The Acute Effect of Moderate Intensity Stair-Climbing on Postprandial Blood Glucose
Phase: NA
Conditions: Postprandial Hyperglycemia
Sponsor: San Diego State University

 
 
 
 
 
 
 
 
 
 
 
 
 
The Acute Effect of Moderate Intensity Stair-Climbing on Postprandial Blood Glucose 
 
NCT Number: Not assigned yet 
 
February 24, 2016 

BASIC STUDY INFORMATION 
 
 
Background & Significance 
* Discuss relevant background information and literature reviewed to provide the rationale for the proposed 
research. 
Blood sugar (glucose) increase following meal consumption (i.e postprandial) is an 
independent predictor for developing cardiovascular disease and diabetes {{2485 
Blaak, EE 2012;}}. In fact for people within a non-diabetic glucose range the 
association for postprandial glucose increase and CVD is even stronger than for the 
gold standard of glucose regulation (glycohemoglobin, HbA1c) and CVD risk {{2485 
Blaak, EE 2012;}}. In addition intermittent glucose spikes elicit a greater 
inflammatory/oxidative stress response than consistently high glucose levels {{2485 
Blaak, EE 2012;}}. Since in western societies most people spend the majority of their 
wake time in the non-fasted state (i.e. when metabolites from a previous meal   are 
still being processed or distributed throughout the body) it is important to investigate 
how to mitigate the postprandial glucose spike as well as the concomitant rise in 
inflammatory and oxidative  stress. 
One of the most effective ways to improve the postprandial glucose response is 
exercise. Multiple studies have shown that even low-moderate intensity exercise of 
relatively short duration can attenuate postprandial glucose increases {{2486  
Aadland, Eivind 2008; 2488 Lunde, Marianne SH 2012; 2487 Nygaard, Håvard 
2009; 2485 Blaak, EE 2012;}}. The shortest single exercise bout that showed 
significant reductions in postprandial glucose for men with impaired glucose 
tolerance using moderate intensity stair climbing (21 up and down) for ~6   minutes 
{{2489 Takaishi , Tetsuo 2011;}}. Whether this can also be accomplished in healthy 
individuals or women is unknown. It is also unknown what the shortest bout of stair 
climbing is that still has a significant glucose lowering  effect. 
The purpose of this study is therefore to investigate whether low-moderate intensity 
stair climbing of short durations can result in significant lowering of postprandial 
blood glucose responses in healthy men and women. In addition, we aim to 
investigate how short such an effective stair climbing bout can possibly be. 
We hypothesize that stair climbing will reduce postprandial blood glucose in a dose 
dependent manner at 10 and 3 minutes but will be an insufficient stimulus at 1 
minute duration. 
 
* Please provide a list of references to support the information found in the background and significance section. 
Aadland, Eivind, and Arne T. Høstmark. "Very Light Physical Activity After a  Meal 
Blunts the Rise in Blood Glucose and Insulin." Open Nutrition Journal 2 (2008): 
94-9. Print. 
Blaak, EE, et al. "Impact of Postprandial Glycaemia on Health and Prevention of 
Disease." obesity reviews 13.10 (2012): 923-84.   Print. 
Lunde, Marianne SH, Victoria Telle Hjellset, and Arne T. Høstmark. "Slow Post Meal 
Walking Reduces the Blood Glucose Response: An Exploratory Study in Female 
Pakistani Immigrants." Journal of Immigrant and Minority Health 14.5  (2012): 
816-22. Print. 
Nygaard, Håvard, Sissel Erland Tomten, and Arne Torbjørn Høstmark. "Slow 
Postmeal Walking Reduces Postprandial Glycemia in Middle-Aged Women." 
Applied Physiology, Nutrition, and Metabolism 34.6 (2009): 1087-92. Print. 
Takaishi, Tetsuo, et al. "A Short Bout of Stair climbing–descending Exercise 
Attenuates Postprandial Hyperglycemia in Middle-Aged Males with Impaired 
Glucose Tolerance." Applied Physiology, Nutrition, and Metabolism 37.1 (2011): 
193-6. Print. 
 
 
Study Abstract 
Briefly complete the following Study Abstract components: 
* 1. Purpose/objective: 
Blood sugar (glucose) increases after meal consumption (postprandial) and the larger 
this response the higher the risk of developing cardiovascular disease (CVD) and 
diabetes later in life. The rise in glucose and the concomitant rise in 
inflammatory/oxidative stress can be attenuated with relatively short  and 
low-moderate intensity exercise. Particularly effective is stair climbing. A single bout 
of climbing 21 stairs (up and down) for ~6 min was effective in reducing postprandial 
glucose increases in men with impaired glucose tolerance. Whether this can be 
extended to healthy people, women or shorted bouts is currently unknown. We 
therefore propose to investigate moderate intensity stair climbing of  various 
durations (i.e. 1, 3, and 10min) following ingestion of a standard 75 g glucose   drink 
in a total of 30 healthy men and women. We will take standard finger stick blood 
glucose measurements every 15 minutes for one hour following drink consumption. 
We will also take two venipuncture blood draws, one at baseline and one 30    min 
after drink consumption (i.e. at the expected blood glucose peak). We hypothesize 
that stair climbing will reduce postprandial glucose rise in a dose dependent manner 
for 10 and 3 min bouts but not 1 min bouts. The risk is minimal (standard test such as 
venipuncture, finger stick and maximal exercise testing only). Direct benefits to 
participants are only the knowledge gained about blood glucose response and 
maximal exercise capacity. 
* 2. Methods: 
We therefore propose to investigate moderate intensity stair climbing of various 
durations (i.e. 1, 3, and 10min) following ingestion of a standard 75 g glucose  drink 
in a total of 30 healthy men and women. We will take standard finger stick blood 
glucose measurements every 15 minutes for one hour following drink consumption. 
We will also take two venipuncture blood draws, one at baseline and one 30 min 
after drink consumption (i.e. at the expected blood glucose    peak) 
* 3. Subjects 

a. This proof-of principle study will recruit 30 healthy adults (men and women) 
classified as low risk for exercise participation by the American college of sports 
medicine (ACSM 2014). 
* 4. Planned analyses: 
Oxygen consumption: 
Maximal and stair climbing expired gases will be continuously collected through a 
softmask worn by the subject and analyzed by an open-circuit indirect calorimetry 
system (Vmax or Oxycon Mobile, CareFusion Corporation, CA,   USA). 
 
Blood Analysis: 
Finger stick for blood glucose measurement will use standard over the counter 
diabetes analysis kits (Nova Max Plus, Nova Biomedical   Corp.). 
Blood will be collected in 5 mL EDTA tubes and centrifuged at 2,300 x g for 10 
minutes at 4℃. Plasma will be extracted and stored for later analysis in at -80˚C. 
Markers of glycemic and inflammatory/oxidative stress response will be assessed by 
standard methods. E.g. glucose by the glucose oxidase method, insulin by  electro- 
chemi¬luminescence, tumor necrosis factor (TNF)-α by enzyme linked immunoassay 
(ELISA) and IL-6 by sandwich enzyme immunoassay as per manufacturer instructions 
and guidelines. 
 
Statistical analysis: 
Data will be analyzed with a 4 way repeated measures analysis of variance.  The 
Level of significance will be set a priori at α ≤   .05. 
* 5. Potential benefits: 
a. This study will help to identify the shortest possible bout of exercise that is still 
effective in significantly reducing postprandial blood glucose using a simple, cheap 
and ubiquitously available exercise mode – stair climbing. Subjects will learn 
VO2max, which may be useful for assessing cardiovascular fitness and exercise 
prescription. In addition subject will be informed of their fasting and postprandial 
blood glucose, insulin and inflammatory response they so desire. At the end of the 
study, individuals that want their test results will be given a copy by the principle or 
co-investigator. However, we cannot guarantee the subjects will benefit from this 
information. 
* 6. Potential risks: 
a. During the testing participants may get light handedness, and fatigue. They may 
feel delayed muscle soreness (24-48 hours) after exercise. There is also a low risk of a 
cardiac event, such as a heart attack, cardiac arrest, or dangerous arrhythmia. This 
risk is less than 1 occurrence in 12,000 tests of healthy subjects. At least one person 
during testing will be certified in CPR and present for all exercise testing and    an 
AED is located just outside of the lab. In addition, there is a telephone located in 
the laboratory should a medical emergency arise. 
Whenever blood is drawn, there is a small risk of bruising. Although infection is a risk, 
this is minimized by use of alcohol to cleanse the area for the blood   draw. 
b. To decrease the anxiety of wearing the mask, for people doing it for the first time, 
they get to sit with it for 5 minutes before starting any testing, to get comfortable 
breathing through the mouthpiece. 
Exercise termination for the maximal exercise test will be consistent with the ACSM 
Guidelines for Exercise Testing and Training. Indications for stopping the testing 
protocols in this research study include the   following: 
1) the onset of chest pain, or 
2) a drop in systolic blood pressure (20 mm Hg), or 
3) an absence of increased systolic blood pressure with increased intensity of 
exercise, or 
4) a rise in blood pressure which is greater than 260 mm Hg for systolic pressure and 
greater than 115 mm Hg for diastolic pressure, or 
5) if the participants experiences any combination of these signs and symptoms: 
lightheadedness, confusion, nausea, cold skin, clammy skin, pale skin, blue skin, lack 
of muscle coordination, or 
6) an absence of increased heart rate with increased intensity of exercise, or 
7) noticeable abnormal changes in heart rhythm, or 
8) participant requests to stop the testing protocol, or 
9) signs and symptoms of severe fatigue, or 
10) failure of the testing equipment. 
Participants will be continuously monitored (including assessment of blood pressure) 
by the research team for the presence of these termination    points. 
Whenever handling blood the investigators will wear gloves at all times, and all 
contaminated materials are deposited in a bio-hazard container, in accordance with 
the blood borne pathogens standard of OSHA. 
c. N/A 
* 7. Risk management procedures: 
a. During the testing participants may get light handedness, and fatigue. They may 
feel delayed muscle soreness (24-48 hours) after exercise. There is also a low risk of a 
cardiac event, such as a heart attack, cardiac arrest, or dangerous arrhythmia. This 
risk is less than 1 occurrence in 12,000 tests of healthy subjects. At least one person 
during testing will be certified in CPR and present for all exercise testing and    an 
AED is located just outside of the lab. In addition, there is a telephone located in 
the laboratory should a medical emergency arise. 
Whenever blood is drawn, there is a small risk of bruising. Although infection is a risk, 
this is minimized by use of alcohol to cleanse the area for the blood   draw. 
b. To decrease the anxiety of wearing the mask, for people doing it for the first time, 
they get to sit with it for 5 minutes before starting any testing, to get comfortable 
breathing through the mouthpiece. 
Exercise termination for the maximal exercise test will be consistent with the ACSM 
Guidelines for Exercise Testing and Training. Indications for stopping the testing 
protocols in this research study include the   following: 
1) the onset of chest pain, or 
2) a drop in systolic blood pressure (20 mm Hg), or 
3) an absence of increased systolic blood pressure with increased intensity of 
exercise, or 
4) a rise in blood pressure which is greater than 260 mm Hg for systolic pressure and 

greater than 115 mm Hg for diastolic pressure,   or 
5) if the participants experiences any combination of these signs and symptoms: 
lightheadedness, confusion, nausea, cold skin, clammy skin, pale skin, blue skin, lack 
of muscle coordination, or 
6) an absence of increased heart rate with increased intensity of exercise, or 
7) noticeable abnormal changes in heart rhythm, or 
8) participant requests to stop the testing protocol, or 
9) signs and symptoms of severe fatigue, or 
10) failure of the testing equipment. 
Participants will be continuously monitored (including assessment of blood pressure) 
by the research team for the presence of these termination    points. 
Whenever handling blood the investigators will wear gloves at all times, and all 
contaminated materials are deposited in a bio-hazard container, in accordance with 
the blood borne pathogens standard of OSHA. 
c. N/A 
 
 
Research Design and Methods 
* Specify aims of the research that include the hypotheses to be tested, research questions to answer, data to be 
gathered and tested. 
a. 30 healthy men and women will report to the lab for the determination   of 
maximal aerobic capacity (VO2max) using a standard incremental treadmill test to 
exhaustion (Bruce protocol, {{2397 Heyward, Vivian H 2010;}}. VO2max data will be 
used to describe the stair climbing bout in absolute (i.e. metabolic cost) and relative 
terms (i.e. relative to maximal capacity). For all testing participants will abstain from 
exercise for a period of 24 h prior to testing. Participants will also abstain from 
making any changes to their habitual diet during the duration of their study 
involvement. 
At least 24 hours but no more than one week after the max test, participants will 
come in for an oral glucose tolerance test (OGTT). Participants will be instructed to 
stay fasted overnight (i.e 10 hours). For example, an 8 am test would mean no 
calorie consumption after 10 pm the night before. There will be no restriction of 
water consumption. Upon arrival at the lab, participants will sit quietly for 5 minutes 
and be fitted with a heart rate monitor strap around the chest. Participants will then 
consume 75 g glucose dissolved in 2 cups of water within 5 minutes. Finger-stick 
blood glucose sampling will be performed at baseline and every 15 minutes 
thereafter for 1 hour for a total of 5 samples. Finger-stick blood draws are easy, 
convenient and impose very little burden on subjects and are therefore suitable for 
frequent measurements; they are ill suited to obtain enough blood for more precise 
and additional measurements (described below). Therefore, two venipuncture blood 
samples will be obtained, one at baseline and one at 30 minutes (expected glucose 
peak) by a certified phlebotomist (Jochen Kressler, PhD) for a total amount of blood 
drawn at each visit of 10 mL. These blood draws will allow verification of the 
accuracy of the finger stick at the expected low point (i.e. baseline) and peak of the 
blood glucose response. It will also provide enough blood to investigate other key 
components of the postprandial response to glucose ingestion, namely insulin and 
inflammatory markers (described below). Participants will remain seated and calm 
throughout this hour of testing. Participants will be allowed to read or watch passive 
entertainment (e.g. videos). After one hour participants will be introduced to the 
(hand railed) stairwell that will be used for the stair climbing exercise. Participants 
will be asked to try out the stairs and self-determine the fastest stair stepping pace 
they would consider comfortable to maintain for 10 minutes. This pace will be 
recorded and employed for the other stair climbing  bouts. 
During the next three visits participants will go through the same overnight fast,  
OGTT and blood sampling procedures but will climb stairs (32 standard steps up and 
down) starting at 15, 22, or 24 minutes after finishing the glucose drink for 10, 3 and 1 
min, respectively. This will ensure that everyone finish the stair climbing at the   
same time (i.e. start 15 min after ingestion --> climb for 10 min --> end at 25 min, 
start 22 min after ingestion --> climb for 3 min --> end at 25 min, start 24 min after 
ingestion --> climb for 1 min --> end at 25 min) five minutes before the expected 
peak. The order of trials will be randomized. All visits will be at least 24 hours but no 
more than 1 week apart and all visits will be at the same time of day.   Participants 
will be encouraged to eat the same or similar dinner the night before each test. 
During the stair climbing bouts respired gases will be measured via the ambulatory 
open-circuit method using the same type of softmask as was for the VO2 max test. 
The gas measurement will continue for 15 minutes after stair stepping is   done. 
 
Outcome Measures 
Oxygen consumption: 
Maximal and stair climbing expired gases will be continuously collected  thr 
 
* Describe procedures used to test the hypotheses or answer the research  question. 
a. 30 healthy men and women will report to the lab for the determination   of 
maximal aerobic capacity (VO2max) using a standard incremental treadmill test to 
exhaustion (Bruce protocol, {{2397 Heyward, Vivian H 2010;}}. VO2max data will be 
used to describe the stair climbing bout in absolute (i.e. metabolic cost) and relative 
terms (i.e. relative to maximal capacity). For all testing participants will abstain from 
exercise for a period of 24 h prior to testing. Participants will also abstain from 
making any changes to their habitual diet during the duration of their study 
involvement. 
At least 24 h but no more than a week after the max test participants come in for an 
oral glucose tolerance test (OGTT). Participants will be instructed to stay fasted 
overnight (i.e 10 hours). So for an 8 am test that would mean no calorie 
consumption after 10 pm the night before. There will no restriction of water 
consumption. Upon arrival at the lab, people will sit quietly for 5 min and be fitted 
with a heart rate monitor strap around the chest. Participants will then consume 75 g 
glucose dissolved in 2 cups of water within 5 minutes. Fingerstick blood glucose 
sampling will be performed at baseline and every 15 minutes thereafter for 1 hour 
for a total of 5 samples. While finger stick blood draws are easy and convenient and 
impose very little burden on subjects and therefore a suitable for frequent 
measurements they are ill suited to obtain enough blood for more precise   and 

additional measurements (described below). Therefore, two venipuncture blood 
samples will be obtained one at baseline and one at 30 minutes (expected glucose 
peak) by a certified phlebotomist (Jochen Kressler, PhD) for a total amount of blood 
drawn at each visit of 10 mL. These blood draws will allow to verify the accuracy of 
the finger stick at the expected low point (i.e. baseline) and peak of the blood 
glucose response. It will also provide enough blood to investigate another key 
components of the postprandial response to glucose ingestion namely insulin and 
inflammatory markers (described below). Participants will remain seated and calm 
throughout the hour of testing. Participants will be allowed to read or watch passive 
entertainment (e.g. videos). After one hour participants will be introduced to the 
(hand railed) stairwell that will be used for the stair climbing exercise. Participants 
will be asked to try out the stairs and self-determine the fastest stair stepping pace 
they would consider comfortable to maintain for 10 minutes. This pace will be 
recorded and employed for the other stair climbing  bouts. 
Over the next three visits participants will go through the same overnight fast, OGTT 
and blood sampling procedures but will climb stairs (32 standard steps up and down) 
starting at 15, 22, or 24 minutes after finishing the glucose drink for 10, 3 and 1 min, 
respectively. This will ensure that everyone finish the stair climbing at the same time 
(i.e. start 15 min after ingestion D climb for 10 min D end at 25 min, start 22 min 
after ingestion D climb for 3 min D end at 25 min, start 24 min after ingestion D 
climb for 1 min D end at 25 min) five minutes before the expected peak. The order 
of trials will be randomized. All visits will be at least 24 hours but no more than 1 
week apart and all visits will be at the same time of day. Participants will be 
encouraged to eat the same or similar dinner the night before each test. During the 
stair climbing bouts respired gases will be measured via the ambulatory open-circuit 
method using the same type of softmask as was for the VO2 max test. The gas 
measurement will continue for 15 minutes after stair stepping is  done.