Dr. Gibala: Yeah. So there's various ways to measure insulin sensitivity. But, you know, generally exercise increases insulin sensitivity.

There are some systematic reviews and meta-analyses that have suggested that maybe more high-intensity, vigorous effort can lead to some greater improvements in markers of insulin sensitivity. But again, even though, you know, we think of, oh, systematic reviews, meta-analyses, those are really definitive evidence.

But many of the underlying studies tend to be relatively small, tend to be relatively low numbers of participants, all of the potential bias, you know, not that researchers are purposely trying to bias their results. But they don't always include all of the proper controls from a research design standpoint that you might like to see.

So sometimes the underlying evidence is limited as well, which limits the veracity of the systematic reviews and meta-analyses. But certainly there is some evidence to suggest that vigor intensity, more intense exercise may lead to some superior benefits there. You know, just...I'm sure we might hit on it later, but this idea of multiple bouts through the day, one of the things that we and some others are looking at right now are what we termed exercise snacks.

So these brief bouts of vigorous intensity exercise that are spread throughout the day, and we're running right now two randomized controlled studies at, you know, our lab in the University of British Columbia, my colleague, Professor John Little. And one of the main outcomes is measures of insulin sensitivity or blood glucose control in groups that are doing these very short one-minute bursts of vigorous effort spread throughout the day to try and get at exactly this question.

How many times a day? So we're encouraging people to do at least four or five times a day of those snacks. So, you know, we define an exercise snack as less than or equal to one minute of vigorous intensity exercise. It could be jumping on a stationary bike. It could be a series of air squats or bodyweight style exercise.

And we're delivering in the intervention…we've partnered with a company that's delivering prompts on people's cell phones. And so they basically get a prompt that says, hey, it's time for your exercise snack. That links to a little YouTube video that shows the individual what they should do. And we're encouraging them to do that four or five times a day.

More is better. And we're following them for three months, a 12-week intervention. And we're comparing it to a movement snacks control group. So a group that's getting a very similar intervention, but they're not engaging in vigorous intensity exercise. So it's more stretching, mobility exercise. And so the key variable that's changing there is the intensity of the movements.

And we're seeing, you know, how do people adhere to that? Like, will people even do that? And if they do it, is it enough to move the needle in terms of things like cardiorespiratory fitness, blood markers of fat, immune function, glucose, and measures of insulin sensitivity as well? One of the studies that we're doing is going to be using continuous glucose monitoring in individuals with type 2 diabetes.