise is highly heterogeneous. Remarkably, a large proportion (7 to 69%) of individuals either do not respond or have an adverse response to exercise in terms of insulin sensitivity and glucose metabolism. Therefore, in order for exercise to be fully incorporated into treatment regimens of these conditions, there is an urgent need to identify mechanisms and predictors of this heterogeneity.

In this quest, Liu et al. looked to the gut. Dysbiosis of the gut microbiota has been implicated in T2D, and the microbiome of professional athletes displays higher diversity and metabolic capacity compared with sedentary controls. The researchers randomized 39 overweight men with prediabetes into a sedentary or 12-week supervised high-intensity exercise training group. The study identified 14 responders to the exercise intervention who showed improvements in insulin sensitivity and glucose metabolism and 6 nonresponders. The responders’ gut microbiome altered favorably in response to exercise in terms of enhanced production of short-chain fatty acids and breaking down of branched-chain amino acids. Nonresponders’ gut microbiomes looked similar to those of sedentary controls, with increased production of metabolically detrimental compounds that are also elevated in insulin-resistant individuals. Mice transplanted with feces from responders showed improvements in glycemic control and insulin sensitivity. The researchers were able to use the microbiome signature of individuals before exercise to accurately predict a positive metabolic response to exercise.

Taken together, this study shines a light on the importance of gut microbiome and its metabolism in terms of glycemic control. Next steps will be to understand the mechanisms by which exercise changes the composition and function of our gut microbiome. The ability to use our microbiome signature as a predictive marker to identify responders versus nonresponders is particularly intriguing and will warrant further validation and confirmation in larger-scale studies.

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