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Faculty of Health, Medicine and Life SciencesRegistration form (basic details)
1a. DETAILS APPLICANTS
Tutorial group number: ….
Name supervisor: …..
Submission date: 26-01-2021
1b. TITLE OF RESEARCH PROPOSAL
How to HIIT prediabetes in young adults?
HMS4001 Designing Intervention research_application form 2020-2021 1
, Faculty of Health, Medicine and Life Sciences
1c. SCIENTIFIC SUMMARY OF RESEARCH PROPOSAL
Background: Diabetes mellitus (DM) is a growing worldwide problem. In the Netherlands, ~1 million
people have DM. The main risk factor for T2DM is overweight. Prediabetes, a preceding stage of DM,
is characterised by an elevated fasting blood glucose level (100-125 mg/dL) or glycated haemoglobin
level (HbA1c; 5.7-6.4%). Per year, ~5-10% of prediabetic patients will progress to DM. Data on
prediabetes in the Netherlands is lacking, but 1 in 4 young adults in the US have prediabetes. High
intensity interval training (HIIT) has been shown to be more effective than moderate intensity
training (MIT) in lowering HbA1c levels in DM patients. However, it has not been investigated in
prediabetic young adults yet. We hypothesize that HIIT is more effective in lowering HbA1c levels in
prediabetic young adults compared to MIT.
Objective: The aim of this randomized controlled study is to investigate the effect of a 12-week HIIT-
program compared to a MIT-program on cardiometabolic health, primarily measured by HbA1c level,
in prediabetic young adults.
Target group: The target population will be overweight prediabetic young adults that do not meet
the Dutch physical activity guidelines. Inclusion criteria will include age 19-34 years, BMI 25-35kg/m 2,
HbA1c levels 5.7-6.4% and do not exercise for 150 minutes per week.
Methods: The main intervention will consist of a ~30-minute HIIT including 10 times 1-minute
interval (>85% of the maximal heart rate (HRmax)) and 1-minute rest in-between (~60-70% HRmax).
In contrast, the control intervention will consist of a ~50-minute MIT of continuous cycling (~60-70%
HRmax). Sessions will be guided and guarded by a researcher, and will be performed 3-times a week
over a 12-weeks period.
Outcome parameters: Measurements will be performed before and after the intervention. As
primary outcome, HbA1c will be determined by fasted blood sample analysis using high-performance
liquid chromatography. Secondary outcomes will include fasted plasma glucose and serum lipid
profiles (triglycerides, total and LDL/HDL cholesterol); body composition assessed by dual-energy X-
ray absorptiometry; resting blood-pressure defined by a blood-pressure monitor; intensity assessed
by heart rate; perceived exertion assessed with a BORG-scale; activity levels will be assessed with the
SQUASH-questionnaire and food intake will be monitored with a food diary.
1d. KEYWORDS
Young Adults, Prediabetes, High-Intensity Interval Training, Moderate-Intensity Training, HbA1c
levels
HMS4001 Designing Intervention research_application form 2020-2021 2
, Faculty of Health, Medicine and Life Sciences
Research proposal
2a. BACKGROUND OF PROPOSED RESEARCH
Diabetes mellitus (DM) is a metabolic chronic disease characterized by high blood glucose levels (1,
2). It is one of the most common chronic diseases in nearly all countries and continues to increase in
numbers and significance, as economic development and urbanization lead to changing lifestyles
characterized by reduced physical activity and increased obesity (1, 2). Currently, it is estimated that
463 million people are dealing with DM worldwide and this prevalence is estimated to increase up to
700 million in 2045 (3). Within the Netherlands, approximately 1 million people suffer from DM (3).
People with DM have an increased risk of developing serious life-threatening health problems (i.e.
cardiovascular diseases, retinopathy, neuropathy, kidney failure, and lower-limb amputation)
resulting in high medical care costs, reduced quality of life and increased mortality (2, 3). In addition,
the economic burden due to DM-related disability was €6.8 billion in 2016 (4).
Prediabetes is a precursor of DM. Per year, approximately 5-10% of patients diagnosed with
prediabetes will progress to DM (5). A study published in 2020 studied the prevalence of prediabetes
in adolescents and young adults in the United States; about one of five adolescents and one of four
young adults have prediabetes (6). In order to early prevent the progression to DM, it is essential that
young adults adopt a healthy lifestyle to improve health and reduce long-term health care costs. To
our knowledge, the exact prevalence of prediabetes among young adults in the Netherlands is
unknown. It is assumed to be lower but still a major problem as the prevalence of
overweight/obesity, the leading risk factor for type 2 diabetes mellitus (T2DM), is lower in the
Netherlands compared to the United States according to the World Health Organization (7, 8).
According to the American Diabetes Association (ADA), someone is considered prediabetic when
fasting plasma glucose levels are above normal (5.6-6.9 mmol/L) but below DM thresholds (≥7.0
mmol/L). A different method to define prediabetes is by measuring fasting glycated haemoglobin A1c
(HbA1c) levels; between 5.7-6.4% is considered prediabetes and ≥6.5% is defined as diabetes.
Compared to glucose levels, measuring HbA1c levels has the advantage of reflecting blood glucose
levels over the past two to three months (9). Besides being a reliable measure, it has also been
shown to have a high correlation with the risk of long-term DM complications (9). Therefore, it is
important to develop intervention strategies to lower the HbA1c levels in prediabetic young adults.
It is well known that a healthy diet and being physically active has beneficial health effects (10). The
Dutch physical activity guidelines recommend being moderately active for 150 minutes per week in
order to reduce the risk of obesity, DM and cardiovascular disease (11). The recommendation is
based on the risk factors measured by body composition, blood pressure, lipid profiles and insulin
HMS4001 Designing Intervention research_application form 2020-2021 3
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