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Abstract
Background
Exercise offers protection against atherosclerosis and insulin resistance. We evaluated the benefits of exercise at different levels of intensity for ameliorating inflammation, endothelial dysfunction, and insulin resistance in a sample of type 2 diabetic subjects.
Methods
Fifty-nine overweight women with type 2 diabetes were randomly assigned to control (CG, N = 18), moderate-intensity exercise (MEG, N = 17), and vigorous-intensity exercise (VEG, N = 14) groups. Patients in the two experimental groups completed a 12-week exercise program, with their exercise activities monitored by accelerometers. We assessed the patients' body weights, total abdominal fat (TF), subcutaneous fat (SF) and visceral fat (VF) via computed tomography, measurements of plasma levels of hs-C-reactive protein (hs-CRP) and interleukin-6 (IL-6), assessment of endothelial function by brachial artery flow-mediated dilation (FMD), and evaluation of insulin sensitivity by insulin tolerance tests, at baseline, at the end of the 12-week interventions, and one year after initiation of the study.
Results
At baseline, the average age of all subjects was 54 ± 7 years, and average body mass index (BMI) was 26.9 ± 2.5 kg/m2. During the intervention, patients in the MEG and VEG groups expended comparable amounts of activity-related calories (488.6 ± 111.9 kcal/day, 518.8 ± 104.1 kcal/day, respectively). Although BMI, TF, and SF decreased similarly in the MEG and VEG groups (ΔBMI: -1.1 ± 0.7, -0.8 ± 0.5, ΔTF: -4,647 ± 3,613 mm2, -2,577 ± 2,872 mm2, ΔSF: -2,057 ± 2,021 mm2, -1,141 ± 1,825 mm2, respectively), compared to control (P < 0.01), hs-CRP, IL-6, and FMD remained constant in both exercise groups even after completion of the 12-week exercise intervention. Insulin sensitivity improved only in patients subjected to vigorous exercise (VEG). Visceral fat loss was observed only in patients subjected to moderate exercise (MEG). At one-year follow up, these values had all returned to baseline.
Conclusion
Exercise vigorous enough to result in significant weight and fat reduction did not ameliorate inflammation and endothelial dysfunction as measured at the end of a 12-week exercise intervention, nor did it result in sustained improvements in insulin sensitivity in type 2 diabetic subjects.
Figures and Tables
Fig. 1
BMI and abdominal fat area were represented as Mean ± SD. BMI, visceral fat, and subcutaneous fat decreased significantly in moderate exercise group and vigorous exercise group compared with control group (P < 0.01) without difference between 2 exercise groups. Visceral fat loss was found only in moderate intensity exercise group. *P < 0.05 versus control. BMI, body mass index.
Fig. 2
KITT was represented as Mean ± SD. Compared with baseline, KITT was improved only within vigorous exercise group (P < 0.01) without the difference across groups. *P < 0.05 versus control.
Table 1
Baseline characteristics
Data are shown as mean ± SD. BMI, body mass index; CG, control group; CRP, C-reactive protein: DBP, diastolic blood pressure; FPG, fasting plasma glucose; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MEG, moderate intensity exercise group; SBP, systolic blood pressure; VEG, vigorous intensity exercise group.
Table 3
Changes of biochemical variables and endothelial function
Data are shown as mean ± SD. P was calculated from ANOVA test between 3 groups at the time of 12 and 48 week. *Statistically significant in Tukey HSD post-hoc analysis. †Statistically significant vs. baseline level within group. ‡Statistically significant vs. control group. BMI, body mass index; CG; CG, control group; CRP, C-reactive protein; DBP, diastolic blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MEG, moderate intensity exercise group; SBP, systolic blood pressure; VEG, vigorous intensity exercise group.
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