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| Name | Class |
|---|---|
| Bispebjerg Hospital | OTHER |
| Danish Child Cancer Foundation | OTHER |
| University of Copenhagen | OTHER |
| The Danish Cancer Research Foundation |
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Today the overall survival of childhood cancers has increased to above 85%. This increase is partially caused by treatment with bone marrow transplantation. A bone marrow transplantation is an efficient treatment against high-risk leukemia, as well as other life-threatening immunological and hematological diseases. However, it is unfortunately also related to the risk of developing a long series of late effects during early adulthood, such as low muscle mass, cardiovascular disease and diabetes. Conditions known from the older generations of the general population and also conditions highly related to lifestyle factors in the general population.
In the group of survivors after bone marrow transplantation, the cause for these late effects is not fully understood, as the same close association to lifestyle factors as seen in the general population, is not present in this group. Multiple studies have examined the possible causes, and it have been shown that certain elements of a bone marrow transplantation, ie. total body irradiation, are associated with the risk of developing late effects. As the cause is not fully understood, it is not known whether the treatment and preventive strategies, that would be applied in the general population for these conditions, are effective in this group.
Therefore, in this study the investigators aim at examining the effect of a strength training intervention on the development of the aforementioned late effects to treatment with bone marrow transplantation during childhood.
The investigators will invite a group of persons, transplanted during childhood, as well as an age- and sex-matched control group to participate in the study. Both groups will go through a 16-week strength training intervention, and a thorough health examination before and after the intervention, to assess metabolic status and body composition.
If the investigators find a positive effect of strength training on muscle mass and risk factors for developing cardiovascular disease and diabetes in persons, treated with bone marrow transplantation during childhood, it will support the implementation of structured training programs in the follow-up of these patients. Thereby hopefully contributing to an increased quality of life, as well as an increased life expectancy in the group of survivors after bone marrow transplantation during childhood.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Strength training | Experimental | In this arm participants will go through the "Strength training intervention". |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Strength training | Other | The interventon consist of 3 weekly, supervised group sessions for 4 months (16 weeks). The sessions consist of progressive full body strength training with a primary focus on lower extremity muscle strength. The leg exercises are leg press, knee extension and leg curl. In addition, participants will perform two upper body exercises. Physical assessment will take place immediately and monthly until 4 months. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in cross sectional area of m. quadricpes femoris. | Muscle mass as measured by cross sectional area of m. quadriceps femoris at midthigh level, on an MRI scan. | 1 week pre intervention |
| Changes in cross sectional area of m. quadricpes femoris. | Muscle mass as measured by cross sectional area of m. quadriceps femoris at midthigh level, on an MRI scan. | 1 week post intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in components of the Metabolic Syndrome: Waist circumference | Waist circumference will be measured at the level of the superior border of the iliac crest, at the end of a normal expiration with a tape measure to the nearest 0.1 cm, as suggested by The US National Cholesterol Education Programme. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. |
| Measure | Description | Time Frame |
|---|---|---|
| Histology of thigh muscle | Muscle biopsy sampled from the vastus lateralis muscle, with a Bergstroem needle with manual suction. | 1 week pre intervention |
| Histology of thigh muscle | Muscle biopsy sampled from the vastus lateralis muscle, with a Bergstroem needle with manual suction. |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital Copenhagen - Rigshospitalet | Copenhagen | 2100 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38953152 | Derived | Krogh LM, Nissen A, Weischendorff S, Hartmann B, Andersen JL, Holst JJ, Sorensen K, Fridh MK, Mackey AL, Muller K. Bone remodeling in survivors of pediatric hematopoietic stem cell transplantation: Impact of heavy resistance training. Pediatr Blood Cancer. 2024 Sep;71(9):e31159. doi: 10.1002/pbc.31159. Epub 2024 Jul 2. |
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| ID | Term |
|---|---|
| D024821 | Metabolic Syndrome |
| D002318 | Cardiovascular Diseases |
| ID | Term |
|---|---|
| D007333 | Insulin Resistance |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
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| ID | Term |
|---|---|
| D055070 | Resistance Training |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
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| UNKNOWN |
The same interventon will be applied to two groups, a group of previously recipients of bone marrow transplantation, and a group of age- and sex-matched controls.
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|
| 1 week pre intervention |
| Changes in components of the Metabolic Syndrome: Waist circumference | Waist circumference will be measured at the level of the superior border of the iliac crest, at the end of a normal expiration with a tape measure to the nearest 0.1 cm, as suggested by The US National Cholesterol Education Programme. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week post intervention |
| Changes in components of the Metabolic Syndrome: Triglycerides | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week pre intervention |
| Changes in components of the Metabolic Syndrome: Triglycerides | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week post intervention |
| Changes in components of the Metabolic Syndrome: HDL-cholesterol | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week pre intervention |
| Changes in components of the Metabolic Syndrome: HDL-cholesterol | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week post intervention |
| Changes in components of the Metabolic Syndrome: Fasting glucose | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week pre intervention |
| Changes in components of the Metabolic Syndrome: Fasting glucose | Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week post intervention |
| Changes in components of the Metabolic Syndrome: Blood pressure | Blood pressure will be measured on the upper arm while sitting in the suppine position, after 10 minutes of rest, with an automated blood pressure monitor. Blood pressure will be measured three times, or untill there is less than 10 mmHg difference between measurements. The final blood pressure will be a mean of the two last measurements. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week pre intervention |
| Changes in components of the Metabolic Syndrome: Blood pressure | Blood pressure will be measured on the upper arm while sitting in the suppine position, after 10 minutes of rest, with an automated blood pressure monitor. Blood pressure will be measured three times, or untill there is less than 10 mmHg difference between measurements. The final blood pressure will be a mean of the two last measurements. Patients will be classified according to The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) definition of the Metabolic Syndrome. We will report changes in the number of components fulfilled. | 1 week post intervention |
| Hip circumference | Measurement of hip circumference at the widest part of the buttocks with a tape measure, to the nearest 0.1 cm. | 1 week pre intervention |
| Hip circumference | Measurement of hip circumference at the widest part of the buttocks with a tape measure, to the nearest 0.1 cm. | 1 week post intervention |
| Urine sample - microalbuminurea | A urine sample for analyses of microalbuminurea in mg/L. | 1 week pre intervention |
| Urine sample - microalbuminurea | A urine sample for analyses of microalbuminurea in mg/L. | 1 week post intervention |
| Muscle strength of quadriceps femoris | Rate of force development, maximal isometric and dynamic force capacity measured by KinCom Dynamometer | 1 week pre intervention |
| Muscle strength of quadriceps femoris | Rate of force development, maximal isometric and dynamic force capacity measured by KinCom Dynamometer | 1 week post intervention |
| Handgrip strength | Handgrip strength measured with handheld Dynamometer | 1 week pre intervention |
| Handgrip strength | Handgrip strength measured with handheld Dynamometer | 1 week post intervention |
| Muscle performance: Timed-up-and-go | Timed-up-and-go test: The participant sits on a chair, that allow the participant to flex the leg at a 90 degree angle, with the back against the chair and arms on the knees. From this position the participant stands up straight and walk 3 m, turns around and go back to the chair and sit down as fast as possible, time in seconds is the outcome. The lowest score of three consecutive tries will be used in the analysis. | 1 week pre intervention |
| Muscle performance: Timed-up-and-go | Timed-up-and-go test: The participant sits on a chair, that allow the participant to flex the leg at a 90 degree angle, with the back against the chair and arms on the knees. From this position the participant stands up straight and walk 3 m, turns around and go back to the chair and sit down as fast as possible, time in seconds is the outcome. The lowest score of three consecutive tries will be used in the analysis. | 1 week post intervention |
| Muscle performance: Sit-to-stand 30 sec. | Sit-to-Stand 30 sec: The participant sits on a chair allowing the participant to flex the legs at a 90 degree angle. The participant is instructed to stand up straight, and return to sitting, as many times as possible in 30 sec. The arms should be crossed in front of the body or hanging by the side. Number of repititions is the outcome. | 1 week pre intervention |
| Muscle performance: Sit-to-stand 30 sec. | Sit-to-Stand 30 sec: The participant sits on a chair allowing the participant to flex the legs at a 90 degree angle. The participant is instructed to stand up straight, and return to sitting, as many times as possible in 30 sec. The arms should be crossed in front of the body or hanging by the side. Number of repititions is the outcome. | 1 week post intervention |
| Muscle performance: Sit-to-stand 60 sec. | Sit-to-Stand 60 sec: The participant sits on a chair allowing the participant to flex the legs at a 90 degree angle. The participant is instructed to stand up straight, and return to sitting, as many times as possible in 60 sec. The arms should be crossed in front of the body or hanging by the side. Number of repititions is the outcome. | 1 week pre intervention |
| Muscle performance: Sit-to-stand 60 sec. | Sit-to-Stand 60 sec: The participant sits on a chair allowing the participant to flex the legs at a 90 degree angle. The participant is instructed to stand up straight, and return to sitting, as many times as possible in 60 sec. The arms should be crossed in front of the body or hanging by the side. Number of repititions is the outcome. | 1 week post intervention |
| Cardiorespiratory fitness: 6 minute walk test | 6 min. walk test: The participant walks as far as possible on a 15 m lane in 6 min. Distance in meters is the outcome. | 1 week pre intervention |
| Cardiorespiratory fitness: 6 minute walk test | 6 min. walk test: The participant walks as far as possible on a 15 m lane in 6 min. Distance in meters is the outcome. | 1 week post intervention |
| 1 week post intervention |
| Body composition: Intraabdominal visceral fat | Amount of visceral fat intraabdominally, as measured on a multisectional MRI scan from diaphragma to the pelvis with Dixon sequences. | 1 week pre intervention |
| Body composition: Intraabdominal visceral fat | Amount of visceral fat intraabdominally, as measured on a multisectional MRI scan from diaphragma to the pelvis with Dixon sequences. | 1 week post intervention |
| Body composition: Abdominal subcutaneous fat | Amount of subcutaneous fat in the abomen region, as measured on a multisectional MRI scan from diaphragma to the pelvis with Dixon sequences. | 1 week pre intervention |
| Body composition: Abdominal subcutaneous fat | Amount of subcutaneous fat in the abomen region, as measured on a multisectional MRI scan from diaphragma to the pelvis with Dixon sequences. | 1 week post intervention |
| Body composition: Hepatic fat | Amount of hepatic fat (%), as measured on a MRI scan fromof the liver with Dixon sequences. | 1 week pre intervention |
| Body composition: Hepatic fat | Amount of hepatic fat (%), as measured on a MRI scan fromof the liver with Dixon sequences. | 1 week post intervention |
| Body composition: Fat mass | Body fat mass (%) will be analyzed on a whole-body DEXA scan | 1 week pre intervention |
| Body composition: Fat mass | Body fat mass (%) will be analyzed on a whole-body DEXA scan | 1 week post intervention |
| Body composition: Fat free mass | Fat free mass (%), as a surrogate measure of lean mass, will be analyzed on a whole-body DEXA scan | 1 week pre intervention |
| Body composition: Fat free mass | Fat free mass (%), as a surrogate measure of lean mass, will be analyzed on a whole-body DEXA scan | 1 week post intervention |
| Body composition: Android-gynoid ratio | Android-gynoid ratio will be calculated, as a ratio of the fat mass in the abdominal region and the fat mass in the hip area, obtained by a whole-body DEXA scan | 1 week pre intervention |
| Body composition: Android-gynoid ratio | Android-gynoid ratio will be calculated, as a ratio of the fat mass in the abdominal region and the fat mass in the hip area, obtained by a whole-body DEXA scan | 1 week post-intervention |
| Body composition: Bone mineral density | Bone mineral density, will be analyzed on a whole-body DEXA scan. Z- and T-scores will be calculated. | 1 week pre intervention |
| Body composition: Bone mineral density | Bone mineral density, will be analyzed on a whole-body DEXA scan. Z- and T-scores will be calculated. | 1 week post intervention |
| Body mass index (BMI) | BMI will be calculated based on measurements of height and weight. To measure height the participants will stand up straight against a wall, in bare feet looking straight forward, and will be measured to the nearest 0.1 cm. Weight will be measured on an automated weight wearing only light indoor clothing with empty pockets and no shoes. BMI is calculated as wieght in kg diveded by height in meters squared. | 1 week pre intervention |
| Body mass index (BMI) | BMI will be calculated based on measurements of height and weight. To measure height the participants will stand up straight against a wall, in bare feet looking straight forward, and will be measured to the nearest 0.1 cm. Weight will be measured on an automated weight wearing only light indoor clothing with empty pockets and no shoes. BMI is calculated as wieght in kg diveded by height in meters squared. | 1 week post intervention |
| Total-cholesterol | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Total-cholesterol | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| LDL-cholesterol | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| LDL-cholesterol | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Adipokines: Adiponectin | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Adipokines: Adiponectin | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Adipokines: Leptin | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Adipokines: Leptin | Will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Growth factors | Growth factors, i.e. IGF-1 and IGFBP-3, will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Growth factors | Growth factors, i.e. IGF-1 and IGFBP-3, will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Thyroid hormones | Thyroid hormones, free triiodothyronine (T3) and thyroxine (T4) as well as thyroid stimulating hormone (TSH) will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Thyroid hormones | Thyroid hormones, triiodothyronine (T3) and thyroxine (T4) as well as thyroid stimulating hormone (TSH) will be analyzed in a plasma sample. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Sex hormones | Analyses of sex hormones, including testosterone and estrogen levels. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Sex hormones | Analyses of sex hormones, including testosterone and estrogen levels. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Markers of inflammation | Analyses of markers of inflammation, including high sensitivity CRP and IL-6 levels. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week pre intervention |
| Markers of inflammation | Analyses of markers of inflammation, including high sensitivity CRP and IL-6 levels. Blood samples will be drawn from a cannual placed in an antecubital vein or a dorsal vein in the hand. | 1 week post intervention |
| Oral glucose tolerance test: Glucose | Analyses of plasma glucose levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Glucose | Analyses of plasma glucose levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Oral glucose tolerance test: Insulin | Analyses of plasma insulin levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Insulin | Analyses of plasma insulin levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Oral glucose tolerance test: C-peptide | Analyses of plasma insulin levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: C-peptide | Analyses of plasma insulin levels during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Oral glucose tolerance test: Gut hormones | Analyses of plasma levels of gut hormones, including GLP-1, GIP and glucagon during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Gut hormones | Analyses of plasma levels of gut hormones, including GLP-1, GIP and glucagon during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Oral glucose tolerance test: Bone remodeling markers | Analyses of plasma levels of bone remodeling markers, including CTX and P1NP during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Bone remodeling markers | Analyses of plasma levels of bone remodeling markers, including CTX and P1NP during a 3 hour oral glucose tolerance test. Blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Health related quality of life - SF36 | Measure of health related quality of life, by the validated questionnaire SF-36. Outcome will be total score based o the questionnaire. | 1 week pre intervention |
| Health related quality of life - SF36 | Measure of health related quality of life, by the validated questionnaire SF-36. Outcome will be total score based o the questionnaire. | 1 week post intervention |
| Accelerometry using actigraph | measure of physical activity and sedentary behavior measured over 7 days recorded as counts per day | 1 week pre intervention |
| Accelerometry using actigraph | measure of physical activity and sedentary behavior measured over 7 days recorded as counts per day and minutes in moderate to vigorous activity | 1 week post intervention |
| Oral glucose tolerance test: Matsuda Index | Based on glucose and insulin values from the OGTT the Matsuda Index will be calculated, as a measure of peripheral insulin sensitivity. For the OGTT blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Matsuda Index | Based on glucose and insulin values from the OGTT the Matsuda Index will be calculated, as a measure of peripheral insulin sensitivity. For the OGTT blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| Oral glucose tolerance test: Insulinogenic Index | Based on glucose and insulin values from the OGTT the insulinogenic Index will be calculated, as a measure of beta-cell function. For the OGTT blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week pre intervention |
| Oral glucose tolerance test: Insulinogenic Index | Based on glucose and insulin values from the OGTT the insulinogenic Index will be calculated, as a measure of beta-cell function. For the OGTT blood samples will be drawn before and 7, 15, 30, 45, 60, 90, 120, 150 and 180 minutes after the intake of 75 g of glucose disolved in 250 ml of water. | 1 week post intervention |
| D009750 |
| Nutritional and Metabolic Diseases |
| D005791 |
| Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D064797 | Physical Conditioning, Human |
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |