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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 8
| Issue : 2 | Page : 119-127 |
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Short-term aerobic exercise improves clinical and metabolic parameters in male type 2 diabetic patients
Isyaku Gwarzo Mukhtar1, Yunusa Mako Mohammed2, Mohamed Mabrouk Elkhashab1, Salisu Ahmed Ibrahim1
1 Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Kano, Nigeria
2 Department of General Studies, Emirates College of Health Sciences and Technology, Kano, Nigeria
| Date of Submission | 06-Sep-2020 |
| Date of Decision | 22-Sep-2020 |
| Date of Acceptance | 08-Oct-2020 |
| Date of Web Publication | 11-Feb-2021 |
Correspondence Address:
Dr. Isyaku Gwarzo Mukhtar
Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/njecp.njecp_34_20
Background: Exercise has been reported to improve glycemic and lipidemic control in type 2 diabetes. However, there is no consensus on the type and duration of exercise that is necessary for glycemic and lipidemic control. Aim: The aim of the study was to determine the effects of short-term aerobic exercise on clinical and metabolic parameters in male type 2 diabetic patients in Kano, Nigeria. Materials and Methods: Forty-six male participants (23 type 2 diabetics and 23 non-diabetics) were recruited using systematic random sampling. Baseline clinical and metabolic parameters (blood pressure, weight, height, body mass index (BMI), fasting blood glucose (FBG), glycated hemoglobin (HbAic), total cholesterol, triglyceride, and high-density lipoprotein cholesterol [HDL-c]) were measured using standard protocols. All the participants underwent 6 sessions of aerobic exercise made up of 3 sessions per week for 2 consecutive weeks using an Orbitrac cycle ergometer. All measurements were repeated at the end of the 2 weeks exercise period. The data were analyzed on IBM SPSS version 23.0. Paired t-test was used to compare mean values of preexercise and postexercise parameters and P = 0.05 was considered significant. Results: The mean age of the diabetic and nondiabetic participants was 42 ± 11.84 and 30 ± 3.45 years, respectively. Systolic and diastolic blood pressure, FBG, HbAic, weight, and BMI were significantly reduced after exercise. Similarly, serum total cholesterol and low-density lipoprotein cholesterol were significantly reduced. However, serum triglyceride and HDL-c were significantly increased after exercise. Conclusion: Short-term aerobic exercise improved clinical and metabolic parameters in type 2 male diabetics.
Keywords: Aerobic exercise, dyslipidemia, hyperglycemia, short term, type 2 diabetes
How to cite this article:
Mukhtar IG, Mohammed YM, Elkhashab MM, Ibrahim SA. Short-term aerobic exercise improves clinical and metabolic parameters in male type 2 diabetic patients. Niger J Exp Clin Biosci 2020;8:119-27 |
How to cite this URL:
Mukhtar IG, Mohammed YM, Elkhashab MM, Ibrahim SA. Short-term aerobic exercise improves clinical and metabolic parameters in male type 2 diabetic patients. Niger J Exp Clin Biosci [serial online] 2020 [cited 2021 Mar 1];8:119-27. Available from: https://www.njecbonline.org/text.asp?2020/8/2/119/309170 |
| Introduction | |  |
Type 2 diabetes is a clinical syndrome of impaired glucose, protein, and fat metabolism primarily caused by insensitivity of tissues and organs (skeletal muscle and liver) to the physiological effects of insulin. This insensitivity (resistance) results in sustained hyperglycemia and dyslipidemia which mediate most of the chronic complications of the disease.
Diabetes mellitus has continued to be one of the major noncommunicable diseases causing significant morbidity and mortality and thus depleting resources available for health care. Globally, about 425 million people were living with diabetes in 2017 and this figure is estimated to rise to 629 million by 2045 largely due to rapid urbanization, sedentary lifestyle, and consumption of unhealthy diet.[1] Although Sub-Saharan Africa currently contributes only about 3.3% (16 million people) of the global burden of the disease, the region is projected to have the highest percentage rise of 156% (41 million people) by 2045.[1]
In Nigeria, the prevalence of diabetes mellitus has been estimated mainly from systematic review and meta-analysis since the last national non-communicable disease survey was in 1992. As at 1992, the crude prevalence of diabetes mellitus in Nigeria was 2.2%.[2] The reported prevalence varies greatly especially among the different geo-political zones. In their systematic review and meta-analysis of published data spanning the period 1990–2017, Uloko et al.[3] reported a pooled national prevalence of 5.77% with 3.0%, 3.8%, 4.6%, 5.5%, 5.9%, and 9.8% for north-west, north-central, south-east, south-west, north-east, and south-south geopolitical zones, respectively.
Type 2 diabetes, which constitutes about 90% of cases of diabetes mellitus, has been linked with derangement in serum lipids and consequent cardiovascular events. Specifically, type 2 diabetes is associated with low serum level of high-density lipoprotein cholesterol (HDL-c) and higher serum levels of triglyceride, total cholesterol, and low-density lipoprotein cholesterol (LDL-c).[4]
Exercise or physical activity (PA) has been reported to affects fat and carbohydrate oxidation and blood pressure regulation in type 2 diabetic patients.[5],[6],[7] This observation has led to increasing interest in the role of exercise in the management of type 2 diabetes. However, there is wide variation in the effects of exercise on glycemic, lipidemic, and blood pressure in type 2 diabetic patients depending on type of exercise and its duration.[8],[9],[10],[11] Aerobic exercise, alone or in combination with resistance training, has been associated with improvement in glycemic control irrespective of duration of the exercise.[8],[9],[10] The effects on serum lipid parameters are however not uniform; aerobic exercise, alone or in combination, is linked to reduction in serum triglycerides only[9] and after at least 4 weeks duration.[10] Improvement in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) has been associated with single exercise modality as against combination of 2 or more modalities that tend to have influence on DBP only.[11] Similar variations were reported on the effects of exercise on body mass. Chudyk and Petrella[9] reported an improvement in waist circumference, a major of central obesity, by aerobic exercise, alone or in combination, in their systematic review and meta-analysis of 34 studies spanning the period 1970–2009. They, however, noted no significant change in body mass index (BMI).
Lifestyle modification has continued to be the cornerstone of the nonpharmacological management of type 2 diabetes. Exercise is one of the most important lifestyle modifications that has been reported to improve glycemic and lipidemic control in patients with established type 2 diabetes.[9] However, there is no consensus on the type and duration of exercise that is necessary for glycemic and lipidemic control. Similarly, while is there is growing number of literatures on the effects of long-term exercise on blood glucose, systolic and diastolic pressure, and serum lipid, not much is known about effects of short-term exercise on the same parameters.[8],[9],[12],[13] The aim of this study was to determine the effects of short-term aerobic exercise on clinical and metabolic parameters in male type 2 diabetic patients at Murtala Muhammad Specialist Hospital, Kano, North Western part of Nigeria.
| Materials and Methods | | |
Study design
This quasi-experimental pretest-posttest study, involving preexercise and postexercise assessments, was conducted at the male section of the diabetic clinic and the Physiotherapy unit of Murtala Muhammad Specialist Hospital, Kano, Nigeria, between July and September, 2018. The study population was made up of all adult male type 2 diabetic patients aged 20–60 years attending the diabetic clinic. Healthy nondiabetic community dwelling male adults were recruited as controls. We used healthy nondiabetic controls in order to reduce the possible confounding effect (s) of medications because the diabetic participants were allowed their routine medications throughout the duration of the study. G-power computer software was used to calculate sample size using effect size of 0.5, alpha level of significance of 0.05, and statistical power of 0.8. Forty-six male adults consisting of 23 type 2 diabetic and 23 healthy nondiabetic participants were randomly recruited using systematic sampling technique. We used systematic random sampling technique due to difficulty in obtaining a comprehensive list of all male diabetic patients attending the clinic, which is a compulsory requirement for use of simple random sampling technique. Using a sampling frame of 400 based on an estimated weekly clinic attendance of 100 and the calculated sample size of 23, we obtained a sampling interval (400/23) of 17. A random number table was used to randomly select a number between 1 and 17 which turned out to be 5. Beginning from patient number 5, every 17th patient who satisfied the inclusion criteria was recruited until the calculated sample size was obtained. Ethical approval was obtained from the Health Research Ethics Committee of Kano state ministry of health (MOH/04/09/18/803) and all participants were requested to sign an individual informed consent form prior to commencement of the study. All procedures complied with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.
Inclusion criteria
All adult male type 2 diabetic patients aged 20–60 years who passed initial physical fitness test and signed an individual informed consent form were included in the study.
Exclusion criteria
Participants with clinical evidence of any cardiovascular disease, history of active smoking, and alcohol ingestion were excluded from the study.
Data collection
All participants were initially screened for readiness to undergo PA by the PA Readiness Questionnaire of the Department of Physical and Health Education, Bayero university, Kano. Data capture form developed by the researchers was used to obtain sociodemographic information of the participants.
Baseline clinical and laboratory assessment of all the participants including measurement of blood pressure, weight, height, FBG, glycated hemoglobin (HbAic), serum total cholesterol, triglyceride, LDL-c, and HDL-c was conducted at the beginning and the same was repeated after 2 weeks of aerobic exercise.
Blood pressure was measured on left arm with the participants seated comfortably using mercury sphygmomanometer (Accoson™ Ltd., Ayrshire, UK) and Littmann's stethoscope (3M Littmann®, Minnesota, USA). Weight was measured with the participants wearing light clothing and standing erect on a digital weighing scale Omron HN286 (Kyoto, Japan). Height was measured using a stadiometer HM202P (QuickMedical, Warwick, UK) with the participant standing upright and looking forward.
Exercise modality
Orbitrac cycle ergometer with stepper, twister, and backrest (Xiamen Sports Goods Co., Ltd., Fujian, China) was used for the aerobic exercise by the participants. A total of 6 sessions of aerobic exercise consisting of 3 sessions per week for 2 consecutive weeks were carried out by each participant. Each session lasted 50 min and consisted of 3 phases: warming-up phase, active-training phase, and cooling-down phase.
In the warming-up phase, participants were made to pedal at low intensity for about 10 min. This was then followed by the active-training phase in which participants pedaled for 30 min at graded intensity starting at 40% of age-predicted maximum heart rate until they achieve a heart rate of 70% of age-predicted maximum. The cooling-down phase lasted for 10 min and involved pedaling at decreasing intensity.[12]
Laboratory procedures
Blood sample was collected from each participant between 8 and 9 am after an overnight fast. Fasting blood glucose (FBG) was determined by glucose oxidase method using Accu-Chek® glucometer (Roche Diabetes Care, Inc., Indianapolis, USA). HbAic was determined using ion exchange chromatography as described by Pecoraro et al.[14]
Serum total cholesterol and triglyceride were determined by enzymatic method. It involves enzymatic hydrolysis of serum total cholesterol and triglycerides by specific enzymes using reagents from Randox Laboratories Ltd. (Randox Laboratories Ltd., Crumlin, County Antrim, UK) to give colored solutions. High-density lipoprotein cholesterol was determined by quantitative precipitation of LDL-c and very low-density lipoproteins using phosphotungstic acid in the presence of magnesium ions. The absorbance of the resultant colored solutions was then measured using Ortho clinical Vitros DT60 II autoanalyzer (Diamond Diagnostics Inc., Holliston, Massachusetts, USA) at wavelength of 560 nm. Concentration of each parameter was calculated manually from the absorbance and concentration of the standard.[15],[16],[17]
Serum concentration of LDL-c was calculated indirectly from the concentrations of HDL-c, total cholesterol, and triglycerides.[18]
LDL-c = (Total cholesterol – HDL-c – Triglyceride)/5
Data analysis
Data were analyzed using? IBM SPSS version 23.0 (IBM, Armonk, New York, USA). Paired t-test was used to compare mean values of FBG, HbAic, SBP, DBP, mean arterial pressure, weight, BMI, serum total cholesterol, triglyceride, LDL-c, and HDL-c before and after exercise. Pearson's correlation coefficient was used to determine relationship between HbAic and serum total cholesterol, triglyceride, LDL-c, and HDL-c. P = 0.05 was considered statistically significant.
| Results | | |
Sociodemographic characteristics of the participants
[Table 1] shows the results of sociodemographic characteristics of the participants. The mean ages of the diabetic and nondiabetic participants were 42 ± 11.84 and 30 ± 3.45 years, respectively (t = 4.74, P = 0.001). Thirteen of the diabetic participants were aged 40 years and above (56.5%), while 12 (52.2%) of the nondiabetic participants were between 30 and 39 years. Age group categories of the participants differed significantly between the diabetic and nondiabetic groups (P = 0.015) with the diabetics being older. Similarly, 13 (56.5%) of the diabetic participants were petty traders in contrast to the nondiabetics who were mostly civil servants 18 (78.3%).
Clinical, anthropometric, and laboratory parameters of the diabetic participants before and after exercise
[Table 2] shows results of clinical, anthropometric, and laboratory parameters of the diabetic participants before and after exercise. There was a statistically significant reduction in each of the systolic and DBPs among the diabetic participants after 2 weeks of aerobic exercise (SBPpre-intervention: 126.70 ± 10.56 mmHg and SBPpost-intervention: 119.87 ± 8.08 mmHg, t = -2.99, P = 0.007; DBPpre-intervention: 76.22 ± 5.99 mmHg and DBPpost-intervention; 69.96 ± 7.79 mmHg, t = 3.89, P = 0.003, respectively). Similarly, there was a statistically significant reduction in weight (Weightpre-intervention: 60.39 ± 6.45 kg and Weightpost-intervention: 58.87 ± 6.45 kg; t = 2.23, P = 0.036) and BMI (BMIpre-intervention: 21.12 ± 2.04 kg/m2 and BMIpost-intervention: 20.57 ± 1.84 kg/m2; t =, P = 0.026) among the diabetic participants following 2 weeks of aerobic exercise, respectively. | Table 2: Clinical, anthropometric, and laboratory parameters of the diabetic participants
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There was a statistically significant improvement in FBG (FBGpre-intervention: 10.53 ± 5.26 mmol/L and FBGpost-intervention; 7.53 ± 1.56 mmol/L, t = 3.69, P = 0.001) among the diabetic participants following 2 weeks of aerobic exercise. Similarly, HbAic was significantly improved after 2 weeks of aerobic exercise (HbAicpre-intervention: 12.71 ± 3.32% and HbAicpost-intervention: 9.75 ± 2.91%, t = 5.56, P = 0.001).
Serum total cholesterol (Tcholpre-intervention: 4.42 ± 0.72 mmol/L and Tcholpost-intervention: 4.26 ± 0.68 mmol/L, t = 6.45, P = 0.001) and LDL-c (LDL-cpre-intervention; 1.93 ± 0.81 mmol/L and LDL-cpost-intervention: 1.56 ± 0.64 mmol/L, t = 2.67, P = 0.014, respectively) were significantly reduced among the diabetic participants after 2 weeks of aerobic exercise. However, serum triglycerides (Trigly. pre-intervention: 1.05 ± 0.52 mmol/L and Trigly. post-intervention: 1.48 ± 0.74 mmol/L, t = -2.53, P = 0.019) and HDL-c (HDL-cpre-intervention: 1.97 ± 0.64 mmol/L and HDL-cpost-intervention: 2.17 ± 0.67 mmol/L, t = -2.02, P = 0.05) were significantly increased after the exercise.
Clinical, anthropometric, and laboratory parameters of the nondiabetic participants
[Table 3] shows results of clinical, anthropometric, and laboratory parameters of the nondiabetic participants. There was a statistically significant reduction in SBP (SBPpre-intervention: 113.13 ± 6.77 mmHg and SBPpost-intervention: 104.61 ± 21.56 mmHg, t = 2.04, P = 0.053) and DBP (DBPpre-intervention: 77.52 ± 5.13 mmHg and DBPpost-intervention: 67.83 ± 7.39 mmHg, t = 8.97, P = 0.001) among the non-diabetic controls following 2 weeks of aerobic exercise. There was, however, no significant change in weight (Weightpre-intervention: 63.65 ± 8.56 Kg and Weightpost-intervention: 62.44 ± 7.06 Kg, t = 2.03, P = 0.055) and BMI (BMIpre-intervention: 21.79 ± 3.26 Kg/m2 and BMIpost-intervention: 21.39 ± 2.81 Kg m2, t = 1.96, P = 0.062) after 2 weeks of aerobic exercise. | Table 3: Clinical, anthropometric, and laboratory parameters of the nondiabetic participants
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Fasting blood glucose (FBGpre-intervention: 5.83 ± 0.54 mmol/L and FBGpost-intervention: 5.56 ± 0.55 mmol/L, t = 5.77, P = 0.001) and HbAic (HbAicpre-intervention: 5.54 ± 0.32% and HbAicpost-intervention: 4.43 ± 0.40%, t = 12.15, P = 0.001) were significantly reduced following 2 weeks of aerobic exercise. Similarly, serum total cholesterol (Tchol. pre-intervention: 3.18 ± 0.15 mmol/L and Tchol. post-intervention: 2.98 ± 0.21 mmol/L, t = 7.03, P = 0.001) and LDL-c (LDL-cpre-intervention: 1.37 ± 0.39 mmol/L and LDL-cpost-intervention: 1.24 ± 0.40 mmol/L, t = 2.64, P = 0.015) were significantly reduced after the exercise. Furthermore, there was a significant increase in serum HDL-c after the exercise (HDL-cpre-intervention: 2.10 ± 0.37 mmol/L and HDL-cpost-intervention: 2.34 ± 0.26 mmol/L, t = -7.77, P = 0.001). However, there was no statistically significant change in serum triglycerides before and after 2 weeks of aerobic exercise (Trigly. pre-intervention: 0.76 ± 0.15 mmol/L and Trigly. post-intervention: 0.75 ± 0.14 mmol/L, t = 0.87, P = 0.395).
Correlation between glycated hemoglobin and serum lipids among diabetic and nondiabetic participants before and after exercise
[Table 4] shows the results of correlation analysis between HbAic and serum lipid parameters. HbAic was negatively correlated with serum HDL-c among the diabetic participants postexercise (r = -0.435, P = 0.019). However, none of the other serum lipids parameters was significantly correlated with HbAic in both the diabetic and non-diabetic participants before and after 2 weeks of aerobic exercise. | Table 4: Correlation between glycated hemoglobin and serum lipid parameters among the diabetic and nondiabetic participants before and after exercise
Click here to view |
| Discussion | | |
This study has demonstrated significant reduction in systolic and DBP in both diabetic and non-diabetic participants following 2 weeks of aerobic exercise even though the two groups were not matched for age. This is similar to what was reported by Adeniyi et al.[10] They reported a significant reduction in SBP following long-term combined resistance and aerobic exercise among a population of male type 2 diabetic patients with other co-morbidities in Kano, Nigeria. However, unlike in this study in which reduction in blood pressure was noted after 2 weeks of aerobic exercise, Adeniyi's group reported significant reduction only after 12 weeks of combined aerobic and resistance exercise. Dimeo et al.[19] in a randomized controlled trial demonstrated a significant reduction in both systolic and DBP in patients with resistant hypertension using aerobic exercise lasting 8–12 weeks. Similarly, Hua et al.[20] observed significant reduction in both systolic and DBP among hypertensive patients using low-intensity aerobic exercise that lasted 12 weeks. Morais et al.[21] reported that acute resistance exercise is more effective in reducing blood pressure than aerobic exercise in the first 24 h following the exercise. However, this study did not look at blood pressure changes in the first 24 h following exercise and hence direct comparison with their findings could be misleading. The works cited above that used either aerobic or resistance exercise only, including this work, have all demonstrated significant reduction in both systolic and DBP irrespective of duration of the exercise. On the other hand, when aerobic and resistance exercises were combined, the reduction was noticed only on SBP, on male participants, and over a longer period of time. Shorter isolated aerobic or resistance exercise could therefore be more effective in reducing systolic and DBP than combined exercise. Indeed, in their systematic review and meta-analysis of 93 published works involving 5223 participants, Cornelissen and Smart[11] concluded that isolated endurance, dynamic resistance, and isometric resistance exercise lowered both systolic and DBP while combined exercise had effect only on DBP.
The mechanical force exerted on the wall of arteries by exercising muscles is believed to cause enhanced release of vasodilator substances especially nitric oxide by vascular endothelium; the sensitivity of baroreceptor reflex is also altered during exercise; substance P, a neuropeptide released by exercising muscles is also thought to decrease sympathetic activity; these and other factors are some of the mechanisms mediating reduction in blood pressure following exercise.[7] Since most of the positive effects of exercise on blood pressure are mediated by a functional vascular endothelium, and since endothelial injury/dysfunction is one of the common pathological features of type 2 diabetes, it is could be argued that exercise may not have any positive effect on blood pressure in type 2 diabetic patients. However, this study has demonstrated a significant reduction in systolic and DBP in both type 2 diabetic patients and their non-diabetic controls following short-term aerobic exercise, suggesting that there may be other mechanisms mediating reduction in blood pressure following exercise independent of vascular endothelium. It has been proposed that high-intensity exercise augments synthesis and release of nitric oxide via the Kallikrein–kinin system with eventual reduction in blood pressure.[22] Indeed, Simões et al.[23] were only able to demonstrate reduction in blood pressure among type 2 diabetic patients using high intensity exercise training.
Weight and BMI were significantly reduced following 2 weeks of aerobic exercise among the diabetic participants. However, there was no significant change in weight and BMI among the non-diabetic participants following exercise. Similar reduction, though in waist circumference, was reported by Adeniyi et al.[10] among male type 2 diabetic patients on combined aerobic and resistance exercise at 4-week period. In contrast, looking at the effects of exercise on lean body weight among type 2 diabetic patients, Boule et al.[8] found no significant difference in lean body mass between exercise and control groups in a systematic review and meat-analysis of published works. Changes in lean body mass and hence BMI are susceptible to many behavioral factors like food intake. Since most studies evaluating changes in body weight and BMI over a period of time hardly control or restrict participant's food intake, there have been inconsistent reports on exercise-induced weight changes.[24],[25]
Measures of glycemic control, FBG and HbAic, were significantly improved in both the diabetic and non-diabetic participants following 2 weeks of aerobic exercise. Adeniyi et al.[10] reported a similar reduction in FBG among male type 2 diabetic patients 2 weeks after commencement of combined aerobic and resistance exercise. However, there seems to be sex difference in the reduction in FBG in their study as female participants did not demonstrate significant change in FBG until 4 weeks into the commencement of the exercise. Since this study used male participants only, it is difficult to make a sex-related comparison. Several studies have demonstrated the positive effect of exercise on glycemic control.[26],[27],[28]
Exercise promotes glucose uptake and utilization by the exercising muscles. Exercising muscles seem to have enhanced translocation of glucose transporter 4 from the cytoplasm to the cell membrane and thus increasing glucose uptake.[29] Exercise-induced glucose utilization and uptake by the skeletal muscle and liver is said to be dependent on intensity and duration of the exercise. Prolonged intense exercise causes decline in plasma glucose due enhanced uptake and utilization of glucose by the exercising muscle,[30] while brief intense exercise causes temporary increase in plasma glucose level because hepatic glucose production exceeds muscle utilization.[31]
This study demonstrated a significant improvement in serum total cholesterol, LDL-c, and HDL-c in both the diabetic and non-diabetic participants following 2 weeks of aerobic exercise. However, serum triglyceride worsened significantly among the diabetic patients following 2 weeks of exercise, while there was no significant change among the nondiabetic controls. This finding contrast what was reported by Adeniyi et al.[10] They reported a significant improvement in serum triglyceride among male diabetics 4 weeks after commencement of combined aerobic and resistance exercise. None of the other serum lipid parameters reportedly improved among their male and female cohorts. The finding of this study on serum total cholesterol, LDL-c, and HDL-c is, however, similar to many other studies.[7],[32],[33] Although most studies demonstrated improvement in serum lipid profile following at least 8–12 weeks of either single or combined aerobic and resistance exercise, this study reported similar improvement following 2 weeks aerobic exercise.
Type 2 diabetes is associated with derangements in serum lipid–dyslipidemia. A special type of dyslipidemia that is commonly found in type 2 diabetes is called diabetic dyslipidemia. It is characterized by elevated serum level of triglyceride, low serum level of HDL-c, and postprandial lipemia.[4],[34] The exact pathophysiological mechanisms mediating dyslipidemia in type 2 diabetic patients is not completely understood. However, disturbances in insulin signal transduction pathway and sustained hyperglycemia play significant roles in the process.[35] Altered insulin sensitivity by liver and skeletal muscle cells causes abnormality in the production and clearance of lipoproteins. Hepatic production and subsequent clearance of apolipoprotein B, an important component of lipoproteins, is influenced by insulin action and concentration of fatty acid in the plasma.[35] While insulin enhances degradation of apolipoprotein B, excess fatty acid binds to it and delays its clearance. Thus, type 2 diabetic patients tend to have excess small density lipoproteins because of impaired glucose metabolism, enhanced mobilization and utilization of fat for energy, and resistance to the physiological effects of insulin by liver cells.[36]
Physical exercise increases carbohydrate and fat oxidation in type 2 diabetes both during and after exercise. Improvement in glycemic control enhances insulin sensitivity and thus degradation of apolipoprotein B with subsequent clearance of plasma lipoproteins.[26],[37] Increase in oxidation of fat on the other hand deprives apolipoprotein B of its natural substrate and thus exposing it to degradation and clearance.?[5],[6]
| Conclusion | | |
Short-term aerobic exercise improved systolic and DBP, glycemic control, and serum lipid parameters in male type 2 diabetic patients. Short-term aerobic exercise should be advocated in the non-pharmacological management of type 2 diabetes.
Limitations
Even though the study was restricted to male participants due to cultural and religious considerations, its results could be extrapolated to female diabetic patients as well. Our inability to match the participants for age and to control for potential confounders like use of glucose and lipid lowering drugs during the study period might have had some influence on the outcome of the study. However, the fact that most of the significant findings were replicated on healthy controls who were not on glucose and lipid lowering drugs means that the outcome could not have been entirely due to medication. Similarly, our use of healthy controls instead of diabetic patients with placebo exercise regimen might have also affected the outcome of the study. We therefore recommend inclusion of diabetic patients with minimal or placebo exercise regimen in future studies of this nature.
In spite of these limitations, this study has demonstrated improved glycemic, blood pressure, and lipidemic control following short-term aerobic exercise in both type 2 male diabetics and their nondiabetic controls. This implies that short-term aerobic exercise could be employed in the nonpharmacological treatment of people with impaired glucose homeostasis and those with full blown type 2 diabetes. The shorter regimen may provide more flexibility and compliance especially in the initial phase of treatment.
Acknowledgment
We would like to thank the staff and management of Murtala Muhammed Specialist Hospital, Kano, for allowing us access to the diabetic and physiotherapy units.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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