The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with type 2 diabetes

Comparative efficacy of different exercise types on inflammatory markers in women with overweight and obesity: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to compare and rank the effectiveness of aerobic exercise, resistance training, combined aerobic and resistance exercise, and high-intensity interval training on inflammatory marker levels in women with overweight and obesity by using network meta-analysis.

DESIGN

Systematic review with network meta-analysis and Grading Recommendations Assessment, Development, and Evaluation of the evidence.

METHODS

Literature as of April 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO, and English-language randomized controlled trials that meet the inclusion criteria were selected. A random-effects network meta-analysis was performed within a frequentist framework.

RESULTS

A total of 75 articles and 4048 participants were included. Resistance training was the most recommended type of exercise to decrease C-reactive protein levels (surface under cumulative ranking = 90.1; standardized mean difference = -0.79, 95 % confidence interval: -1.17, -0.42); aerobic exercise was the most effective exercise type to reduce tumor necrosis factor-α levels (surface under cumulative ranking = 87.9; standardized mean difference = -0.79, 95 % confidence interval: -1.19, -0.39); combined aerobic and resistance exercise was the most effective type of exercise to reduce interleukin-6 levels (surface under cumulative ranking = 75.8; standardized mean difference = -0.77, 95 % confidence interval: -1.38, -0.16) and leptin levels (surface under cumulative ranking = 77.1; standardized mean difference = -0.96, 95 % confidence interval: -1.72, -0.20), and high-intensity interval training was the type of exercise that was well suited to increase adiponectin levels (surface under cumulative ranking = 87.2; standardized mean difference = 0.99, 95 % confidence interval: 0.27, 1.71).

CONCLUSIONS

This network meta-analysis based on randomized controlled trials confirmed that different exercise types have different efficacies on inflammation indicators among women with overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for women struggling with overweight and obesity.

The influence of resistance exercise and aerobic exercise on type 2 diabetes: a meta-analysis

INTRODUCTION

Diabetes is a worldwide chronic disease. The incidence rate of this disease is high, and it is a common disease in clinics. At present, the incidence rate of diabetes patients is increasing year by year due to the increasing work pressure, the accelerated pace of life, the change of diet, the reduction of labor, and the acceleration of aging.

EVIDENCE ACQUISITION

The computer retrieves four databases to obtain random controlled trials on the influence of resistance exercise and aerobic exercise on type 2 diabetes. After a rigorous literature quality evaluation, data analysis was performed using RevMan 5.3 software.

EVIDENCE SYNTHESIS

Ten studies were ultimately included in this meta-analysis. 10 studies reported the HbA1c of the test group and the control group, which was no significant statistical significance (SMD: -0.01; 95% CI: -0.20,0.19; P=0.959) than the control group, HOMA-IR (SMD: 0.02; 95% CI: -0.65,0.69; P=0.954), SBP (SMD: 3.92; 95% CI: -0.92,8.75; P=0.112), DBP (SMD: 0.67; 95% CI: -3.66,5.01; P=0.761), HDL (SMD: -0.08; 95% CI: -2.79,2.64; P=0.955), TG (SMD: -7.51; 95% CI: -21.25,6.22; P=0.284) and TC (SMD: 9.10; 95% CI: -13.43,31.62; P=0.428).

CONCLUSIONS

The results of this study suggest that both resistance exercise and aerobic exercise may be effective on patients with type 2 diabetes, as evidenced by HbA1c, HOMA-IR, SBP, DBP, HDL, TG and TC. There is no significant difference in their impact on type 2 diabetes patients, and the above conclusions need to be verified by more high-quality studies.

Enhanced glucose utilization of skeletal muscle after 4 weeks of intermittent hypoxia in a mouse model of type 2 diabetes

BACKGROUND

Intermittent hypoxia intervention (IHI) has been shown to reduces blood glucose and improves insulin resistance in type 2 diabetes (T2D) and has been suggested as a complementary or alternative intervention to exercise for individuals with limited mobility. Previous research on IHI has assessed cellular glucose uptake rather than utilization. The purpose of this study was to determine the effect of a 4-week IHI, with or without an aerobic exercise, on skeletal muscle glucose utilization as indicated by the changes in pyruvate, lactate, NAD+, and NADH, using a mouse model of diet-induced T2D. In addition, the effects of one exposure to hypoxia (acute) and of a 4-week IHI (chronic) were compared to explore their relationship.

METHODS

C57BL/6J mice were randomly assigned to normal control and high-fat-diet groups, and the mice that developed diet-induced diabetes were assigned to diabetes control, and intervention groups with 1 hour (acute) or 4 weeks (1 hour/day, 6 days/week) exposure to a hypoxic envrionment (0.15 FiO2), exercise (treadmill run) in normoxia, and exercise in hypoxia, respectively, with N = 7 in each group. The effects of the interventions on concentrations of fasting blood glucose, muscle glucose, GLUT4, lactate, pyruvate, nicotinamide adenine dinucleotide (NAD+), and NADH were measured, and statistically compared between the groups.

RESULTS

Compared with diabetes control group, the mice treated in the hypoxic environment for 4 weeks showed a significantly higher pyruvate levels and lower lactate/pyruvate ratios in the quadriceps muscle, and the mice exposed to hypoxia without or with aerobic exercise for either for 4 weeks or just 1 hour showed higher NAD+ levels and lower NADH/NAD+ ratios.

CONCLUSIONS

Exposure to moderate hypoxia for either one bout or 4 weeks significantly increased the body's mitochondrial NAD cyclethe in diabetic mice even in the absence of aerobic exercise. The hypoxia and exercise interventions exhibited synergistic effects on glycolysis. These findings provide mechanistic insights into the effects of IHI in respect of the management of hyperglycemia.

Effects of blood flow restriction training on muscle fitness and cardiovascular risk of obese college students

Purpose: The aim of this study was to investigate the effect of blood flow restriction (BFR) combined with low-intensity resistance training (RT) on cardiovascular risk factors in obese individuals. Methods: Twenty-six male obese college students were recruited and randomly assigned to a control group (CON, n = 8), a low-intensity RT group (RT, n = 9), and a combined BFR training and low-intensity RT group (BFRT, n = 9). Results: The subjects in BFRT group showed significant reductions in body fat percentage and waist-to-hip ratio and a significant increase in lean mass and muscle mass; the peak torque, peak power, and endurance ratio of knee extensors and elbow flexors were significantly upregulated; the root mean square (RMS) for the medial femoral muscle, lateral femoral muscle and biceps significantly increased; the diastolic blood pressure (DBP) showed a significant decrease. The BFRT group also showed significant up-regulations in RMS of the difference between the adjacent R-R intervals (RMSSD), high-frequency power (HF) of parasympathetic modulatory capacity, the standard deviation of R-R intervals (SDNN) of overall heart rate variability (HRV) changes and low-frequency power (LF) of predominantly sympathetic activity. In addition, glycated hemoglobin (HbA1C), insulin resistance index (HOMA-IR) and fasting blood glucose (FBG) were all significantly downregulated in BFRT group. In parallel, low-density lipoprotein (LDL-C) significantly reduced while high-density lipoprotein (HDL-C) significantly increased in BFRT group. Conclusion: BFR combined with low-intensity RT training effectively improved body composition index, increased muscle mass, improved neuromuscular activation, enhanced muscle strength and endurance, which in turn improved abnormal glucolipid metabolism and enhanced cardiac autonomic regulation.

Association Between Physical Activity and Arterial Stiffness in Patients with Type 2 Diabetes in Ningbo, China: A Cross-Sectional Study

Aim

The study aimed to investigate the association between physical activity and arterial stiffness in patients with type 2 diabetes mellitus (T2DM) in Ningbo, China.

Methods

A cross-sectional study was conducted using the Metabolic Management Center (MMC) dataset of The First Affiliated Hospital of Ningbo University from 1st March 2018 to 28th February 2023. 4444 adults with T2DM were included in the study. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ)-Short and was categorized into high, moderate, and low. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1800cm/s or common carotid artery intima-media thickness (CCA IMT) ≥1mm. Multiple logistic regression analyses were performed to identify the association between physical activity and arterial stiffness.

Results

6.5%, 47.0%, and 46.5% of patients with T2DM had high, moderate, and low physical activity, respectively. 18.8% and 17.5% of patients had arterial stiffness based on baPWV and CCA IMT, respectively. The odds of arterial stiffness (based on baPWV) were lower in patients having moderate to high physical activity (OR 0.82, 95% CI 0.68 to 0.98 and OR 0.58, 95% CI 0.39 to 0.87, respectively). The odds of arterial stiffness (based on CCA IMT) were found to be lower in patients having high physical activity (OR 0.49, 95% CI 0.33 to 0.74).

Conclusion

Higher physical activity was found to be associated with lower arterial stiffness in patients with T2DM in Ningbo, China. This was a cross-sectional study, and there is a need to conduct longitudinal studies on this topic.

Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis

IMPORTANCE

Postmenopausal women affected by overweight and obesity are susceptible to a variety of diseases due to inflammation. Exercise may reduce the risk of disease by attenuating low-grade chronic inflammation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the effects of exercise on inflammatory markers in postmenopausal women struggling with overweight and obesity.

METHOD

Literature as of May 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO and English-language randomized controlled trials (RCTs) that meet the inclusion criteria were selected. Studies were included based on the following criteria: (A) Written in English; (B) RCTs; (C) Postmenopausal women impacted by overweight and obesity as research objects; (D) Outcome measurements include CRP, TNF-α, IL-6, and adiponectin; (E) Duration of the exercise intervention is eight weeks.

RESULTS

A total of 34 articles and 2229 participants were included. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.59, 95 % CI: -0.87 to -0.31, p < 0.00001), tumor necrosis factor-α (TNF-α) (MD: -0.65, 95 % CI: -0.94 to -0.35, p < 0.00001), interleukin-6 (IL-6) (MD: -0.48, 95 % CI: -0.75 to -0.21, p < 0.00001), and exercise can significantly increase the level of adiponectin (MD: 0.33, 95 % CI: 0.02 to 0.65, p = 0.04) in women impacted by overweight and obesity.

CONCLUSION

These results suggest that exercise may be an effective intervention for reducing pro-inflammatory markers and increasing adiponectin in postmenopausal women impacted by overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for postmenopausal women living with overweight and obesity.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

The Complementary Effects of Dabigatran Etexilate and Exercise Training on the Development and Stability of the Atherosclerotic Lesions in Diabetic ApoE Knockout Mice

Aim: To determine the complementary effects of dabigatran etexilate (DE), exercise training (ET), and combination (DE + ET) on the development and stability of the atherosclerotic lesions in diabetic apoE knockout (apoE-/-) mice. Methods: In 48 male apoE-/- diabetic mice, streptozotocin (STZ) was induced for 5 consecutive days. Mice received a high-fat diet (HFD) for 8 weeks and then were randomized into four groups (1. Control/CG, 2. DEG: HFD with DE, 3. ETG: ET on treadmill, 4. DE + ETG: combination DE and ET treatment). At the end of the eighth week, all mice were euthanatized and morphometry of the aortic lesions at the level of aortic valve was obtained. Collagen, elastin, MCP-1, TNF-a, matrix metalloproteinases (MMP-2,-3,-9), and TIMP-1 concentrations within plaques at the aortic valve were determined. Results: All active groups had significantly smaller aorta stenosis (DEG:7.9 ± 2.2%, ETG:17.3 ± 5.3%, DE + ETG:7.1 ± 2.7%) compared to CG (23.3 ± 5.5% p < 0.05), reduced the relative intra-plaque content of MCP-1, macrophages, MMP-3, and MMP-9, and considerably increased collagen, elastin, and TIMP-1 (p < 0.05). Group 4 showed the most pronounced results (p < 0.05). Both DEG and DE + ETG significantly reduced MMP-2 and TNF-a concentrations compared to ETG and CG (p < 0.010). Conclusion: DE and ET treatment of diabetic apoE-/- mice resulted in complementary amelioration of atherosclerotic lesions development and stability, mediated by the anti-inflammatory modulation of both DE and ET.

Effects of concurrent aerobic and resistance training on vascular health in type 2 diabetes: a systematic review and meta-analysis

Objective

To determine the impacts of concurrent aerobic and resistance training on vascular structure (IMT) and function (PWV, FMD, NMD) in type 2 diabetes (T2D).

Methods

The electronic databases PubMed, Web of Science Core Collection, Cochrane Library, Embase, Scopus, CINAHL, and SPORTDiscus were systematically searched for articles on "type 2 diabetes" and "concurrent training" published from inception to August 2, 2022. We included randomized controlled trials that examined the effects of concurrent training versus passive controls on IMT, PWV, FMD and NMD in T2D.

Results

Ten studies were eligible, including a total of 361 participants. For IMT, concurrent training showed a slight decrease by 0.05 mm (95% CI -0.11 to 0.01, p > 0.05). concurrent training induced an overall significant improvement in FMD by 1.47% (95% CI 0.15 to 2.79, p < 0.05) and PWV by 0.66 m/s (95% CI -0.89 to -0.43, p < 0.01) in type 2 diabetics. However, concurrent training seemed to exaggerate the impaired NMD (WMD = -2.30%, 95% CI -4.02 to -0.58, p < 0.05).

Conclusions

Concurrent training is an effective method to improve endothelial function and artery stiffness in T2D. However, within 24 weeks concurrent training exacerbates vascular smooth muscle dysfunction. More research is needed to explore whether longer and/or higher-intensity concurrent training interventions could enhance the vascular structure and smooth muscle function in this population.

Systematic review registration

www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350604.

Physical Activity as a Modern Intervention in the Fight against Obesity-Related Inflammation in Type 2 Diabetes Mellitus and Gestational Diabetes

Diabetes is one of the greatest healthcare problems; it requires an appropriate approach to the patient, especially when it concerns pregnant women. Gestational diabetes mellitus (GDM) is a common metabolic condition in pregnancy that shares many features with type 2 diabetes mellitus (T2DM). T2DM and GDM induce oxidative stress, which activates cellular stress signalling. In addition, the risk of diabetes during pregnancy can lead to various complications for the mother and foetus. It has been shown that physical activity is an important tool to not only treat the negative effects of diabetes but also to prevent its progression or even reverse the changes already made by limiting the inflammatory process. Physical activity has a huge impact on the immune status of an individual. Various studies have shown that regular training sessions cause changes in circulating immune cell levels, cytokine activation, production and secretion and changes in microRNA, all of which have a positive effect on the well-being of the diabetic patient, mother and foetus.

Exercise therapy for sarcopenia and diabetes

Aging is characterized by the gradual deterioration of function at the molecular, cellular, tissue, and organism levels in humans. The typical diseases caused by changes in body composition, as well as functional decline in the human body’s organs due to aging include sarcopenia and metabolic disorders. The accumulation of dysfunctional aging β cells with age can cause decreased glucose tolerance and diabetes. Muscle decline has a multifactorial origin, involving lifestyle habits, disease triggers, and age-dependent biological changes. The reduced function of β cells in elderly people lowers insulin sensitivity, which affects protein synthesis and interferes with muscle synthesis. The functional decrease and aggravation of disease in elderly people with less regular exercise or physical activity causes imbalances in food intake and a continuous, vicious cycle. In contrast, resistance exercise increases the function of β cells and protein synthesis in elderly people. In this review, we discuss regular physical activities or exercises to prevent and improve health, which is sarcopenia as decreased muscle mass and metabolic disorders as diabetes in the elderly.

The Role of Adipokines in Health and Disease

Adipokines are cell-signaling proteins secreted by adipose tissue that has been related to a low-grade state of inflammation and different pathologies. The present review aims to analyze the role of adipokines in health and disease in order to understand the important functions and effects of these cytokines. For this aim, the present review delves into the type of adipocytes and the cytokines produced, as well as their functions; the relations of adipokines in inflammation and different diseases such as cardiovascular, atherosclerosis, mental diseases, metabolic disorders, cancer, and eating behaviors; and finally, the role of microbiota, nutrition, and physical activity in adipokines is discussed. This information would allow for a better understanding of these important cytokines and their effects on body organisms.

Long-term effects of different exercise training modes on cytokines and adipokines in individuals with overweight/obesity and cardiometabolic diseases: A systematic review, meta-analysis, and meta-regression of randomized controlled trials

The present study aimed to investigate the evidence on the effects of different long-term training interventions (aerobic [AeT], resistance [RT], and combined [COMB]) and spontaneous physical activity (PA) in modifying cytokines and adipokines in individuals with overweight or obesity with or without cardiometabolic diseases while considering potential confounders. Although exercise interventions have become a potentially effective tool for preventing and treating metabolic diseases, the evidence provided by previous systematic reviews is inconclusive since several potential confounders have yet to be addressed. Therefore, we conducted a systematic literature search in Medline, Cochrane, and Embase databases from January 2000 to July 2022 and performed a meta-analysis. Inclusion criteria retrieved 106 full texts comprising 8,642 individuals with a range BMI of 25.1-43.8 kg m^-2 . We found that independently of the training mode, exercise had a beneficial effect on diminishing Adiponectin, C-reactive protein (CRP), IL-6, IL-18, IL-20, Leptin, sICAM, and TNF-α levels circulating levels. Furthermore, by subsequent analysis, we detected differential effects of AeT, RT, and COMB, with sex, age, body composition, and trial length acting as moderators. The comparison of training modes revealed a difference favoring COMB over AeT for regulating the increase in CRP with no differences in the remaining biomarkers. Meta-regression analysis revealed an effect of change in maximal oxygen uptake (VO_2max ) on CRP, IL-6, and TNF-α, while IL-10 was influenced by the change in body fat. The results suggest that all interventions, except PA, are effective in lessening this population's inflammatory status, provided that exercise results in an increase of VO_2max .

The anti-inflammatory effects of aerobic exercise training in patients with type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a low-grade, chronic inflammatory disease, associated with increased cardiovascular risk. The purpose of this systematic review/ meta-analysis was to evaluate the effects of aerobic exercise training (AET) on inflammatory markers in T2DM patients.

METHODS

The literature search was conducted utilizing PubMed, Web of Science, Embase, and the Cochrane Library from their inception up to April 2022. We screened only for randomized controlled trials (RCTs) investigating the effects of AET on C-reactive protein (CRP) and adipokines: adiponectin, resistin, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-a), along with changes in anthropometric indices and glycemic control in adult T2DM patients. Pooled post-exercise weighted mean differences (WMDs) with 95% Confidence Intervals (CIs) were calculated for all outcomes of interest between exercise-treated patients and controls.

RESULTS

Twenty-six RCTs involving 1239 T2DM patients were retrieved from the databases for meta-analysis. The cumulative results showed that post-AET inflammatory markers were lower in exercise-treated patients compared to controls regarding CRP (mg/L): WMD: -0.91; 95%CIs: -1.43, -0.40; p < 0.001 resistin (mg/ml): (WMD: -2.08; 95%CIs: -3.32, -0.84; p < 0.001); TNF-a (pg/ml): (WMD: -2.70; 95%CIs: -4.26, -1.14; p < 0.001), and IL-6 (pg/ml): (WMD: -1.05; 95%CIs: -1.68, -0.43; p < 0.001). Those effects were accompanied by significant amelioration of fasting glucose (mg/dl) (WMD: -13.02; 95%CIs: -25.39, -0.66; p = 0.04), HbA1c (%) (WMD: -0.51; 95%CIs: -0.73, -0.28, p < 0.001), and fat mass (%) (WMD: -3.14; 95%CI: -4.71, -1.58; p < 0.001). Our meta-analysis demonstrated less-consistent results for adiponectin (μg/ml), (WMD: 1.00; 95%CI: -0.12, 2.12; p = 0.08) and body-mass index (kg/m²) (WMD: -1.34; 95%CI: -2.76, 0.08; p = 0.06) tending to differ between AET and control group.

CONCLUSIONS

AET can significantly reduce the inflammatory burden in T2DM patients. by ameliorating the circulating levels of CRP, resistin, TNF-a and IL-6, even without accompanied significant weight-loss. The clinical impact of those anti-inflammatory effects of AET needs to be determined.

Physical Exercise and Diet: Regulation of Gut Microbiota to Prevent and Treat Metabolic Disorders to Maintain Health

Each person's body is host to a large number and variety of gut microbiota, which has been described as the second genome and plays an important role in the body's metabolic process and is closely related to health. It is common knowledge that proper physical activity and the right diet structure can keep us healthy, and in recent years, researchers have found that this boost to health may be related to the gut microbiota. Past studies have reported that physical activity and diet can modulate the compositional structure of the gut microbiota and further influence the production of key metabolites of the gut microbiota, which can be an effective way to improve body metabolism and prevent and treat related metabolic diseases. In this review, we outline the role of physical activity and diet in regulating gut microbiota and the key role that gut microbiota plays in improving metabolic disorders. In addition, we highlight the regulation of gut microbiota through appropriate physical exercise and diet to improve body metabolism and prevent metabolic diseases, aiming to promote public health and provide a new approach to treating such diseases.

Exercise training-induced changes in exerkine concentrations may be relevant to the metabolic control of type 2 diabetes mellitus patients: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

This study investigates the effects of exercise training on exerkines in patients with type 2 diabetes mellitus to determine the optimal exercise prescription.

METHODS

A systematic search for relevant studies was performed in 3 databases. Randomized controlled trials investigating the effects of exercise training on at least one of the following exerkines were included: adiponectin, apelin, brain-derived neurotrophic factor, fetuin-A, fibroblast growth factor-21, follistatin, ghrelin, interleukin (IL)-6, IL-8, IL-10, IL-15, IL-18, leptin, myostatin, omentin, resistin, retinol-binding protein 4, tumor necrosis factor-α, and visfatin.

RESULTS

Forty randomized controlled trials were selected for data extraction (n = 2160). Exercise training induces changes in adiponectin, fetuin-A, fibroblast growth factor-21, IL-6, IL-10, leptin, resistin, and tumor necrosis factor-α levels but has no significant effects on apelin, IL-18, and ghrelin compared to controls. Physical exercise training favored large and positive changes in pooled exerkines (i.e., an overall effect size calculated from several exerkines) (Hedge's g = 1.02, 95% confidence interval (95%CI): 0.76-1.28), which in turn were related to changes in glycated hemoglobin (mean difference (MD) = -0.81%, 95%CI: -0.95% to -0.67%), fasting glucose (MD = -23.43 mg/dL, 95%CI: -30.07 mg/dL to -16.80 mg/dL), waist circumference (MD = -3.04 cm, 95%CI: -4.02 cm to -2.07 cm), and body mass (MD = -1.93 kg, 95%CI: -2.00 kg to -1.86 kg). Slightly stronger effects were observed with aerobic, resistance, or high-intensity interval protocols at moderate- to vigorous-intensity and with programs longer than 24 weeks that comprise at least 3 sessions per week and more than 60 min per session.

CONCLUSION

Exercise training represents an anti-inflammatory therapy and metabolism-improving strategy with minimal side effects for patients with type 2 diabetes mellitus.

Chronic Resistance Training Effects on Serum Adipokines in Type 2 Diabetes Mellitus: A Systematic Review

(1) Background: Non-communicable diseases (NCD) are an important concern for public health because of their high rates of morbidity and mortality. A prevalent lifestyle-linked NCD is type 2 diabetes mellitus (T2D). Recently, molecular biomarkers secreted by adipocytes, called adipokines, have been linked with T2D and muscle function disturbances. However, the effects of resistance training (RT) interventions on adipokine levels in patients with T2D have not been systematically studied. (2) Methods: The PRISMA guidelines were followed. Searches for the studies were performed in the PubMed/MEDLINE and Web of Science electronic databases. Eligibility criteria included: (i) participants with T2D; (ii) RT interventions; (iii) randomized controlled trials; and (iv) measurement of serum adipokines. The PEDro scale was used to assess the methodological quality of the selected studies. Significant differences (p ≤ 0.05) and effect size were screened for each variable. (3) Results: Of the initial 2166 records, database search extraction yielded 14 studies to be included. The methodological quality of the included data was high (median PEDro score of 6.5). Analyzed adipokines in the included studies were leptin, adiponectin, visfatin, apelin, resistin, retinol-binding protein 4 (RBP4), vaspin, chemerin, and omentin. RT interventions (6-52 weeks; minimal effective duration >12 weeks) exert a meaningful effect on serum adipokine, (e.g., leptin) levels in T2D patients. (4) Conclusions: RT may be an alternative, but not an optimal, option in adipokine disruptions in T2D. Combined (i.e., aerobic and RT) long-term training may be considered the optimal intervention for treating adipokine level disturbances.

Intensity Differences of Resistance Training for Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis

Resistance training is used as adjunctive therapy for type 2 diabetes (T2DM), and the aim of this study was to investigate the differences in the treatment effects of different intensities of resistance training in terms of glycemia, lipids, blood pressure, adaptations, and body measurements. A comprehensive search was conducted in the PubMed, EMBASE (Excerpta Medica dataBASE), EBSCO (Elton B. Stephens Company) host, Cochrane Library, WOS (Web of Science), and Scopus databases with a cut-off date of April 2022, and reference lists of relevant reviews were also consulted. The literature screening and data extraction were performed independently by two researchers. RoB2 (Risk of bias 2) tools were used for the literature quality assessment, the exercise intensity was categorized as medium-low intensity and high intensity, and the meta subgroup analysis was performed using R Version. A fixed or random effects model was selected for within-group analysis based on the heterogeneity test, and a random effects model was used for the analysis of differences between subgroups. A total of 36 randomized controlled trials were included, with a total of 1491 participants. It was found that resistance training significantly improved HbA1c (glycated hemoglobin), fasting blood glucose, TG (triglycerides), TC (total cholesterol), and LDL (low-density lipoprotein cholesterol) levels in patients with T2DM and caused a significant reduction in systolic blood pressure, percent of fat mass, and HOMA-IR (homeostatic model assessment for insulin resistance) indexes. The effects of high and medium-low intensity resistance training on T2DM patients were different in terms of HOMA-IR, maximal oxygen consumption, weight, waist-to-hip ratio, and body mass indexes. Only medium-low intensity resistance training resulted in a decrease in HOMA-IR. In addition to weight (MD = 4.25, 95% CI: [0.27, 8.22], I² = 0%, p = 0.04; MD = -0.33, 95% CI: [-2.05, 1.39], I² = 0%, p = 0.76; between groups p = 0.03) and HOMA-IR (MD = 0.11, 95% CI: [-0.40, -0.63], I² = 0%, p = 0.85; MD = -1.09, 95% CI: [-1.83, -0.36], I² = 87%, p = < 0.01; between groups p = 0.0085), other indicators did not reach statistical significance in the level of difference within the two subgroups of high intensity and medium-low intensity. The treatment effects (merger effect values) of high intensity resistance training were superior to those of medium-low intensity resistance training in terms of HbA1c, TG, TC, LDL levels and diastolic blood pressure, resting heart rate, waist circumference, fat mass, and percentage of fat mass. Therefore, high intensity resistance training can be considered to be a better option to assist in the treatment of T2DM and reduce the risk of diabetic complications compared to medium-low intensity resistance training. Only one study reported an adverse event (skeletal muscle injury) associated with resistance training. Although results reflecting the difference in treatment effect between intensity levels reached no statistical significance, the practical importance of the study cannot be ignored.

Meta-Analysis of the Effect of Different Exercise Mode on Carotid Atherosclerosis

(1) Background: There is increasing evidence showing the health benefits of exercise on carotid atherosclerosis. However, little is known about the different exercise modes for carotid atherosclerosis. This study was designed to perform a meta-analysis of effect of different exercise modes on carotid atherosclerosis so as to provide evidence-based suggestions for the prevention and management of cardiovascular and cerebrovascular diseases. (2) Methods: Six databases were systematically searched to identify randomized trials that compared exercise to a non-exercise intervention in patient with carotid atherosclerosis. We a priori specified changes in cIMT, TC, LDL-C, and HDL-C biomarkers as outcomes. (3) Results: Thirty-four trials met the eligibility criteria, comprising 2420 participants. The main analyses showed pronounced differences on cIMT (MD = -0.06, 95%CI (-0.09, -0.04), p < 0.00001, TC (MD = -0.41, 95%CI (-0.58, -0.23), p < 0.00001), LDL-C (MD = -0.31, 95%CI (-0.43, -0.20), p < 0.00001), and HDL-C (MD = 0.11, 95%CI (0.04, 0.19), p = 0.004), which significantly reduced the risk factors of carotid atherosclerosis disease. In the different exercise modes, the effect was pronounced for aerobic exercise for all outcomes except TC; high-intensity interval exercise also showed significance for all outcomes except TC and HDL-C; aerobic exercise combined with resistance exercise did not affect any outcome except HDL-C; (4) Conclusions: Exercise has a prominent prevention and improvement effect on carotid atherosclerosis. In the perspective of exercise pattern, aerobic exercise and high-intensity intermittent exercise can improve carotid atherosclerosis; however, aerobic exercise has a more comprehensive improvement effect.

A Meta-Analysis of the Influence on Inflammatory Factors in Type 2 Diabetes among Middle-Aged and Elderly Patients by Various Exercise Modalities

The purpose of this study was to investigate the effects of various exercise modalities on inflammatory factors in middle-aged and elderly patients with type 2 diabetes (MEPT2D), as lifestyle changes, such as physical activity and dietary modifications, are considered important in the prevention of type 2 diabetes. For the study methodology, Pubmed, CNKI, EBSCO, Wanfang Data, and Web of Science were selected for the search. The methodological quality of the included studies was assessed by the Cochrane Risk of Bias (ROB) tool, and statistically analyzed using the RevMan 5.4.1 analysis software, which included 18 investigations involving 853 study subjects. Meta-analysis findings indicated that aerobic training (AT), resistance training (RT), combined training (CT), and high-intensity interval training (HIIT) showed significant reductions in CRP, TNF-α, IL-6, and IL-10 levels in MEPT2D. Among them, HIIT was superior to other training modalities in reducing TNF-α levels, while CT was superior to AT, RT, and HIIT in decreasing IL-6, IL-10, and CRP in MEPT2D. Meanwhile, RT had limited effects in reducing CRP and TNF-α levels in MEPT2D. However, HIIT had no significant effect on IL-6 and IL-10 in MEPT2D. In conclusion, long-term regular AT, RT, CT, and HIIT all contributed to the reduction of inflammatory status (CRP, TNF-α, IL-6, and IL-10) in MEPT2D, while CT (for CRP, IL-6, and IL-10) and HIIT (for TNF-α) represent the best approaches to counteract the inflammatory response in MEPT2D.

Effectiveness of Resistance Exercise on Inflammatory Biomarkers in Patients with Type 2 Diabetes Mellitus: A Systematic Review with Meta-Analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is related to increased inflammatory processes. The effects of resistance exercise on inflammatory biomarkers in T2DM are controversial. Our purpose was to determine the effectiveness of resistance exercise on inflammatory biomarkers in patients diagnosed with T2DM.

METHODS

We searched four databases until September 2021. We included randomized clinical trials (RCTs) of the effects of resistance exercise on inflammatory biomarkers (C-reactive protein [CRP], tumor necrosis factor alpha, interleukin-6, and interleukin-10) in patients with T2DM. A random effects meta-analysis was conducted to determine the standardized mean difference (SMD) and the raw mean difference (MD) for CRP.

RESULTS

Thirteen RCTs were included in the review, and 11 in the meta-analysis for CRP. Lower CRP levels were observed when resistance exercise was compared with the control groups (SMD=-0.20; 95% confidence interval [CI], -0.37 to -0.02). When conducting the MD meta-analysis, resistance exercise showed a significant decrease in CRP of -0.59 mg/dL (95% CI, -0.88 to -0.30); otherwise, in the control groups, the CRP values increased 0.19 mg/dL (95% CI, 0.17 to 0.21).

CONCLUSION

Evidence supports resistance exercise as an effective strategy to manage systemic inflammation by decreasing CRP levels in patients with T2DM. The evidence is still inconclusive for other inflammatory biomarkers.

Effect of Exercise on Carotid Artery Intima-Media Thickness in Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis that is independently associated with the risk for cardiovascular disease. Recent studies on the effect of exercise on cIMT have yielded conflicting results.

METHODS

Studies that were available up until October 30, 2021 from the PubMed, Cochrane Library, Embase, and Web of Science databases were included in the analysis. Subgroup analyses were performed to determine the effects of the type, intensity, and duration of exercise on cIMT.

RESULTS

This review included 26 studies with 1370 participants. Compared with control participants, those who engaged in exercise showed a decline in cIMT (weighted mean difference [WMD] -0.02; 95% confidence interval [CI], -0.03 to -0.01; I2 = 90.1%). Participants who engaged in aerobic (WMD -0.02; 95% CI, -0.04 to -0.01; I2 = 52.7%) or resistance (WMD -0.01; 95% CI, -0.02 to -0.00; I2 = 38.5%) exercise showed lower cIMT compared with control participants. An exercise duration of >6 months was associated with a 0.02 mm reduction in cIMT. In participants with low cIMT at baseline (<0.7 mm), exercise alone was not associated with a change in cIMT (WMD -0.01; 95% CI, -0.03 to 0.00; I2 = 93.9%).

CONCLUSIONS

Exercise was associated with reduced cIMT in adults. Aerobic exercise is associated with a greater decline in cIMT than other forms of exercise. Large, multicenter, randomized controlled trials are required to establish optimal exercise protocols for improving the pathological process of atherosclerosis.

Comparison of the Effect of Endurance, Strength and Endurance-Strength Training on Glucose and Insulin Homeostasis and the Lipid Profile of Overweight and Obese Subjects: A Systematic Review and Meta-Analysis

The most effective type of training to improve cardiometabolic parameters in overweight subjects is unknown. This meta-analysis compared the effect of endurance, strength and combined training on glucose, insulin metabolism and the lipid profile of overweight and obese adults. The Cochrane, PubMed, Scopus and Web of Science databases were searched to identify randomised trials assessing the effect of training intervention on fasting and 2 h glucose and insulin levels, glycated haemoglobin (HbA1c), homeostatic model assessment of insulin resistance (HOMA), C-peptide, total cholesterol (TC), low- (LDL-C) and high-density lipoprotein cholesterol and triglycerides (TG). Forty-six studies were included showing that endurance training more favourably reduced HbA1c (p = 0.044), and LDL-C (p = 0.021) than strength training. Endurance-strength training more effectively decreased glucose (p = 0.002), HbA1c (p = 0.032), HOMA (p = 0.002), TC (p = 0.039), LDL-C (p = 0.046), HDL (p = 0.036) and TG levels (p = 0.025) than strength training. Combined training significantly reduced the HOMA index (p = 0.009) and TG levels (p = 0.039) compared with endurance training. Endurance and endurance-strength training have a more favourable effect on glucose and insulin homeostasis and lipid profile than strength training in overweight and obese adults. However, the results from this meta-analysis should be interpreted cautiously due to significant heterogeneity among included studies.

Effectiveness of exercise in reducing cerebral stroke risk factors: A systematic review and meta-analysis

OBJECTIVES

This study aimed to explore the relationship between exercise and cerebral stroke and provide evidence for the prevention of cerebral stroke.

MATERIALS/METHODS

All clinical trials of exercise intervention for atherosclerosis were systematically reviewed. Five major databases were searched to retrieve relevant studies from their inception to May 2022. According to the magnitude of heterogeneity, the random and fixed-effect models were used to test reasonably.

RESULTS

According to the inclusion and exclusion criteria, 1341 articles were screened and 13 articles involving 825 patients were identified. The result showed that in the randomized controlled trials carotid intima-media thickness index was lower in the exercise group (-0.04 mm, 95% confidence interval: -0.07 to -0.01). All were statistically significant (P < .005) and subgroup analysis showed that the intervention period and paper quality are sources of heterogeneity.

CONCLUSIONS

The results of this systematic review suggest that exercise is associated with a slow increase in carotid intima-media thickness, which may provide evidence that exercise helps reduce cerebral stroke.

Impact of concurrent training versus aerobic or resistance training on cardiorespiratory fitness and muscular strength in middle-aged to older adults: A systematic review and meta-analysis

The effects of aerobic training (AT) on cardiorespiratory fitness (CRF), and resistance training (RT) on muscular strength, are well known in older adults. However, less is known about the potential additive benefits of concurrent training (CT) versus AT or RT alone in this population. We conducted a systematic review and meta-analysis to investigate the effects of CT, versus AT or RT, on CRF and muscular strength in middle-aged to older adults. PubMed and Web of Science were searched through October 2021 to identify randomized trials evaluating CT versus AT and/or RT in middle-aged and older adults (>50 yrs). Studies were included that measured CRF, using maximal or peak oxygen uptake (VO_2max/peak); and/or lower- and upper-body muscular strength measured using 1-repetition maximum (1RM) to 10RM tests during isoinertial contractions, or peak torque during isometric dynamometry or isokinetic dynamometry at 30 to 60°/s. Standardized mean differences (SMD) and 95% confidence intervals (95% CIs) were determined using random or fixed effects models. Forty-nine studies involving 2,587 middle-aged to older participants with mean ages ranging from 55 to 88 years, were included in the meta-analysis. Results indicated that CT effectively increased VO_2max/peak (SMD: 0.77, p = 0.005, 12 intervention arms) when compared to RT. In addition, CT effectively increased lower- (SMD: 0.60, p = 0.001, 43 intervention arms) and upper-body (SMD: 0.57, p = 0.001, 28 intervention arms) muscular strength when compared to AT. However, there were no differences in VO_2max/peak (SMD: 0.09, p = 0.09, 33 intervention arms) between CT and AT, or in lower-body (SMD: 0.07, p = 0.48, 21 intervention arms) and upper-body (SMD: -0.07, p = 0.38, 17 intervention arms) muscular strength between CT and RT. Overall, CT was shown to be effective for increasing CRF and muscular strength in middle-aged to older adults and there was no negative effect on the magnitude of changes in these outcomes compared to either AT or RT alone. These results suggested that CT should be considered a viable strategy to improvement of CRF and muscular strength with aging.

Improved blood pressure and flow-mediated dilation via increased plasma adropin and NOx induced by high-intensity interval training in patients with type 2 diabetes

NEW FINDINGS

What is the central question of this study? Exercise training increases adropin and NOx plasma levels in middle-aged and older healthy people. We hypothesized that high-intensity interval training may improve blood pressure and flow-mediated dilation through the effects of adropin and NOx in patients of this age with type 2 diabetes. What is the main finding and its importance? High-intensity interval training may be more effective than moderate-intensity continuous training in improving endothelial function, blood pressure and flow-mediated dilation through its effects on adropin and NOx in patients with type 2 diabetes.

ABSTRACT

Adropin is a newly identified bioactive protein that is important in energy hemostasis and vascular endothelial function. Lower levels of adropin in patients with type 2 diabetes are related to coronary atherosclerosis, characterized by impaired flow-mediated dilation (FMD). The purpose of the present study was to investigate FMD, and plasma levels of adropin and nitrite/nitrate (NOx), in patients with type 2 diabetes at baseline and follow-up after 12 weeks of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT). Sixty-six persons with type 2 diabetes were divided into HIIT, MICT and control groups. The HIIT group intervention was 12 intervals (1.5 min) at 85% to 90% maximal heart rate (HR_max ) separated by 2 min at 55% to 60% HR_max in 3 session per week for 12 weeks. MICT training consisted of 42 min of cycling at 70% HR_max . Before and after the intervention, FMD was recorded with high-resolution Doppler ultrasound. Plasma levels of adropin and NOx were measured by enzyme-linked immunosorbent assay. After training FMD was significantly higher in the MICT and HIIT groups compared to the control group (P<0.05). Plasma levels of adropin and NOx were higher in both exercise groups, but the increase was greater in the HIIT group (P<0.01). Peak oxygen consumption was increased after exercise training in both groups compared to the control group (P<0.01). Percent FMD showed a positive correlation with plasma levels of adropin and NOx (both P<0.01), and a negative correlation with DBP (r = -0.530, P = 0.035) and SBP (r = -0.606, P = 0.013) in the HIIT group. The results indicate that HIIT improved FMD whilst increasing adropin, NOx and peak oxygen consumption. Increased plasma levels of adropin may contribute, in part, to blood pressure reduction by increasing nitric oxide production. This article is protected by copyright. All rights reserved.

Comparison of the Effect of Endurance, Strength, and Endurance-Strength Training on Inflammatory Markers and Adipokines Levels in Overweight and Obese Adults: Systematic Review and Meta-Analysis of Randomised Trials

The aim of this meta-analysis was to compare the effects of endurance, strength, and combined training on inflammatory markers and adipokine concentrations in overweight and obese adults. We performed a literature search of the Cochrane Library, PubMed, Scopus, and Web of Science databases and identified 24 randomised control trials published prior to June 2021. Our findings indicate that endurance training was significantly more beneficial than strength training in reducing C-reactive protein (CRP) (standard mean difference (SMD): −1.317, 95% confidence intervals (CI): −2.565, −0.070, p = 0.0385), interleukin 6 (IL-6) (SMD: −0.363, 95% CI: −0.648, −0.078, p = 0.0126), and visfatin (SMD: −0.618, 95% CI: −1.015, −0.222, p = 0.0023) concentrations. Moreover, combined training was more beneficial than strength training alone in lowering tumour necrosis factor-alpha (TNF-α) levels (SMD: 0.890, 95% CI: −0.301, 1.478, p = 0.0030). There were no differences between the effects of different types of training programmes on adiponectin and leptin concentrations. In conclusion, compared with strength training, endurance training is more effective in lowering CRP, IL-6, and visfatin concentrations, while combined training is more beneficial in reducing TNF-α levels in overweight and obese adults. Further studies are needed to determine which type of training has a better effect on adiponectin and leptin concentrations in this population.

Exercise and Nutrition Strategies for Combating Sarcopenia and Type 2 Diabetes Mellitus in Older Adults

Medical and technology development have drastically the improved quality of life and, consequently, life expectancy. Nevertheless, the more people who enter the third-age, the more geriatric syndromes expand in the elderly. Sarcopenia and Type 2 diabetes mellitus (T2DM) are common diseases among the elderly and the literature has extensively studied these two diseases separately. Recent evidence, however, revealed that there is a bidirectional relationship between sarcopenia and T2DM. The aims of the present review were: (1) to present diet and exercise interventions for the management of sarcopenia and T2DM and (2) identify which diet and exercise interventions can be used simultaneously in order to effectively deal with these two disorders. Exercise and a balanced diet are used as effective countermeasures for combating sarcopenia and T2DM in older adults based on their bidirectional relationship. Lifestyle changes such as exercise and a balanced diet seem to play an important role in the remission of the diseases. Results showed that chronic exercise can help towards glycemic regulation as well as decrease the incidence rate of muscle degradation, while diet interventions which focus on protein or amino acids seem to successfully treat both disorders. Despite the fact that there are limited studies that deal with both disorders, it seems that a combined exercise regime (aerobic and resistance) along with protein intake > 1gr/kg/d is the safest strategy to follow in order to manage sarcopenia and T2DM concurrently.

Combined training improves the diagnostic measures of sarcopenia and decreases the inflammation in HIV-infected individuals

BACKGROUND

HIV-related sarcopenia is an emerging health issue that often remains undiagnosed and can lead to reduced quality of life, independence, and premature death if untreated. This study investigated the effects of a 6 month combined training (resistance plus aerobic exercise) (CT) intervention on diagnostic measures of sarcopenia, including grip strength, appendicular lean mass index (ALMI), and gait speed.

METHODS

Forty participants were randomized into either a CT group (n = 20; age = 38.3 ± 4.9 years) or a control group (CON; n = 20; age = 37.9 ± 5.1 years). Participants in the CT group performed three supervised sessions per week for 6 months, consisting of weekly reverse linear periodized resistance training followed by 20 min aerobic training. Participants in the CON group were instructed to continue with their current lifestyle habits. Assessments were completed at baseline and after 6 months. Statistical analyses were performed using a two-way analysis of covariance (ANCOVA) adjusted for sex and preintervention values. Primary outcomes included grip strength, ALMI, and gait speed. Secondary outcomes were changes in levels of pro-inflammatory cytokines (IL-6 and TNF-α), IGF-1, and myostatin. Associations were explored between changes in inflammatory markers (IL-6 and TNF-α), gait speed, and ALMI with grip strength.

RESULTS

A significant increase in ALMI was found for CT compared with CON (0.29 ± 0.13 kg/m² vs. -0.11 ± 0.14 kg/m² , respectively; P < 0.001). Significant improvements in grip strength (7.86 ± 8.50 kg for CT vs. -1.58 ± 2.47 kg for CON) and gait speed (0.16 ± 0.07 m/s² for CT vs. -0.06 ± 0.52 m/s² for CON; both P < 0.001) were also observed in CT compared with CON. Reduction in inflammatory biomarkers was found in CT compared with CON (IL-6; TNF-α, both P < 0.001). An increase in IGF-1 (74.36 ± 56.64 pg/mm³ for CT vs. 7.19 ± 99 pg/mm³ for CON; P < 0.001) and a decrease in myostatin (-158.90 ± 62.03 pg/mm³ for CT vs. -43.33 ± 146.60 pg/mm³ for CON; P < 0.001) was found following CT compared with the CON group. Change in grip strength was correlated with changes in IL-6 (r = -0.65, P < 0.001), TNF-α (r = -0.63, P < 0.001), gait speed (r = 0.63, P < 0.001), and ALMI (r = 0.54, P = 0.001), but not IGF-1 and myostatin. No adverse events were recorded, and compliance with the CT exercise sessions was high (>85%).

CONCLUSIONS

Combined training appears to be an effective means to counteract sarcopenia and improve various inflammatory markers and growth hormones in people living with HIV.

The Role of Apelin-APJ System in Diabetes and Obesity

Nowadays, diabetes and obesity are two main health-threatening metabolic disorders in the world, which increase the risk for many chronic diseases. Apelin, a peptide hormone, exerts its effect by binding with angiotensin II protein J receptor (APJ) and is considered to be linked with diabetes and obesity. Apelin and its receptor are widely present in the body and are involved in many physiological processes, such as glucose and lipid metabolism, homeostasis, endocrine response to stress, and angiogenesis. In this review, we summarize the literatures on the role of the Apelin-APJ system in diabetes and obesity for a better understanding of the mechanism and function of apelin and its receptor in the pathophysiology of diseases that may contribute to the development of new therapies.

Physical activity and adipokine levels in individuals with type 2 diabetes: A literature review and practical applications

We review the effects of acute and long-term physical activity on adipokine levels in individuals with type 2 diabetes (T2D). Three electronic databases were searched. Studies made in animal models were excluded, while studies based on participants with and without T2D, and also studies with type 1 diabetes were included. Of the 2,450 citations, 63 trials, including randomised control trials, cross-sectional and longitudinal studies, met our inclusion criteria. Seventy and five percent of studies reported the effects of physical activity on tumor necrosis factor-alpha (TNFα), interleukin 6 (IL-6), adiponectin, visfatin, omentin-1, and leptin levels. There are no robust results due to variations in exercise modality, intensity, duration, and also differences in cohort characteristics in the literature. Only four studies described the effects of an acute session of physical activity on adipokine levels. Overall, physical activity improves diabetes status by regulating adipokine levels. However, long-term aerobic + resistance training combined with dietary modifications is likely to be a more effective strategy for improving adipokines profiles in patients with type 2 diabetes.

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AIM

Aim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes.

DATA SYNTHESIS

This metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing 'no exercise' as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (-0.3 [-0.1;-0.4]%, -1.44 [-2.22, -0.66]%, and -5.6 [-9.5, -1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, -0.4 [-0.6;-0.3], -0.2 [-0.4;-0.1], and -0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise.

CONCLUSIONS

Physical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.

Decreased muscle-derived musclin by chronic resistance exercise is associated with improved insulin resistance in rats with type 2 diabetes

Chronic resistance exercise induces improved hyperglycemia in patients with type 2 diabetes mellitus. Musclin, a muscle‐derived secretory factor, is involved in the induction of insulin resistance via the downregulation of the glucose transporter‐4 (GLUT‐4) signaling pathway in skeletal muscles. However, whether musclin affects the mechanism of resistance exercise remains unclear. This study aimed to clarify whether decreased muscle‐derived musclin secretion in chronic resistance exercise is involved in the improvement of insulin resistance via the GLUT‐4 signaling pathway in rats with type 2 diabetes. Male, 20‐week‐old, Otsuka Long‐Evans Tokushima Fatty (OLETF) rats, a type 2 diabetes model, were randomly divided into two groups: sedentary control (OLETF‐Con) and chronic resistance exercise (OLETF‐RT; climbing a ladder three times a week on alternate days for 8 weeks), whereas Long‐Evans Tokushima Otsuka rats were used as the nondiabetic sedentary control group. OLETF‐Con rats showed increased fasting glucose levels, decreased insulin sensitivity index (QUICKI), muscle GLUT‐4 translocation, and protein kinase B (Akt) phosphorylation, and concomitantly increased muscle musclin expression. In contrast, OLETF‐RT rats significantly reduced muscle musclin expression, improved hyperglycemia, and QUICKI through an accelerated muscle GLUT‐4/Akt signaling pathway. Moreover, chronic resistance exercise‐induced reduction of muscle musclin was correlated with changes in fasting glucose, QUICKI, GLUT‐4 translocation, and Akt phosphorylation. These findings suggest that the reduction in muscle‐derived musclin production by chronic resistance exercise may be involved in improved insulin resistance in rats with type 2 diabetes.

Effect of Calorie Restriction and Exercise on Type 2 Diabetes

Type-2 diabetes (T2D) is a chronic condition, generally regarded as an irreversible, that is among the top 10 causes of death globally. The hallmark of T2D is hyperglycemia, which results from disturbances in insulin sensitivity, insulin secretion, β-cell dysfunction and insulin resistance. Several clinical and lifestyle factors are involved in the progression of T2D, such as obesity and physical inactivity. A high-calorie diet is the main contributor to the development of obesity, which results in T2D, as obesity or increased intra-abdominal adipose tissue is related to insulin resistance. Technological advances have contributed to individuals having a more sedentary lifestyle, leading to obesity and T2D. T2D can be treated with lifestyle interventions, such as diet and exercise. Herein, we highlight the positive impact of a very low-calorie diet (VLCD) and lifestyle modalities in the treatment and prevention of T2D. An inclusion of VLCD 400-800 kcal/day for 8 weeks and ≥ 150 minutes exercise 5 times a week as lifestyle interventions can decrease glucose levels to normal, reduce HbA1c and improve insulin resistance and sensitivity. Therefore, a potential mechanism in maintaining glucose homeostasis and remission of T2D by VLCD and exercise reduces body weight.

Omentin-1 and vaspin serum levels in patients with pre-clinical carotid atherosclerosis and the effect of statin therapy on them

BACKGROUND

Omentin-1 and vaspin are novel adipokines, and their association with atherosclerosis is still under investigation. The present study aimed to assess the relationship of those adipokines with preclinical, non-significant carotid atherosclerosis and the impact of statin therapy on their levels, suggesting a link between adiposity and atherosclerosis.

METHODS

Eighty-four statin-free subjects with non-significant, preclinical carotid atherosclerosis and elevated LDL- cholesterol levels (>130 mg/dl) were recruited to receive atorvastatin (from 10 to 80 mg per day) (atorvastatin group - AG group). Forty-six age- and gender-matched healthy individuals, without any chronic disease served as controls (control group - CG). Clinical parameters, metabolic profile, serum omentin-1, vaspin concentrations and ultrasound measurements of carotid thickening were obtained at the beginning and after 12 months.

RESULTS

At baseline, AG showed lower omentin-1 and vaspin serum levels than CG (p ≤ 0.001). Along the entire study population at baseline, omentin-1 levels were independently related to LDL-cholesterol, while vaspin levels were independently associated with hsCRP and the presence of carotid atherosclerosis (p < 0.05). Within AG, 12-months atorvastatin treatment significantly increased omentin-1 (from 202.79 ± 91.41 ng/ml to 262.56 ± 101 ng/ml, p < 0.001) and vaspin concentrations (from 1.29 ± 0.51 ng/ml to 1.70 ± 0.5 ng/ml, p = 0.002). In standard multiple regression analysis, the presence of carotid atherosclerosis related to baseline vaspin levels (β = -0.232, p < 0.001), while the atorvastatin-induced increase of vaspin was independently associated with hsCRP reduction (β = -0.198, p = 0.045).

CONCLUSION

Low omentin-1 and vaspin serum levels associated with preclinical, non-significant carotid atherosclerosis. Notably, atorvastatin administration significantly increased both adipokines, but the underlying mechanisms and the clinical impact of those changes requires further investigation.

The Association of Self-Reported Muscle-Strengthening Activities With Carotid Intima-Media Thickness in Older Adults: Cooper Center Longitudinal Study

The purpose of the current investigation was to examine the cross-sectional associations of participation in muscle-strengthening activities (MSAs) with carotid intima-media thickness (CIMT) among older adults. The data are from 2,557 older adult participants enrolled in an observational cohort who reported no history of cardiovascular disease. MSA was determined using a questionnaire. Carotid ultrasound was performed to measure the CIMT of the common carotid artery bilaterally. Logistic regression models were constructed to estimate the association of MSA with CIMT after adjustment for potential confounders. The participants were aged 68.6 ± 7.0 years, and the majority were male (71.7%) and White (96.5%); 18% had abnormal CIMT. Meeting the physical activity guidelines for MSA was inversely associated with abnormal CIMT after adjustment for age and sex. However, this observed inverse relation became statistically null after further adjustment for cardiovascular disease risk factors, including aerobic physical activity.

Insulin resistance is associated with an exaggerated blood pressure response to ischemic rhythmic handgrip exercise in nondiabetic older adults

Patients with type 2 diabetes display an exaggerated pressor response to exercise. However, evidence supporting the association between the magnitude of the pressor response to exercise and insulin resistance-related factors including hemoglobin A1c (HbA1c) or homeostatic model assessment of insulin resistance (HOMA-IR) in nondiabetic subjects has remained sparse and inconclusive. Thus we investigated the relationship between cardiovascular responses to exercise and insulin resistance-related factors in nondiabetic healthy men (n = 23) and women (n = 22) above 60 yr old. We measured heart rate (HR) and blood pressure (BP) responses during: isometric handgrip (IHG) exercise of 30% maximal voluntary contraction, a period of skeletal muscle ischemia (SMI) induced by tourniqueting the arm after IHG, and rhythmic dynamic handgrip (DHG) exercise during SMI. Greater diastolic BP (DBP) responses to DHG with SMI was associated with male sex (r = 0.44, P = 0.02) and higher HbA1c (r = 0.33, P = 0.03), heart-ankle pulse wave velocity (haPWV) (r = 0.45, P < 0.01), and resting systolic BP (SBP) (r = 0.36, P = 0.02). HbA1c persisted as a significant determinant explaining the variance in the DBP response to DHG with SMI in multivariate models despite adjustment for sex, haPWV, and resting SBP. It was also determined that the DBP response to DHG with SMI in a group in which HOMA-IR was abnormal (Δ33 ± 3 mmHg) was significantly higher than that of groups in which HOMA-IR was at intermediate (Δ20 ± 4 mmHg) and normal (Δ23 ± 2 mmHg) levels. These data suggest that even in nondiabetic older adults, insulin resistance is related to an exaggerated pressor response to exercise especially when performed under ischemic conditions.NEW & NOTEWORTHY The diastolic blood pressure response to rhythmic dynamic handgrip exercise under ischemic conditions was demonstrated to be correlated with insulin resistance-related factors in nondiabetic older adults. This finding provides important insight to the prescription of exercise in this particular patient population as the blood pressure response to exercise, especially under ischemic conditions, could be exaggerated to nonsafe levels.

Semaphorin 3 C is a Novel Adipokine Representing Exercise-Induced Improvements of Metabolism in Metabolically Healthy Obese Young Males

This study investigated the endurance exercise-induced changes in lesser known adipokines (visfatin, chemerin, apelin, semaphorin 3 C) related to obesity and metabolism, and their correlations with the changes in the parameters of obesity and glucose homeostasis. Forty metabolically healthy obese young males were randomly assigned to control group (C, n = 12) or exercise group (Ex, n = 28). The subjects in Ex participated in a 8-week supervised endurance exercise training program, comprised of four sessions of treadmill running at 65–70% of VO_2max per week. Serum levels of visfatin, chemerin, apelin, and semaphorin 3 C were significantly decreased in Ex. At baseline, apelin and semaphorin 3 C appeared to be correlated with obesity measures, including body mass index, % total fat and trunk fat, and waist circumference. Exercise-induced changes in these obesity measures significantly correlated with the changes in chemerin and semaphorin 3 C. Basal chemerin, apelin and semaphorin 3 C correlated with glucose homeostasis parameters, including fasting plasma glucose, fasting plasma insulin, homeostasis model assessment of insulin resistance and β-cell function, and quantitative insulin-sensitivity check index to different extents. Furthermore, the changes in apelin and semaphorin 3 C well predicted the improvements in glycemic parameters. We suggest that semaphorin 3 C is a novel adipokine involved in pathophysiology of obesity and metabolism, and that it is a biomarker representing an exercise-induced improvement in metabolically healthy obese young males.

Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis

Resistance training (RT) is a powerful first-line intervention for the management of type 2 diabetes mellitus (T2DM). Nonetheless, the effects of the most frequent RT (hypertrophy training [HT] and muscular endurance training [MERT]) employed for the management of T2DM, and which type of RT might exert superior effects, remain elusive. Thus, this review aims to assess the effects of HT and MERT on glycaemic control, physical fitness, body composition, lipid profile, blood pressure, C-reactive protein, and quality of life in patients with T2DM; to analyse which particular RT is more effective; to assess the effects of general RT; and to identify RT components, characteristics of patients, and medications that could mediate the effects of RT. Randomized controlled trials (RCT) and non-RCT (RT≥ 4 weeks) in adults with T2DM were selected. Both HT and MERT improved HbA1c, insulin levels and sensitivity, muscle strength, body mass index, waist circumference, and fat mass. Additionally, HT improved glucose, cardiorespiratory fitness, fat percentage, lean body mass, lipid profile, systolic blood pressure, and C-reactive protein, and MERT improved weight. Overall, HT and MERT exert beneficial effects well comparable with aerobic training. Both types of RT can be used as potent therapeutic interventions for the management of T2DM depending on patients' limitations/preferences.

Comparative Effects of Curcumin versus Nano-Curcumin on Insulin Resistance, Serum Levels of Apelin and Lipid Profile in Type 2 Diabetic Rats

BACKGROUND AND PURPOSE

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and abnormalities in insulin production. Apelin is associated with insulin resistance. According to the anti-diabetic properties of curcumin, the purpose of this study was to compare the effects of curcumin and nano-curcumin intake on insulin resistance and serum levels of fasting blood sugar (FBS), Apelin, and lipid profile (cholesterol, triglyceride, LDL, HDL and VLDL) in T2DM rats.

MATERIALS AND METHODS

Forty-eight male Wistar rats were divided into six groups: Control, diabetic, diabetic treated with two doses of curcumin (100 and 200 mg/kg) and diabetic treated with two doses of nano-curcumin (100 and 200 mg/kg). Induction of T2DM was performed by intraperitoneal injection of Nicotinamide (110 mg/kg) and Streptozotocin (45 mg/kg) in the fasting state. Rats received different doses of nano-curcumin and curcumin by gavage (daily) for 28 days. At the end of the intervention period, insulin resistance and serum levels of FBS, apelin and lipid profiles were measured.

RESULTS

Insulin resistance and serum levels of FBS, Apelin, cholesterol, triglycerides, LDL, and VLDL were significantly decreased in diabetic rats treated with curcumin and nano-curcumin (p<0.05) so that nano-curcumin in reducing lipid profile is more effective than curcumin (P<0.05). Serum level of HDL in nano-curcumin groups was significantly higher than diabetic and curcumin groups (p<0.05). Also, with increasing insulin resistance, serum level of apelin increased (P<0.05).

CONCLUSION

The therapeutic effects of curcumin and nano-curcumin were effective in decreasing insulin resistance, serum levels of FBS, apelin and lipid profile. The dose of 100 mg/kg nano-curcumin was more effective in reducing lipid profile.

Improved carotid intima-media thickness-induced high-intensity interval training associated with decreased serum levels of Dkk-1 and sclerostin in type 2 diabetes

AIMS

Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis. Dickkopf-1 (Dkk-1) and sclerostin modulate wingless signaling, which is involved in atherosclerosis. The purpose of this study was to investigate whether 12 weeks of high-intensity interval training (HIIT) would improve cIMT and serum Dkk-1 and sclerostin levels in patients with type 2 diabetes.

METHODS

Seventy-four sedentary patients with type 2 diabetes were randomly divided into HIIT and control groups. The HIIT group intervention was 6 intervals (4 min) at 85%-90% HR_max separated by 3 min at 45%-50% HR_max in 3 sessions/week for 12 weeks. Before and after the intervention, cIMT, artery diameter and wall/lm ratio were recorded with high-resolution ultrasound. Serum sclerostin and Dkk-1 were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

cIMT decreased significantly in the HIIT group (0.83 ± 0.17 baseline, 0.71 ± 0.14 follow-up) compared to the control group (0.84 ± 0.20 baseline, 0.85 ± 0.19 follow-up) (P < .05). Dkk-1 and sclerostin decreased significantly after 12 weeks of HIIT (P < .01). In addition, VO_2peak was increased in the HIIT group than the control group (by 6.2 mL/kg/min) (P < .05). There was a positive correlation between percent changes in cIMT and percent changes in Dkk-1 and sclerostin (both P < .01). Additionally, there were a negative correlation between percent changes VO2peak and cIMT (r = - 0.740, P = .003), Dkk-1 (r = - 0.844, P < .001) and sclerostin (r = - 0.575, P = .001) in HIIT group.

CONCLUSION

Our results indicate that HIIT decreases cIMT, serum levels of Dkk-1 and sclerostin and improves VO_2peak in patients with type 2 diabetes.

Does exercise-induced apelin affect sarcopenia? A systematic review and meta-analysis

PURPOSE/OBJECTIVE

There have been a number of studies on the role of the novel protein apelin, identified in 1998, in improving muscular function and structure in various human organs, as well as on how it is involved in pathological processes. The aim of this systematic review and meta-analysis was to determine the effect of exercise on serum apelin levels to provide up-to-date data for the development of an exercise intervention for older adults.

METHODS

We searched for articles in PubMed, Ovid MEDLINE, and EMBASE from database inception to May 31, 2019. To conduct a meta-analysis of the primary outcome (serum apelin level), we analyzed intervention effect sizes of the differences between the exercise group and control groups for the primary outcome measure at post-treatment. The outcomes were analyzed using Hedge's statistic effect size (Zr) for weight mean difference (WMD) from various statistical results, including t, F, x², and r. A heterogeneity test was conducted using Higgin's I² statistic and Q statistics (p > 0.10) via a forest plot. A fixed-effect model was considered if Higgin's I² was less than 50%. If heterogeneity was high (I² > 50%), a random-effects model with a subgroup analysis or meta-regression was used. A meta-analysis using nine studies showed that exercise could increase serum apelin levels, which was beneficial for such metabolic diseases as diabetes.

RESULTS

In the subgroup analysis, the 50-60-year-old group showed significant effects of exercise. However, the BMI (normal, overweight, and obesity) categories failed to show any difference in exercise-induced effect.

CONCLUSION

Further studies are needed to clarify in greater detail the effect of resistance exercise on apelin levels, including data on frequency, type, intensity, and time of aerobic exercise, to compare their effects on sarcopenia and cognitive disorders.

Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of -0.45% (P < 0.00001) and 0.03 (P = 0.002), respectively; the differences in within-group changes in glycated hemoglobin were synthesized, yielding mean differences of -0.19% (P = 0.1), -0.25% (P = 0.0006), and -0.64% (P = 0.006) for aerobic versus resistance, combined versus aerobic, and combined versus resistance exercise, respectively. Exercise has a significant effect on reducing glycated hemoglobin, whereas combined exercise is more effective compared with aerobic or resistance exercise alone. Exercise also improves ankle brachial index. However, evidence regarding the association between exercise and peripheral neuropathy and risks of diabetic foot ulcers in people with type 2 diabetes mellitus remains insufficient.

Regulation of Skeletal Muscle Glucose Transport and Glucose Metabolism by Exercise Training

Aerobic exercise training and resistance exercise training are both well-known for their ability to improve human health; especially in individuals with type 2 diabetes. However, there are critical differences between these two main forms of exercise training and the adaptations that they induce in the body that may account for their beneficial effects. This article reviews the literature and highlights key gaps in our current understanding of the effects of aerobic and resistance exercise training on the regulation of systemic glucose homeostasis, skeletal muscle glucose transport and skeletal muscle glucose metabolism.

Blood Flow Restriction Resistance Exercise Improves Muscle Strength and Hemodynamics, but Not Vascular Function in Coronary Artery Disease Patients: A Pilot Randomized Controlled Trial

Resistance training may be associated with unfavorable cardiovascular responses (such as hemodynamic alterations, anginal symptoms or ventricular arrhythmias). In healthy adults, blood flow-restricted (BFR) resistance training improves muscle strength and hypertrophy improvements at lower loads with minimal systemic cardiovascular adverse responses. The aim of this study was to assess the safety and efficacy of BFR resistance training in patients with coronary artery disease (CAD) compared to usual care. Patients with stable CAD were randomized to either 8 weeks of supervised biweekly BFR resistance training (30-40% 1RM unilateral knee extension) or usual exercise routine. At baseline and after 8 weeks, patients underwent 1-RM knee extension tests, ultrasonographic appraisal of vastus lateralis (VL) muscle diameter and of systemic (brachial artery) flow-mediated dilation, and determination of markers of inflammation (CD40 ligand and tumor necrosis factor alfa), and fasting glucose and insulin levels for homeostatic model assessment (HOMA). A total of 24 patients [12 per group, mean age 60 ± 2 years, 6 (25%) women] were included. No training-related adverse events were recorded. At baseline groups significantly differ in age (mean difference: 8.7 years, p < 0.001), systolic blood pressure (mean difference: 12.17 mmHg, p = 0.024) and in metabolic control [insulin (p = 0.014) and HOMA IR (p = 0.014)]. BFR-resistance training significantly increased muscle strength (1-RM, +8.96 kg, p < 0.001), and decreased systolic blood pressure (-6.77 mmHg; p = 0.030), whereas VL diameter (+0.09 cm, p = 0.096), brachial artery flow-mediated vasodilation (+1.55%; p = 0.079) and insulin sensitivity (HOMA IR change of 1.15, p = 0.079) did not improve significantly. Blood flow restricted resistance training is safe and associated with significant improvements in muscle strength, and may be therefore provided as an additional exercise option to aerobic exercise to improve skeletal muscle functioning in patients with CAD. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03087292.

The Role of Aerobic Training Variables Progression on Glycemic Control of Patients with Type 2 Diabetes: a Systematic Review with Meta-analysis

BACKGROUND

Aerobic training (AT) improves glycemic control in patients with type 2 diabetes. However, the role of the progression of training variables remains unclear. The objective of this review was to analyze the effects of progressive AT (PAT) and non-progressive AT (NPAT) on glycated hemoglobin (HbA1c) in patients with type 2 diabetes.

METHODS

Data sources used were PubMed, Cochrane Central, Embase, SPORTDiscus, and LILACS. Studies that evaluated the effect of at least 12 weeks of PAT and NPAT compared to a control condition on HbA1c levels in type 2 diabetes patients were eligible for analysis. Two independent reviewers screened the search results, extracted the data, and assessed the risk of bias. Effect sizes (ESs) were calculated using the standardized mean difference in HbA1c levels between the intervention and control groups using a random-effect model.

RESULTS

Of 5848 articles retrieved, 24 randomized clinical trials (825 participants) were included. Among the included studies, 92% reported to have performed a randomization process, 8% presented allocation concealment, 21% reported blinding of outcome assessment, and 38% reported complete outcome data. AT reduced HbA1c levels by 0.65% (ES: - 1.037; 95% confidence interval [CI]: - 1.386, - 0.688; p < 0.001). The reduction in HbA1c induced by PAT was 0.84% (ES: - 1.478; 95% CI - 2.197, - 0.759; p < 0.001), and NPAT was 0.45% (ES: - 0.920; 95% CI - 1.329, - 0.512; p < 0.001). Subgroup analysis of the different forms of progression showed a reduction in HbA1c levels of 0.94% (ES: - 1.967; 95% CI - 3.783, - 0.151; p = 0.034) with progression in volume, 0.41% (ES: - 1.277; 95% CI - 2.499, - 0.056; p = 0.040) with progression in intensity, and 1.27% (ES: - 1.422; 95% CI - 2.544, - 0.300; p = 0.013) with progression in both volume and intensity. Subgroup analysis of the different modalities of AT showed a reduction of 0.69% (ES: - 1.078; 95% CI - 1.817, - 0.340; p = 0.004) with walking and/or running and of 1.12% (ES: - 2.614; 95% CI - 4.206, - 1.022; p = 0.001) with mixed protocols while progressive training was adopted. In non-progressive protocols, a significant HbA1c reduction was only found with walking and/or running (- 0.43%; ES: - 1.292; 95% CI - 1.856, - 0.72; p < 0.001).

CONCLUSION

The effect of PAT on glycemic control was greater than that of NPAT, especially when volume and intensity were progressively incremented throughout the interventions.

Metabolic effects of antidiabetic drugs on adipocytes and adipokine expression

Several classes of antidiabetic agents have been developed that achieve their hypoglycemic outcomes via various molecular mechanisms. Adipose tissue is a major metabolic and energy-storing tissue and plays an important role in many metabolic pathways, including insulin signaling and insulin sensitivity. Adipose tissue monitors and regulates whole body homeostasis via production and release of potent proteins, such as adipokine and adiponectin, into the circulation. Therefore, any agent that can modulate adipocyte metabolism can, in turn, affect metabolic and glucose homeostatic pathways. Antidiabetic drugs are not only recognized primarily as hypoglycemic agents but may also alter adipose tissue itself, as well as adipocyte-derived adipokine expression and secretion. In the current review, we present the major evidence concerning routinely used antidiabetic agents on adipocyte metabolism and adipokine expression.

Effects of aerobic and resistance exercises on circulating apelin-12 and apelin-36 concentrations in obese middle-aged women: a randomized controlled trial

BACKGROUND

The risk for obesity-related diseases increases with the prevalence of obesity. In obesity, adipokines secreted from adipose tissue induce inflammation, causing adverse effects. Recently, adipokines such as apelin, visfatin, and chemerin have been studied. Long-term resistance training improves health in middle-aged women by improving metabolic risk factors, body composition, and muscle strength. However, there is still a lack of evidence on the association of apelin concentration with different exercise types in middle-aged obese women This study aimed to investigate the effects of 8 weeks of aerobic and resistance exercises on apelin-12 and apelin-36 levels and thereby verify the effects of different exercise types in obese, middle-aged women.

METHODS

Participants were middle-aged women aged 50-61 years, with no experience of systematic exercise in the last 6 months, and met the WHO obesity criteria for the Asia-Pacific region of waist circumference ≥ 80 cm and body fat percentage ≥ 30%. Subjects were selected and allocated to the aerobic exercise, resistance exercise, or no exercise group by block randomization. Body weight, body fat, and body mass index were measured by bioelectrical impedance analysis. Analysis of variance, the t-test, and Tukey's post-hoc test were performed.

RESULTS

A total of 24 participants were selected with eight participants in each group. Both aerobic and resistance exercises were effective in altering the physical composition, showing significant decreases in weight, waist circumference, BMI, and body fat. The aerobic and resistance exercise group showed a significant, positive change in apelin-12 levels.

CONCLUSIONS

In obese individuals, aerobic and resistance exercise were effective in improving obesity and reducing blood apelin-12 concentration, which is closely correlated with indicators of metabolic syndrome. Future research should focus on comparing the response of apelin to exercise in obese subjects treated with only dietary control and the response in the obese subjects of different ages and sex.

TRIAL REGISTRATION

No. 1040917-201,506-BR-153-04 , Clinical Research Information Service (CRIS), Republic of Korea (05 October 2018, retrospectively registered).