Review Article

Antioxidant and Anti-Inflammatory Effects of Exercise in Diabetic Patients

Table 1

Summary of clinical studies on the anti-inflammatory and antioxidant effects of exercise in diabetic patients reported during the last 10 years.

ReferencePatient characteristicsExercise durationMeasured parametersOutcome

[13]14 T2D versus 12 healthy subjects18 weeks(i) Ability of HDL subfractions to inhibit LDL oxidation in vitro.
(ii) Serum PON activity.
(iii) Total antioxidant status.
(iv) Plasma lipid peroxidation.
(i) Exercise improved the antioxidant role of HDL and reduced plasma lipid peroxidation in diabetic subjects.

[14]50 T2D versus 20 age matched controlsSingle bout (exercise cycle ergometer test)(i) TG, TC, LDL, oxLDL, SOD, GSH-Px, PAI.(i) Exercise increased oxLDL and SOD in both groups; GSH-Px was increased only in diabetic patients.

[15]13 diabetic men3 weeks combination of high-fiber, low-fat diet plus aerobic exercise(i) Serum lipids, glucose, insulin, 8-iso-PGF2α, CRP, sICAM-1, sE-selectin
(ii) in vitro measurement of NO, superoxide, and H2O2
(iii) Serum-induced monocyte adhesion, ICAM-1, VCAM-1, MCP-1 in cultured endothelial cells.
(i) Reduction in TC, LDL, FSG, insulin, 8-iso-PGF2α, CRP, sICAM-1, sE-selectin, serum stimulated monocyte adhesion, cellular ICAM-1 and VCAM-1, superoxide and H2O2 and increase in NO production.

[16]134 T2D divided into 3 groups
(i) 43, aerobic training plus using fitness center
(ii) 44 aerobic training only
(iii) 16 controls
12 months(i) Urinary 8-OHdG
(ii) serum glycated albumin, TC, HDL, TG, HbA1c.
(i) Urinary 8-OHdG decrease after 12 months in the exercise groups.

[17]16 T2D with diet restriction and 13 T2D with diet restriction and exercise12 weeks(i) MDA, 24 h urinary nitrate/nitrite, FMD
(ii) BW, waist circumference, BP, HbA1c, glucose, insulin resistance, lipid profile.
(i) Both interventions reduced BW, waist circumference, BP, HbA1c, glucose, insulin resistance, lipids and MDA, and increased urinary nitrite/nitrate ratio
(ii) No change in FMD.

[18](i) 77 T2D in yoga group
(ii) 77 T2D in conventional exercise group
(iii) 77 T2D as controls
6 months(i) FBS, TC, TG, LDL, VLDL, HDL, MDA, POX, PLA2, SOD, catalase activity.(i) Significant reductions in FBS, TC, VLDL, MDA
(ii) SOD increased.
(iii) No significant changes in PLA2 and catalase activity.

[19](i) 56 T2D in t’ ai chi chuan (TCE) group
(ii) 48 conventional exercise group (CE)
12 weeks(i) HbA1c, lipid profile, MDA, CRP
(ii) BW, BMI.
(i) BMI, serum lipids, MDA, and CRP significant improved in TCE group. HbA1c did not decrease.
(ii) No improvement in BMI, lipids, and oxidative stress profiles in the CE group.

[20](i) 12 sedentary nondiabetes subjects (ND)
(ii) 12 sedentary T2D (T2S)
(iii) 9 physically active (T2DA)
Single bout of intense exercise (>85% VO2max)(i) FBS, HbA1c, body fat percent, lipid profile
(ii) TBARS, GSH.
(i) T2DS had higher FBS, HbA1c, and body fat percent than T2SA.
(ii) T2DA had higher VO2max spent more time on treadmill, lower Hb and BP compared with ND and T2DS.
(iii) TBARS in T2DS were higher than T2DA.
(iv) GSH was similar among groups.

[21]11 T2D10 weeks(i) Muscle strength, Wmax, VO2max, MUOX, IMCL and IMCG, systemic inflammatory markers and primary diabetic outcome measures plus daily exogenous insulin requirements (EIRs).(i) Muscle strength and Wmax increased.
(ii) Mean arterial BP and EIR, FBG and nonesterified fatty acids declined.
(iii) No changes in VO2max, MUOX, IMCL or IMCG, HbA1c, adiponectin, TNF-α, and cholesterol

[22]20 T2D (sedentary control, A)
20 T2D (low intensity aerobic exercise, B)
20 T2D (high intensity aerobic exercise, C)
22 T2D (aerobic and resistance exercise, D)
12 monthsHbA1c, FBS, TG, TC, HDL, hs-CRP, IL-1β, IL-4, IL-6, IL-10, TNF-α, IFN-γ, leptin, resistin, adiponectin VO2max. (i) Significant decrease of hs-CRP in groups C and D.
(ii) leptin, resistin, IL-6 decreased in groups C&D, while adiponectin increased.
(iii) IL-1β, TNF-α, IFN-γ decreased in group D, whereas anti-inflammatory IL-4 & 10 levels declined.

[23]406 T2D out of 522 participants from the Finnish Diabetes Prevention Study1 yearCRP and IL-6 levels.(i) Increases in fiberintake and moderate to vigorous leisure time physicalactivity (LTPA), but not total LTPA, predicted decreases inCRP and/or IL-6.

[24]15 T2D (control)
15 T2D (10000 steps/day)
6 weeks(i) Anthropometric measures plus, HbA1c, FBS, insulin, lipid profile, fructosamine, total radical antioxidant parameter, PAI-1, homocysteine and lipoprotein(a).(i) HDL and resting energy expenditure increased while PAI-1 levels decreased in the active group.

[25]25 T2D (exercise group)
25 T2D (control group)
16 weeks(i) Anthropometric measures and insulin resistance, MMP-2, TIMP-1, lipid profile, HbA1c, fibrinogen, hsCRP, VO2max, VT.(i) Systolic and mean BP, LDL, HbA1c, fibrinogen, hsCRP, MMP-9 and MMP-9 to TIMP-1 ratio decreased in exercise group while VO2max, VT and plasma TIMP-2 levels increased.

[26]60 patients with IGTT:
24 in exercise training group
20 in rosiglitazone group
16 in control group
12 months(i) Genotyping of the 174G/C IL-6 variant.
(ii) CRP and IL-6 measurements.
(i) Improved peak VO2max, decreases in BMI, WHR, HbA1c, plasma glucose and insulin, 2-h OGTT glucose level IL-6 and hsCRP in exercise group.

Abbreviations: 8-OHdg: 8-hydroxy-2′-deoxyguanosine, BMI: body mass index, BP: blood pressure, BW: body weight, CRP: C reactive protein, FBS: fasting blood sugar, FMD: flow mediated dilatation, GSH: glutathione, GSH-Px: glutathione peroxidase, HbA1c: hemoglobin A1c, HDL: high density lipoproteins, ICAM-1: intracellular adhesion molecule-1, IFN: interferon, IL: interleukin, IMCG: intramyocellular glycogen, IMCL: intramyocellular lipid, LDL: low density lipoprotein, MCP-1: monocyte chemotactic protein-1, MDA: malondialdehyde, MMPs: matrix metalloproteinases, MUOX: muscle oxidative capacity, oxLDL: oxidized low density lipoproteins, PAI: plasminogen activator inhibitor, PLA2: phospholipase A2, PON: paraoxonase, POX: protein oxidation, sICAM: soluble intracellular adhesion molecule, SOD: superoxide dismutase, T2D: type II diabetes, TBARS: thiobarbituric acid substances, TC: total cholesterol, TG: triglyceride, TIMPs: tissue inhibitor of metalloproteinases, VCAM-1: vascular cell adhesion molecule-1, VLDL: very low density lipoprotein, VO2max: whole body peak oxygen uptake, VT: ventilatory threshold, and Wmax: maximal workload capacity.