Sulwon Lecture 2025
- Lifestyle and Behavioral Interventions
- Exercise, Exerkines, and Sarcopenia
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Hye Soo Chung, Kyung Mook Choi
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Diabetes Metab J. 2026;50(1):19-29. Published online January 1, 2026
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DOI: https://doi.org/10.4093/dmj.2025.0972
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- Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of skeletal muscle mass, strength, and physical function. Closely associated with aging and physical inactivity, it significantly compromises mobility, independence, and quality of life in older adults. Exercise is widely recognized as an effective non-pharmacological intervention for managing sarcopenia. However, the underlying molecular mechanisms remain incompletely elucidated. Among the emerging mediators, exerkines, physical exercise-induced signaling molecules, are secreted by multiple tissues, including the skeletal muscle, bone, liver, and adipose tissue, and mediate the systemic beneficial impacts of exercise via autocrine, paracrine, and endocrine signaling. These factors play critical roles in interorgan communication, regulation of muscle regeneration, mitochondrial function, inflammation, and metabolic homeostasis. Importantly, the secretion profiles and biological functions of exerkines are modulated by exercise-specific parameters such as mode, intensity, and duration. Understanding the regulatory dynamics of exerkine signaling may offer novel therapeutic avenues, particularly for individuals unable to engage in regular physical activity. This review focuses on the recently identified exerkines relevant to skeletal muscle physiology and their implications in the pathophysiology of sarcopenia. We also provided a comprehensive overview of exerkine responses to various exercise modalities in the prevention and treatment of sarcopenia.
Review
- Lifestyle and Behavioral Interventions
- Optimizing Physical Activity Strategies for Older Adults with Diabetes
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Hyeon-Jin Yu, Doyoun Hong, Kyuho Kim, Ji Hye Heo, Dong-Hyeok Cho, Yoshitaka Hashimoto, Jae-Seung Yun
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Diabetes Metab J. 2025;49(6):1178-1197. Published online November 1, 2025
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DOI: https://doi.org/10.4093/dmj.2025.0967
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- The increasing prevalence of diabetes among older adults has emerged as a major socioeconomic burden. This population is highly heterogeneous, ranging from functionally independent to severely impaired individuals, making it difficult to establish standardized recommendations. Physical activity (PA) is a cornerstone of diabetes management; however, current exercise guidelines do not adequately address the wide spectrum of functional capacities observed in older adults. For those with physical limitations, relatively simple activities such as walking, breaking up sedentary time, incorporating movement into daily routines, and aquatic exercise have been proposed, yet supporting evidence remains limited. This review summarizes the pathophysiologic mechanisms of metabolic and functional changes associated with aging and diabetes—including sarcopenia, altered body composition, and cardiovascular decline—and comprehensively discusses the benefits and precautions of various exercise modalities, tailored recommendations according to diabetes-related complications, and key clinical considerations. We further classified older adults with diabetes into three functional levels, individuals in good health, those with some comorbidities or mild disabilities, and those with high comorbidities and/or functional impairment, and proposed corresponding physical activity strategies for each level. Finally, we highlight practical and feasible approaches, including walking, interrupting sedentary behavior, daily functional movements, and aquatic exercise, to enhance clinical applicability for individuals with reduced physical capacity. These tailored, function-based strategies may help older adults with diabetes achieve safer, more effective, and sustainable improvements in glycemic control and overall health.
Original Articles
- Cardiovascular Risk/Epidemiology
- Associations of Cardiocerebrovascular Risks and Exercise according to Menopausal Status in Women with Type 2 Diabetes Mellitus: A Nationwide Cohort Study
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Ji-Hee Ko, Sun Joon Moon, Kyung-Do Han, Hye-Mi Kwon, Se-Eun Park, Eun-Jung Rhee, Won-Young Lee
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Diabetes Metab J. 2026;50(1):101-114. Published online August 13, 2025
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DOI: https://doi.org/10.4093/dmj.2024.0487
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- Background
Menopausal status can increase the risk of cardiocerebrovascular diseases (CCVDs) in women with type 2 diabetes mellitus (T2DM). Regular exercise is well-known to reduce this risk. This study explored the impact of exercise on CCVD and mortality in women with T2DM according to their menopausal status.
Methods
A total of 32,477 premenopausal and 53,690 postmenopausal Korean women with T2DM aged 40 to 60 years from a national health examination cohort (2009 to 2018) were included. We evaluated risks for stroke, myocardial infarction (MI), and mortality based on exercise intensity. Cox proportional hazard regression analyses were performed to obtain the adjusted hazard ratio (aHR) and 95% confidence interval.
Results
Exercise reduced stroke, MI, and mortality risks in women with T2DM, regardless of menopausal status. The highest effects of aHR compared to the sedentary group were 0.68 for stroke, 0.66 for MI, and 0.81 for mortality. Postmenopausal women experienced significant MI risk reductions at most exercise intensities, with the greatest reduction in the ≥1,500 metabolic equivalent of task score group unlike premenopausal women. However, stroke and mortality risk reductions in postmenopausal women were less pronounced compared to premenopausal women.
Conclusion
Exercise reduces CCVD risk in women with T2DM across menopausal status. Postmenopausal women with T2DM had more benefits from exercise on MI but fewer benefits on stroke and mortality than premenopausal women. In premenopausal women with T2DM, exercise was not associated with a lower MI risk.
- Lifestyle and Behavioral Interventions
- The Preventive Effect of Physical Activity on Gestational Diabetes Mellitus: A Korean Longitudinal Prospective Cohort Study
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Ji Hyae Lim, Min Hyoung Kim, Hye-Ji Han, Su Ji Yang, Myung-Gwan Kim, Hyun Jung Lee, You Jung Han, Jin Hoon Chung, Dong Wook Kwak, Seongwoo Yang, Moon Young Kim, Hyun Mee Ryu
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Diabetes Metab J. 2025;49(5):1116-1125. Published online April 23, 2025
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DOI: https://doi.org/10.4093/dmj.2024.0280
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- Background
To assess longitudinally physical activity patterns and intensity from pre-pregnancy to postpartum and evaluate the association between timing and type of physical activity and the development of gestational diabetes mellitus (GDM).
Methods
The Korean Pregnancy Outcome Study (KPOS) is a prospective cohort study conducted from 2013 to 2017. Our study included 3,457 participants with singleton pregnancies in KPOS, classified according to the pregnancy outcome: GDM (n=231) and normal (n=3,226). Physical activity data were collected at five time points using the short form of the International Physical Activity Questionnaire: before pregnancy, at 12, 24, and 36 gestational weeks (GW), and 6–8 weeks postpartum. Pre-pregnancy physical activity was collected through recall at 12 GW.
Results
Maternal age, pre-pregnancy body mass index, educational status, smoking, mini dietary assessment index, first-degree family history of diabetes, hypertension, parity, pre-existing GDM, and previous macrosomia showed significant differences between the GDM group and the normal group (P<0.05 for all). Pre-pregnancy muscle-strengthening activity was significantly associated with a lower risk of GDM (adjusted odds ratio, 0.46; 95% confidence interval, 0.25 to 0.85).
Conclusion
These findings suggest that physical activity, such as muscle-strengthening activities before pregnancy, could be a preventive strategy to reduce GDM risk. Although the study does not provide evidence that physical activity during pregnancy and postpartum reduces GDM risk, it offers significant insights into the importance of maintaining a healthy level of physical activity from pre-pregnancy to prevent GDM.
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Citations
Citations to this article as recorded by

- Pre-Conception Physical Activity and the Risk of Gestational Diabetes Mellitus: Findings from the BORN 2020 Study
Antigoni Tranidou, Antonios Siargkas, Ioannis Tsakiridis, Emmanuela Magriplis, Aikaterini Apostolopoulou, Georgia Koutsouki, Michail Chourdakis, Themistoklis Dagklis
Nutrients.2025; 17(11): 1832. CrossRef - Prediction of Gestational Diabetes Mellitus: A Nomogram Model Incorporating Lifestyle, Nutrition and Health Literacy Factors
Minghan Fu, Menglu Qiu, Zhencheng Xie, Laidi Guo, Yun Zhou, Jia Yin, Wanyi Yang, Lishan Ouyang, Ye Ding, Zhixu Wang
Nutrients.2025; 17(21): 3400. CrossRef
- Basic and Translational Research
- Effect of 4 Weeks Resonance Frequency Breathing on Glucose Metabolism and Autonomic Tone in Healthy Adults
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Benedict Herhaus, Andreas Peter, Julia Hummel, Thomas Kubiak, Martin Heni, Katja Petrowski
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Diabetes Metab J. 2025;49(6):1219-1228. Published online April 3, 2025
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DOI: https://doi.org/10.4093/dmj.2024.0647
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- Background
The autonomic nervous system plays a crucial role in the brain’s communication with metabolically important peripheral organs, modulating insulin sensitivity and secretion. Increased sympathetic tone is a common feature in prediabetes and diabetes. The parasympathetic nervous system activity might be improvable through resonance frequency breathing (RFB) with heart rate variability biofeedback (HRV-BF) training.
Methods
We here investigated the effect of a 4-week mobile RFB-HRV-BF intervention on glucose metabolism and HRV of 30 healthy adults (17 females; mean age 25.77±3.64 years; mean body mass index 22.65±2.95 kg/m2). Before and after the intervention, glucose metabolism was assessed by 75 g oral glucose tolerance tests (with blood sampling every 30 minutes over 2 hours) and HRV was measured through electrocardiography.
Results
RFB-HRV-BF training did not influence glucose metabolism in healthy adults but reduced fasting as well as 2-hour-postload glucose in participants categorized as more insulin resistant before the intervention. In addition, RFB-HRV-BF training was associated with an increase in the time and frequency domain HRV parameters standard deviation of all NN-intervals, root mean square successive differences, HRV high-frequency and HRV low-frequency after 4 weeks of intervention.
Conclusion
Our findings introduce RFB-HRV-BF training as an effective tool to modulate the autonomic nervous system with a shift towards the parasympathetic tone. Along with the observed decrease in glycemia in those with lower insulin sensitivity, RFB-HRV-BF training emerges as a promising non-pharmacological approach to improve glucose metabolism which has to be further investigated in prediabetes and diabetes.
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Citations
Citations to this article as recorded by

- The autonomic nervous system in the regulation of glucose and lipid metabolism
Sabrina Wangler, Marc N. Jarczok, Matthew Ennis, Benedict Herhaus, Róbert Wagner, Ratika Sehgal, Martin Heni
Nature Reviews Endocrinology.2026;[Epub] CrossRef
Reviews
- Cardiovascular Risk/Epidemiology
- Artificial Light at Night and Type 2 Diabetes Mellitus
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Jong-Ha Baek, Yong Zhu, Chandra L. Jackson, Yong-Moon Mark Park
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Diabetes Metab J. 2024;48(5):847-863. Published online September 1, 2024
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DOI: https://doi.org/10.4093/dmj.2024.0237
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- The widespread and pervasive use of artificial light at night (ALAN) in our modern 24-hour society has emerged as a substantial disruptor of natural circadian rhythms, potentially leading to a rise in unhealthy lifestyle-related behaviors (e.g., poor sleep; shift work). This phenomenon has been associated with an increased risk of type 2 diabetes mellitus (T2DM), which is a pressing global public health concern. However, to date, reviews summarizing associations between ALAN and T2DM have primarily focused on the limited characteristics of exposure (e.g., intensity) to ALAN. This literature review extends beyond prior reviews by consolidating recent studies from 2000 to 2024 regarding associations between both indoor and outdoor ALAN exposure and the incidence or prevalence of T2DM. We also described potential biological mechanisms through which ALAN modulates glucose metabolism. Furthermore, we outlined knowledge gaps and investigated how various ALAN characteristics beyond only light intensity (including light type, timing, duration, wavelength, and individual sensitivity) influence T2DM risk. Recognizing the detrimental impact of ALAN on sleep health and the behavioral correlates of physical activity and dietary patterns, we additionally summarized studies investigating the potential mediating role of each component in the relationship between ALAN and glucose metabolism. Lastly, we proposed implications of chronotherapies and chrononutrition for diabetes management in the context of ALAN exposure.
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Environmental Pollution.2025; 379: 126472. CrossRef - Artificial light exposure at night: A hidden risk factor for type 2 diabetes
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Sleep Medicine: X.2025; 10: 100146. CrossRef - Timing and Amplitude of Light Exposure, Not Photoperiod, Predict Blood Lipids in Arctic Residents: A Circadian Light Hypothesis
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BMC Public Health.2025;[Epub] CrossRef - Independent and combined relationships between nighttime light exposure, air pollution, PM2.5 constituents, greenness and diabetes or high blood sugar: a national prospective cohort study
Siyu Qing, Ziyue Liang, Yifang Liang, Renfang Zhang, Xiaojie Chen, Wenqing Wang, Chunejie Xu, Fei Lin, Yongbin Wang
BMC Public Health.2025;[Epub] CrossRef - Glucose homeostasis during recurrent periods of sleep restriction and recovery in healthy young adults
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SLEEPJ.2025;[Epub] CrossRef - Normalized Amplitude of Blue Light Exposure (NA BLE) as a Novel Index for Circadian Light Hygiene: Associations with Actigraphy Measures and Seasonal Dependencies
Denis G. Gubin, Julia V. Boldyreva, Liina A. Danilova, Sergei N. Kolomeichuk, Larisa E. Alkhimova, Alexander A. Markov, Olga A. Malyugina, Natalya V. Kuznetsova, Oliver Stefani, Dietmar Weinert, Germaine Cornelissen
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Mariana Verdelho Machado
Nutrients.2024; 16(24): 4294. CrossRef
- Lifestyle
- Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies
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Jakub Mesinovic, Jackson J. Fyfe, Jason Talevski, Michael J. Wheeler, Gloria K.W. Leung, Elena S. George, Melkamu T. Hunegnaw, Costas Glavas, Paul Jansons, Robin M. Daly, David Scott
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Diabetes Metab J. 2023;47(6):719-742. Published online September 14, 2023
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DOI: https://doi.org/10.4093/dmj.2023.0112
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- 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.
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Original Article
- Basic Research
- Effects Of Exercise Training And Chlorogenic Acid Supplementation On Hepatic Lipid Metabolism In Prediabetes Mice
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Samaneh Shirkhani, Sayyed Mohammad Marandi, Mohammad Hossein Nasr-Esfahani, Seung Kyum Kim
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Diabetes Metab J. 2023;47(6):771-783. Published online September 8, 2023
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DOI: https://doi.org/10.4093/dmj.2022.0265
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- Background
Since prediabetes is a risk factor for metabolic syndromes, it is important to promote a healthy lifestyle to prevent prediabetes. This study aimed to determine the effects of green coffee (GC), chlorogenic acid (CGA) intake, and exercise training (EX) on hepatic lipid metabolism in prediabetes male C57BL/6 mice.
Methods
Forty-nine mice were randomly divided into two groups feeding with a normal diet (n=7) or a high-fat diet (HFD, n=42) for 12 weeks. Then, HFD mice were further divided into six groups (n=7/group): control (pre-D), GC, CGA, EX, GC+EX, and CGA+EX. After additional 10 weeks under the same diet, plasma, and liver samples were obtained.
Results
HFD-induced prediabetes conditions with increases in body weight, glucose, insulin, insulin resistance, and lipid profiles were alleviated in all treatment groups. Acsl3, a candidate gene identified through an in silico approach, was lowered in the pre-D group, while treatments partly restored it. HFD induced adverse alterations of de novo lipogenesis- and β oxidation-associated molecules in the liver. However, GC and CGA supplementation and EX reversed or ameliorated these changes. In most cases, GC or CGA supplementation combined with EX has no synergistic effect and the GC group had similar results to the CGA group.
Conclusion
These findings suggest that regular exercise is an effective non-therapeutic approach for prediabetes, and CGA supplementation could be an alternative to partially mimic the beneficial effects of exercise on prediabetes.
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Sulwon Lecture 2021
- Basic Research
- Exercise, Mitohormesis, and Mitochondrial ORF of the 12S rRNA Type-C (MOTS-c)
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Tae Kwan Yoon, Chan Hee Lee, Obin Kwon, Min-Seon Kim
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Diabetes Metab J. 2022;46(3):402-413. Published online May 25, 2022
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DOI: https://doi.org/10.4093/dmj.2022.0092
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- Low levels of mitochondrial stress are beneficial for organismal health and survival through a process known as mitohormesis. Mitohormetic responses occur during or after exercise and may mediate some salutary effects of exercise on metabolism. Exercise-related mitohormesis involves reactive oxygen species production, mitochondrial unfolded protein response (UPRmt), and release of mitochondria-derived peptides (MDPs). MDPs are a group of small peptides encoded by mitochondrial DNA with beneficial metabolic effects. Among MDPs, mitochondrial ORF of the 12S rRNA type-c (MOTS-c) is the most associated with exercise. MOTS-c expression levels increase in skeletal muscles, systemic circulation, and the hypothalamus upon exercise. Systemic MOTS-c administration increases exercise performance by boosting skeletal muscle stress responses and by enhancing metabolic adaptation to exercise. Exogenous MOTS-c also stimulates thermogenesis in subcutaneous white adipose tissues, thereby enhancing energy expenditure and contributing to the anti-obesity effects of exercise training. This review briefly summarizes the mitohormetic mechanisms of exercise with an emphasis on MOTS-c.
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Review
- Metabolic Risk/Epidemiology
- Lifestyle Interventions for Non-Obese Patients Both with, and at Risk, of Non-Alcoholic Fatty Liver Disease
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Xin-Lei Zhang, Ting-Yao Wang, Giovanni Targher, Christopher D. Byrne, Ming-Hua Zheng
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Diabetes Metab J. 2022;46(3):391-401. Published online May 25, 2022
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DOI: https://doi.org/10.4093/dmj.2022.0048
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- Non-alcoholic fatty liver disease occurring in non-obese subjects (the so-called non-obese NAFLD) is a highly prevalent but neglected liver condition, which is closely associated with metabolic disorders and suboptimal lifestyles. Landmark studies have shown that lifestyle interventions are potentially beneficial in decreasing the risk of developing non-obese NAFLD and in ameliorating NAFLD in non-obese individuals with pre-existing NAFLD. Lifestyle interventions usually refer to changes in eating habits and physical activity, both of which have a powerful effect on non-obese NAFLD and on risk factors for non-obese NAFLD. However, to date, patients and health-care professionals have a poor awareness and understanding of non-obese NAFLD and the beneficial effects of lifestyle interventions in this patient population. The aim of this narrative review is to briefly discuss the evidence for the effects of lifestyle changes and what changes are needed amongst medical personnel and other stakeholders in order to raise awareness of non-obese NAFLD.
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Original Articles
- Lifestyle
- Effectiveness of Resistance Exercise on Inflammatory Biomarkers in Patients with Type 2 Diabetes Mellitus: A Systematic Review with Meta-Analysis
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Rubén Fernández-Rodríguez, Sonia Monedero-Carrasco, Bruno Bizzozero-Peroni, Miriam Garrido-Miguel, Arthur Eumann Mesas, Vicente Martínez-Vizcaíno
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Diabetes Metab J. 2023;47(1):118-134. Published online April 29, 2022
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DOI: https://doi.org/10.4093/dmj.2022.0007
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- 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.
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Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
The Korean Journal of Internal Medicine.2025; 40(5): 696. CrossRef - The Anti-Inflammatory Effects of Resistance Training in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis
Nikolaos P. E. Kadoglou, Chrysostomos Georgiou, Nikolaos Balaskas, Chrystalla Panayiotou, Michail Vardas, Andreas Mitsis, Constantine N. Antonopoulos
Biomolecules.2025; 15(10): 1417. CrossRef - Physical activity for prevention of cardiovascular disease: a consensus statement of the Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 120. CrossRef - Resistance Training Improves Hemodynamics Involving Autonomic and
Immune Responses
Eduarda Teodora Rachid-Wolpp, Boris Brill, Anamei Silva Reis, Meiry Souza Moura-Maia, Naiara Nadia Moreira-Silva, Mariana Alvarez-Souza, Max Silva-Sousa, Elano Silva-Sousa, Fernanda Rodrigues Monteiro, André Luis Lacerda Bachi, Luis V F de Oliveira, Yanes
International Journal of Sports Medicine.2025;[Epub] CrossRef - Exercise as a modulator of systemic inflammation and oxidative stress biomarkers across clinical and healthy populations: an umbrella meta-analysis
Wei Feng, Yanzhong Wang, Xin Gu, Duonan Yu, Zhiwei Liu
BMC Sports Science, Medicine and Rehabilitation.2025;[Epub] CrossRef - Körperliche Aktivität und Trainingstherapie bei Typ-2-Diabetes – ein Update
Andreas M. Nieß, Ansgar Thiel
Diabetologie und Stoffwechsel.2024; 19(01): 38. CrossRef - Genetic predisposition, lifestyle inflammation score, food-based dietary inflammatory index, and the risk for incident diabetes: Findings from the KoGES data
Hye Ah Lee, Hyesook Park, Bomi Park
Nutrition, Metabolism and Cardiovascular Diseases.2024; 34(3): 642. CrossRef - Associations of meeting 24-h movement guidelines and metabolic syndrome in Korean adults during the COVID-19 pandemic
S.W. Shin, Y. Choi, Y.H. Kang, J. Kim
Public Health.2024; 227: 187. CrossRef - Association of hypoglycemic events with cognitive impairment in patients with type 2 diabetes mellitus: Protocol for a dose-response meta-analysis
Min Ye, Ai Hong Yuan, Qi Qi Yang, Qun Wei Li, Fei Yue Li, Yan Wei, Muhammad Shahzad Aslam
PLOS ONE.2024; 19(2): e0296662. CrossRef - Effectiveness of resistance training in modulating inflammatory biomarkers among Asian patients with sarcopenia: a systematic review and meta-analysis of randomized controlled trials
Jingxian Xue, Xi Han, Yan Zheng, Qiuxia Zhang, Lingyu Kong
Frontiers in Immunology.2024;[Epub] CrossRef - Low-Intensity Resistance Exercise in Cardiac Rehabilitation: A Narrative Review of Mechanistic Evidence and Clinical Implications
Jemima Jansen, Paul W. Marshall, Jocelyne R. Benatar, Rebecca Cross, Tia K. Lindbom, Michael Kingsley
Journal of Clinical Medicine.2024; 13(23): 7338. CrossRef - Long-term impact of adherence to muscle-strengthening guidelines on inflammation markers: a 17-year follow-up study with obesity parameters as mediators
Antonio Garcia-Hermoso, Yasmin Ezzatvar, Rodrigo Yáñez-Sepúlveda, Jorge Olivares-Arancibia, Jacqueline Páez-Herrera, José Francisco López-Gil
BMJ Open Sport & Exercise Medicine.2024; 10(4): e002229. CrossRef - Additive impact of diabetes and sarcopenia on all-cause and cardiovascular mortality: A longitudinal nationwide population-based study
Eyun Song, Soon Young Hwang, Min Jeong Park, Ahreum Jang, Kyeong Jin Kim, Ji Hee Yu, Nam Hoon Kim, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi
Metabolism.2023; 148: 155678. CrossRef - Endothelial progenitor cell response to a multicomponent exercise training program in adults with cardiovascular risk factors
Suiane Cavalcante, Manuel Teixeira, Marisol Gouveia, Ana Duarte, Miriam Ferreira, Maria I. Simões, Maria Conceição, Mariana Costa, Ilda P. Ribeiro, Ana Cristina Gonçalves, José Oliveira, Fernando Ribeiro
German Journal of Exercise and Sport Research.2023; 53(2): 225. CrossRef - “Does Physical Exercise Promote Health Benefits for Diabetic Patients during the COVID-19 Pandemic?”: A Systematic Review
Erivaldo de Souza, Daniela Meneses-Santos, Josué Cruz Santos, Felipe J. Aidar, Carla Roberta de Oliveira Carvalho, Jymmys Lopes dos Santos, Anderson Carlos Marçal
Sports.2023; 11(10): 192. CrossRef - Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis
Liang Tan, Weihua Yan, Weilin Yang, Agata Kamionka, Mariusz Lipowski, Zijian Zhao, Gang Zhao
Experimental Gerontology.2023; 183: 112310. CrossRef - Resistance Training Improves Beta Cell Glucose Sensing and Survival in Diabetic Models
Gabriela Alves Bronczek, Gabriela Moreira Soares, Carine Marmentini, Antonio Carlos Boschero, José Maria Costa-Júnior
International Journal of Molecular Sciences.2022; 23(16): 9427. CrossRef
- Lifestyle
- Changes in Patterns of Physical Activity and Risk of Heart Failure in Newly Diagnosed Diabetes Mellitus Patients
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Inha Jung, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee
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Diabetes Metab J. 2022;46(2):327-336. Published online November 24, 2021
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DOI: https://doi.org/10.4093/dmj.2021.0046
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- Background
Exercise is recommended for type 2 diabetes mellitus (T2DM) patients to prevent cardiovascular disease. However, the effects of physical activity (PA) for reducing the risk of heart failure (HF) has yet to be elucidated. We aimed to assess the effect of changes in patterns of PA on incident HF, especially in newly diagnosed diabetic patients.
Methods
We examined health examination data and claims records of 294,528 participants from the Korean National Health Insurance Service who underwent health examinations between 2009 and 2012 and were newly diagnosed with T2DM. Participants were classified into the four groups according to changes in PA between before and after the diagnosis of T2DM: continuously inactive, inactive to active, active to inactive, and continuously active. The development of HF was analyzed until 2017.
Results
As compared with those who were continuously inactive, those who became physically active after diagnosis showed a reduced risk for HF (adjusted hazard ratio [aHR], 0.79; 95% confidence interval [CI], 0.66 to 0.93). Those who were continuously active had the lowest risk for HF (aHR, 0.77; 95% CI, 0.62 to 0.96). As compared with those who were inactive, those who exercised regularly, either performing vigorous or moderate PA, had a lower HF risk (aHR, 0.79; 95% CI, 0.69 to 0.91).
Conclusion
Among individuals with newly diagnosed T2DM, the risk of HF was reduced in those with higher levels of PA after diagnosis was made. Our results suggest either increasing or maintaining the frequency of PA after the diagnosis of T2DM may lower the risk of HF.
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- Global, regional, and national burden of major diabetes-related complications attributable to physical inactivity
Jayne Feter, Natan Feter, Rodrigo Leal-Menezes, Pedro C. Hallal, Daniel Umpierre
Journal of Sport and Health Science.2026; : 101123. CrossRef - Life-course obesity and heart failure: a two-sample Mendelian randomization study
Haili Wang, Jie Min, Lei Zhong, Jinyu Zhang, Lili Ye, Chunrong Chen
Internal and Emergency Medicine.2025; 20(1): 171. CrossRef - Critical Appraisal of Pharmaceutical Therapy in Diabetic Cardiomyopathy—Challenges and Prospectives
Elina Khattab, Michaelia Kyriakou, Elena Leonidou, Stefanos Sokratous, Angeliki Mouzarou, Michael M. Myrianthefs, Nikolaos P. E. Kadoglou
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Mohammadjavad Sotoudeheian, Seyed-Mohamad-Sadegh Mirahmadi, Pedram Salehi Darjani, Mohammad Moradi, Mohammad Pirhayati, Mohammad Sedigh Dakkali, Mehdi Taghizadeh, Reza Azarbad, Hamidreza Pazoki Toroudi
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Dalmacito A. Cordero Jr.
Diabetes & Metabolism Journal.2025; 49(3): 513. CrossRef - Physical activity for prevention of cardiovascular disease: consensus statement of Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
The Korean Journal of Internal Medicine.2025; 40(5): 696. CrossRef - Physical activity for prevention of cardiovascular disease: a consensus statement of the Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 120. CrossRef - Associations Between Physical Activity and the Risk of Hip Fracture Depending on Glycemic Status: A Nationwide Cohort Study
Kyoung Min Kim, Kyoung Jin Kim, Kyungdo Han, Yumie Rhee
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e1194. CrossRef - Association between exercise habits and incident type 2 diabetes mellitus in patients with thyroid cancer: nationwide population-based study
Jiyun Park, Jin-Hyung Jung, Hyunju Park, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyungdo Han, Kyung-Soo Kim
BMC Medicine.2024;[Epub] CrossRef - Dose-Response Relationship Between Physical Activity and the Morbidity and Mortality of Cardiovascular Disease Among Individuals With Diabetes: Meta-Analysis of Prospective Cohort Studies
Yang Chen, Xingsheng Jin, Guochong Chen, Ru Wang, Haili Tian
JMIR Public Health and Surveillance.2024; 10: e54318. CrossRef - Evaluation and Management of Patients With Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement
Kyu-Sun Lee, Junghyun Noh, Seong-Mi Park, Kyung Mook Choi, Seok-Min Kang, Kyu-Chang Won, Hyun-Jai Cho, Min Kyong Moon
International Journal of Heart Failure.2023; 5(1): 1. CrossRef - Evaluation and Management of Patients with Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement
Kyu-Sun Lee, Junghyun Noh, Seong-Mi Park, Kyung Mook Choi, Seok-Min Kang, Kyu-Chang Won, Hyun-Jai Cho, Min Kyong Moon
Diabetes & Metabolism Journal.2023; 47(1): 10. CrossRef - Association of plasma brain-derived neurotrophic factor levels and frailty in community-dwelling older adults
Eun Roh, Soon Young Hwang, Eyun Song, Min Jeong Park, Hye Jin Yoo, Sei Hyun Baik, Miji Kim, Chang Won Won, Kyung Mook Choi
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Jiyun Park, Gyuri Kim, Hasung Kim, Jungkuk Lee, Sang-Man Jin, Jae Hyeon Kim
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- Metabolic Risk/Epidemiology
- Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018
-
Jiun Chae, Moon Young Seo, Shin-Hye Kim, Mi Jung Park
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Diabetes Metab J. 2021;45(6):880-889. Published online July 6, 2021
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DOI: https://doi.org/10.4093/dmj.2020.0185
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- Background
There is a lack of recent research on the changes in risk factors for metabolic syndrome (MetS) in the Asian pediatric population. We aimed to determine the 12-year trends in the prevalence of MetS and relevant lifestyle factors such as smoking, exercise, and calorie intake among Korean adolescents.
Methods
We investigated trends in MetS and lifestyle factors among 6,308 adolescents aged 12 to 18 years from the Korea National Health and Nutrition Examination Survey, 2007 to 2018.
Results
The prevalence of MetS was stable from 2007 to 2018 (1.7% to 2.2%). There were significant increases in the prevalence of central obesity (from 8.1% to 11.2%, P=0.012) and hyperglycemia (from 5.3% to 10.4%, P<0.001) and decreases in hypo-high-density lipoprotein (HDL)-cholesterolemia (from 22.4% to 14.8%, P<0.001). Total calorie intake and calorie intake from fat significantly increased (P<0.001), whereas calorie intake from carbohydrates significantly decreased (P<0.001) during the study period. The proportions of tobacco smokers and regular walkers significantly decreased from 2007 to 2018. After controlling for all covariates, total calorie intake was positively correlated with waist circumference (P<0.05). HDL-cholesterol was negatively associated with carbohydrate consumption (P<0.01) and positively associated with fat consumption (P<0.001). Regular walking and regular strength training were associated with lower waist circumference (P<0.05). Smoking was associated with lower fasting glucose levels (P<0.01).
Conclusion
Although the prevalence rate of MetS is stable among Korean adolescents, the prevalence of central obesity and hyperglycemia has increased greatly in the recent decade. Public education on proper dietary intake and lifestyle modification is required.
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Journal of Korean Medical Science.2025;[Epub] CrossRef - Concentrations of Serum Per- and Polyfluoroalkyl Substances and Lipid Health in Adolescents: A Cross-Sectional Study from the Korean National Environmental Health Survey 2018–2020
Min-Won Shin, Habyeong Kang, Shin-Hye Kim
Toxics.2025; 13(2): 91. CrossRef - Hidden link between endocrine-disrupting chemicals and pediatric obesity
Min Won Shin, Shin-Hye Kim
Clinical and Experimental Pediatrics.2025; 68(3): 199. CrossRef - Association between mothers’ working hours and metabolic syndrome in children and adolescents: data from the Korea National Health and Nutrition Examination Survey, 2016–2020
Myoung-hye Lee, Joo-Eun Jeong, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park
Korean Journal of Family Medicine.2025; 46(2): 84. CrossRef - Age-related insulin resistance changes in children and adolescents and its impact on the accuracy of diagnosis of metabolic syndrome
Insung Kim, Kyu-Na Lee, Juyoung Sung, Yoon Ji Ahn, Minji Im, Kyungdo Han, Sung Yoon Cho
Annals of Pediatric Endocrinology & Metabolism.2025; 30(4): 213. CrossRef - Binational comparison of the association between socioeconomic status and metabolic syndrome: A nationally representative study in South Korea and the United States
Yoon Lee, Ye Won Kim, Juyeong Kim, André Hajek, Yusheng Li, Jiyoung Hwang, Selin Woo, Dong Keon Yon
Preventive Medicine Reports.2025; 60: 103298. CrossRef - Relationship between sedentary time and cognitive decline in hypertensive patients-mediating role of the weight-adjusted waist circumference index
Mengdi Zhang, Donghai Liu, Shunxin Lv, Cong Wang, Huachen Jiao
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Chang In Han, Jaejun Lee
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Frontiers in Nutrition.2024;[Epub] CrossRef - Association between Thyroid Function and Insulin Resistance Indices in Korean Adolescents: Findings from the 2014–2015 Korea National Health and Nutrition Examination Survey
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Munku Song, Seamon Kang, Hyunsik Kang
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Hyun-Jin Kim, Byung Sik Kim, Yonggu Lee, Sang Bong Ahn, Dong Wook Kim, Jeong-Hun Shin
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Hyun-Jin Kim, Byung Sik Kim, Dong Wook Kim, Jeong-Hun Shin
The Korean Journal of Internal Medicine.2024; 39(4): 612. CrossRef - Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020
Sinyoung Kang, Mi Jung Park, Jung Min Kim, Jin-Sung Yuk, Shin-Hye Kim, Jun Mori
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Jiun Chae, Moon Young Seo, Shin-Hye Kim, Mi Jung Park
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- Others
- Can Habitual Exercise Help Reduce Serum Concentrations of Lipophilic Chemical Mixtures? Association between Physical Activity and Persistent Organic Pollutants
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Yu-Mi Lee, Ji-Yeon Shin, Se-A Kim, David R. Jacobs, Duk-Hee Lee
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Diabetes Metab J. 2020;44(5):764-774. Published online May 11, 2020
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DOI: https://doi.org/10.4093/dmj.2019.0158
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9,100
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98
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Background
Low-dose persistent organic pollutants (POPs), especially organochlorine pesticides (OCPs), have emerged as a new risk factor of many chronic diseases. As serum concentrations of POPs in humans are mainly determined by both their release from adipose tissue to circulation and their elimination from circulation, management of these internal pathways may be important in controlling the serum concentrations of POPs. As habitual physical activity can increase the elimination of POPs from circulation, we evaluated whether chronic physical activity is related to low serum POP concentrations.
Methods
A cross-sectional study of 1,850 healthy adults (age ≥20 years) without cardio-metabolic diseases who participated in the U.S. National Health and Nutrition Examination Survey 1999 to 2004 was conducted. Information on moderate or vigorous leisure-time physical activity was obtained based on questionnaires. Serum concentrations of OCPs and polychlorinated biphenyls were investigated as typical POPs.
Results
Serum concentrations of OCPs among physically active subjects were significantly lower than those among physically inactive subjects (312.8 ng/g lipid vs. 538.0 ng/g lipid, P<0.001). This difference was maintained after adjustment for potential confounders. When analyses were restricted to physically active subjects, there were small decreases in the serum concentrations of OCPs with increasing duration of physical activity, showing a curvilinear relationship over the whole range of physical activity (Pquadratic <0.001). In analyses stratified by age, sex, body mass index, and smoking status, a strong inverse association was similarly observed among all subgroups.
Conclusion
Physical activity may assist in decreasing serum concentrations of lipophilic chemical mixtures such as OCPs.
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- Associations between per- and polyfluoroalkyl substances and menstrual cycle regularity in reproductive-aged female: A cross-sectional study
Aiqin Qiu, Kai Luo, Huan Liu, Jialing Huang, Xiaotu Liu, Jun Zhang, Da Chen, Weiwei Cheng, Wei Huang
Emerging Contaminants.2025; 11(1): 100438. CrossRef - Association of Human Milk Dioxin Like-POPs Levels with Maternal Characteristics and Newborn Anthropometric Measurements: A Cross-sectional Study from Southern India
Amala Varghese, Rahul M. Chirackal, V. C. Manoj, C. Kesavachandran, K. P. Prathish
Exposure and Health.2025; 17(4): 1047. CrossRef - Is Physical Activity an Efficient Strategy to Control the Adverse Effects of Persistent Organic Pollutants in the Context of Obesity? A Narrative Review
Quentin A. Serrano, Sébastien Le Garf, Vincent Martin, Serge S. Colson, Nicolas Chevalier
International Journal of Molecular Sciences.2024; 25(2): 883. CrossRef - Untargeted metabolomics reveal signatures of a healthy lifestyle
Wimal Pathmasiri, Blake R. Rushing, Susan McRitchie, Mansi Choudhari, Xiuxia Du, Alexsandr Smirnov, Matteo Pelleigrini, Michael J. Thompson, Camila A. Sakaguchi, David C. Nieman, Susan J. Sumner
Scientific Reports.2024;[Epub] CrossRef - Unraveling the pesticide-diabetes connection: A case-cohort study integrating Mendelian randomization analysis with a focus on physical activity's mitigating effect
Dandan Wei, Jiayu Shi, Zhiwei Chen, Haoran Xu, Xuyan Wu, Yao Guo, Xin Zen, Caini Fan, Xiaotian Liu, Jian Hou, Wenqian Huo, Linlin Li, Tao Jing, Chongjian Wang, Zhenxing Mao
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Dandan Wei, Jiayu Shi, Haoran Xu, Yao Guo, Xueyan Wu, Zhiwei Chen, Taimeng Chen, Huilin Lou, Erbao Han, Guozhen Han, Yumeng Yan, Xiaotian Liu, Xin Zeng, Caini Fan, Jian Hou, Wenqian Huo, Linlin Li, Tao Jing, Chongjian Wang, Zhenxing Mao
Science of The Total Environment.2024; 951: 175694. CrossRef - Associations between polychlorinated biphenyls and cancer risk among type 2 diabetes: The modifying effects of lifestyle
Peiwen Li, Yu Wang, Qianying Liu, Yan Yan, Zhuoya Zhao, Shiyang Zhang, Chengyong Jia, Jun An, Cheng Xu, Xin Zhang, Tao Jing, Huan Guo, Meian He
Chemosphere.2024; 366: 143442. CrossRef - Physical exercise and persistent organic pollutants
Chang Liu, Hui sheng Hou
Heliyon.2023; 9(9): e19661. CrossRef - Exposure to a low concentration of mixed organochlorine pesticides impairs glucose metabolism and mitochondrial function in L6 myotubes and zebrafish
Chul-Min Park, Ki-Tae Kim, Dong-Young Rhyu
Journal of Hazardous Materials.2021; 414: 125437. CrossRef - Can Environmental Pollutants Be a Factor Linking Obesity and COVID-19?
Duk-Hee Lee
Journal of Korean Medical Science.2021;[Epub] CrossRef - Letter to the Editor: Effect of fatty fish or nut consumption on concentrations of persistent organic pollutants in overweight or obese men and women: A randomized controlled clinical trial
Yu-Mi Lee, Duk-Hee Lee
Nutrition, Metabolism and Cardiovascular Diseases.2020; 30(5): 849. CrossRef - Can habitual exercise really increase serum concentrations of persistent organic pollutants?
Yu-Mi Lee, Duk-Hee Lee
Environment International.2020; 140: 105615. CrossRef - Response to correspondence ENVINT_2020_552 “Can habitual exercise really increase serum concentrations of persistent organic pollutants?”
Sidsel L. Domazet, Tina K. Jensen, Anders Grøntved
Environment International.2020; 140: 105616. CrossRef
- Lifesytle
- Combined Aerobic and Resistance Exercise Training Reduces Circulating Apolipoprotein J Levels and Improves Insulin Resistance in Postmenopausal Diabetic Women
-
Yun Kyung Jeon, Sang Soo Kim, Jong Ho Kim, Hyun Jeong Kim, Hyun Jun Kim, Jang Jun Park, Yuen Suk Cho, So Hee Joung, Ji Ryang Kim, Bo Hyun Kim, Sang Heon Song, In Joo Kim, Yong Ki Kim, Young-Bum Kim
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Diabetes Metab J. 2020;44(1):103-112. Published online February 21, 2020
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DOI: https://doi.org/10.4093/dmj.2018.0160
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- Background
Circulating apolipoprotein J (ApoJ) is closely associated with insulin resistance; however, the effect of exercise on circulating ApoJ levels and the association of ApoJ with metabolic indices remain unknown. Here, we investigated whether a combined exercise can alter the circulating ApoJ level, and whether these changes are associated with metabolic indices in patients with type 2 diabetes mellitus.
MethodsPostmenopausal women with type 2 diabetes mellitus were randomly assigned into either an exercise (EXE, n=30) or control (CON, n=15) group. Participants in the EXE group were enrolled in a 12-week program consisting of a combination of aerobic and resistance exercises. At baseline, 4, 8, and 12 weeks, body composition and metabolic parameters including homeostatic model assessment of insulin resistance (HOMA-IR) and serum ApoJ levels were assessed.
ResultsIn the EXE group, ApoJ levels decreased 26.3% and 19.4%, relative to baseline, at 8 and 12 weeks, respectively. Between-group differences were significant at 8 and 12 weeks (P<0.05 and P<0.001, respectively). In the EXE group, 12 weeks of exercise resulted in significant decreases in body weight, percent body fat, and HOMA-IR indices. Concurrently, weight-adjusted appendicular skeletal muscle mass (ASM/wt) was increased in the EXE group compared with the CON group. Importantly, changes in the ApoJ level were significantly correlated with changes in ASM/wt.
ConclusionExercise training resulted in a significant decrease in the circulating ApoJ level, with changes in ApoJ associated with an improvement in some insulin resistance indices. These data suggest that circulating ApoJ may be a useful metabolic marker for assessing the effects of exercise on insulin resistance.
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- Lifestyle
- Body Fat Is Related to Sedentary Behavior and Light Physical Activity but Not to Moderate-Vigorous Physical Activity in Type 2 Diabetes Mellitus
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Keun Hee An, Kyung Ah Han, Tae Seo Sohn, Ie Byung Park, Hae Jin Kim, Sung Dae Moon, Kyung Wan Min
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Diabetes Metab J. 2020;44(2):316-325. Published online November 12, 2019
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DOI: https://doi.org/10.4093/dmj.2019.0029
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- Background
Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accidents. We investigated whether physical activity levels or SB were related to percent body fat (%BF) in type 2 diabetes mellitus (T2DM).
MethodsIn this cross sectional study, we measured the duration of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), total energy expenditure, and step counts using a wireless activity tracker (Fitbit HR; FB) for 7 days in free-living conditions, along with %BF using a bio impedance analyzer (Inbody; Biospace) in 120 smartphone users with T2DM. Subjects were divided into exercise (Exe, n=68) and non-exercise (nonExe, n=52) groups based on self-reports of whether the recommended exercises (30 min/day, 3 days/week for 3 months) were performed. SBt, LPAt, MVPAt were transformed from SB, LPA, MVPA for normally distributed variables.
ResultsParticipants were: female, 59.2%; age, 59.3±8.4 years; body mass index, 25.5±3.4 kg/m2; glycosylated hemoglobin (HbA1c), 7.6%±1.2%; %BF, 30.4%±7.1%. They performed SB for 15.7±3.7 hr/day, LPA for 4.4±1.7 hr/day, and MVPA for 0.9±0.8 hr/day. The %BF was related to SBt and LPAt, but not to MVPA after adjustments for age, gender, and HbA1c. VPA was significantly higher in the Exe group than in the nonExe group, but SB, LPA, and moderate physical activity were not different. Predicted %BF was 89.494 to 0.105 (age), −13.047 (gender), −0.507 (HbA1c), −7.655 (LPAt) (F[4, 64]=62.929, P<0.001), with an R2 of 0.785 in multiple linear regression analysis.
ConclusionReduced body fat in elderly diabetic patients might be associated with reduced inactivity and increased LPA.
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Short Communication
- Clinical Diabetes & Therapeutics
- Three Months Monitored Metabolic Fitness Modulates Cardiovascular Risk Factors in Diabetic Patients
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Ilenia Cirilli, Sonia Silvestri, Fabio Marcheggiani, Fabiola Olivieri, Roberta Galeazzi, Roberto Antonicelli, Rina Recchioni, Fiorella Marcheselli, Tiziana Bacchetti, Luca Tiano, Patrick Orlando
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Diabetes Metab J. 2019;43(6):893-897. Published online June 27, 2019
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DOI: https://doi.org/10.4093/dmj.2018.0254
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Cardiovascular diseases represent the leading cause of death and moderate physical exercise is associated with a reduction in cardiovascular risk. The aim of the study was to evaluate the correlation between the amount of exercise recorded daily by a wearable gravitometer for 3 months and selected biochemical and clinical parameters. Nineteen sedentary type 2 diabetics were recruited and distributed into three homogenous groups, low, medium, and high exercise, according to the level of physical exercise monitored and expressed as MOVEs. Data showed an inverse correlation between MOVEs and oxidative stress indexes and a significant improvement in paraoxonase-1 activities and endothelial functionality. Decrease of visceral/total adipose tissue ratio, systolic blood pressure and a down-regulation of the inflammatory microRNA-146a in high exercise group were observed. Finally, a decrease of glycosylated hemoglobin and an up-regulation of the angiogenic microRNA-130a in medium exercise one was obtained. In this study, precise daily monitoring permitted to underline the importance of the amount of physical activity to counteract some cardiovascular risk factors persisting in diabetes. Finally, it identifies new microRNA biomarkers for future investigation on the same topic.
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Original Articles
- Clinical Diabetes & Therapeutics
- Effectiveness of Exercise Intervention in Reducing Body Weight and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus in Korea: A Systematic Review and Meta-Analysis
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Ji-Eun Jang, Yongin Cho, Byung Wan Lee, Ein-Soon Shin, Sun Hee Lee
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Diabetes Metab J. 2019;43(3):302-318. Published online November 19, 2018
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DOI: https://doi.org/10.4093/dmj.2018.0062
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- Background
This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea.
MethodsCochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model.
ResultsWe identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I2=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I2=17%) in the subgroup analysis.
ConclusionExercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.
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- Beneficial Effects of Aerobic Exercise Training Combined with Rosiglitazone on Glucose Metabolism in Otsuka Long Evans Tokushima Fatty Rats
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Shan-Ji Piao, So Hun Kim, Young Ju Suh, Seong-Bin Hong, Seong Hee Ahn, Da Hae Seo, In-Sun Park, Moonsuk Nam
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Diabetes Metab J. 2017;41(6):474-485. Published online November 15, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.6.474
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- Background
Regular aerobic exercise is essential for the prevention and management of type 2 diabetes mellitus and may be particularly beneficial for those treated with thiazolidinediones, since it may prevent associated weight gain. This study aimed to evaluate the effect of combined exercise and rosiglitazone treatment on body composition and glucose metabolism in obese diabetes-prone animals.
MethodsWe analyzed metabolic parameters, body composition, and islet profiles in Otsuka Long Evans Tokushima Fatty rats after 28 weeks of aerobic exercise, rosiglitazone treatment, and combined exercise and rosiglitazone treatment.
ResultsCombined exercise with rosiglitazone showed significantly less increase in weight and epididymal fat compared to rosiglitazone treatment. Aerobic exercise alone and combined rosiglitazone and exercise treatment led to similar retention of lean body mass. All experimental groups showed a decrease in fasting glucose. However, the combined exercise and rosiglitazone therapy group showed prominent improvement in glucose tolerance compared to the other groups. Rescue of islet destruction was observed in all experimental groups, but was most prominent in the combined therapy group.
ConclusionRegular aerobic exercise combined with rosiglitazone treatment can compensate for the adverse effect of rosiglitazone treatment and has benefit for islet preservation.
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- A Review of Animal Models for Studying Bone Health in Type-2 Diabetes Mellitus (T2DM) and Obesity
Saiful Iqbal Norazman, Anis Syauqina Mohd Zaffarin, Ahmad Nazrun Shuid, Haniza Hassan, Ima Nirwana Soleiman, Wong Sok Kuan, Ekram Alias
International Journal of Molecular Sciences.2024; 25(17): 9399. CrossRef - Impacts of an Exercise Intervention on the Health of Pancreatic Beta-Cells: A Review
Shuang Zhang, Yaru Wei, Chunxiao Wang
International Journal of Environmental Research and Public Health.2022; 19(12): 7229. CrossRef - Molecular mechanisms by which aerobic exercise induces insulin sensitivity
Habib Yaribeygi, Stephen L. Atkin, Luis E. Simental‐Mendía, Amirhossein Sahebkar
Journal of Cellular Physiology.2019; 234(8): 12385. CrossRef
- Others
- The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women
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Zeinab AminiLari, Mohammad Fararouei, Sasan Amanat, Ehsan Sinaei, Safa Dianatinasab, Mahmood AminiLari, Nima Daneshi, Mostafa Dianatinasab
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Diabetes Metab J. 2017;41(3):205-212. Published online May 18, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.3.205
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- Background
Recent studies have shown that omentin-1 derived from adipokines can affect physiological regulations and some metabolic dis-eases such as type 2 diabetes mellitus (T2DM).
MethodsThe purpose of this study was to examine the impact of 12 weeks of aerobic (cycle ergometer), resistance, and combined exercises on omentin-1 level, glucose and insulin resistance indices in overweight middle age women with T2DM. In this study, 60 overweight middle age diabetic women were selected using simple random sampling and they were assigned to three groups of aerobic exercise (n=12), resistant exercise (n=12) and combined exercise (n=13), and one control group (n=15). Exercises were done in a three times per week sessions for a total of 12 weeks. Blood samples were collected before each exercise session and 24 hours after of the last session.
ResultsPresent study showed that fasting blood sugar decreased significantly in all intervention groups, while homeostasis model assessment of insulin resistance (HOMA-IR) decreased only in the aerobic and combined exercises groups. Furthermore, there was a significant increase in the omentin-1 level only in the combined exercise group.
ConclusionCompared to aerobic and resistance exercises, 12 weeks of combined exercise was more efficient in improving HOMA-IR and increasing serum omentin-1 among women with T2DM.
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- Maximal Fat Oxidation Rate during Exercise in Korean Women with Type 2 Diabetes Mellitus
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Min Hwa Suk, Yeo-Jin Moon, Sung Woo Park, Cheol-Young Park, Yun A Shin
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Diabetes Metab J. 2015;39(4):328-334. Published online July 8, 2015
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DOI: https://doi.org/10.4093/dmj.2015.39.4.328
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- Background
The purpose of this study was to determine the appropriate exercise intensity associated with maximum fat oxidation, improvement of body composition, and metabolic status in Korean women with type 2 diabetes mellitus (T2DM).
MethodsThe study included a T2DM group (12 women) and a control group (12 women). The groups were matched in age and body mass index. The subjects performed a graded exercise test on a cycle ergometer to measure their maximal fat oxidation (Fatmax). We also measured their body composition, metabolic profiles, and mitochondrial DNA (mtDNA).
ResultsThe exercise intensity for Fatmax was significantly lower in the T2DM group (34.19% maximal oxygen uptake [VO2 max]) than the control group (51.80% VO2 max). Additionally, the rate of fat oxidation during exercise (P<0.05) and mtDNA (P<0.05) were significantly lower in the T2DM group than the control group. The VO2 max level (P<0.001) and the insulin level (P<0.05) were positively correlated with the rate of fat oxidation.
ConclusionThe results of this study suggest lower exercise intensity that achieves Fatmax is recommended for improving fat oxidation and enhancing fitness levels in Korean women with T2DM. Our data could be useful when considering an exercise regimen to improve health and fitness.
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- Type 2 diabetes mellitus’ impact on heart failure patients’ exercise tolerance: a focus on maximal fat oxidation during exercise
Huiying Zhu, Jianchao Pan, Jianxuan Wen, Xiaojing Dang, Xiankun Chen, Yunxiang Fan, Weihui Lu, Wei Jiang
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef - Methodological issues related to maximal fat oxidation and FATmax reproducibility: a narrative review
Isaac A. Chávez Guevara, Francisco J. Amaro-Gahete
International Journal of Obesity.2025; 49(10): 1984. CrossRef - Toward Exercise Guidelines for Optimizing Fat Oxidation During Exercise in Obesity: A Systematic Review and Meta-Regression
Isaac A. Chávez-Guevara, Francisco J. Amaro-Gahete, Arnulfo Ramos-Jiménez, Jean Frederic Brun
Sports Medicine.2023; 53(12): 2399. CrossRef - Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis
Aline Chagastelles Pinto de Macedo, Camila Wohlgemuth Schaan, Patricia Martins Bock, Mariana Brutto de Pinto, Cintia Ehlers Botton, Daniel Umpierre, Beatriz D. Schaan
Archives of Endocrinology and Metabolism.2023;[Epub] CrossRef - Inclusion of sprints during moderate-intensity continuous exercise enhances post-exercise fat oxidation in young males
Bruno Nicanor Mello-Silva, Gabriel Völz Protzen, Fabrício Boscolo Del Vecchio
Applied Physiology, Nutrition, and Metabolism.2022; 47(2): 165. CrossRef - Resting and exercise metabolic characteristics in obese children with insulin resistance
Cao Youxiang, Zhu Lin, Chen Zekai, Xie Weijun
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Shaea Alkahtani, Osama Aljuhani, Nasser Alkhalidi, Naif Almasuod, Omar Hezam, Ibrahim Aljaloud, Haitham Abdel Hamid Dawoud, Ahmed Abdusalam, Danilo Sales Bocalini
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Zihong He, Ye Tian, Pedro L. Valenzuela, Chuanye Huang, Jiexiu Zhao, Ping Hong, Zilin He, Shuhui Yin, Alejandro Lucia
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Fred J. DiMenna, Avigdor D. Arad
BMC Sports Science, Medicine and Rehabilitation.2018;[Epub] CrossRef - High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes
Eva Maria Støa, Sondre Meling, Lill-Katrin Nyhus, Glenn Strømstad, Karl Magnus Mangerud, Jan Helgerud, Solfrid Bratland-Sanda, Øyvind Støren
European Journal of Applied Physiology.2017; 117(3): 455. CrossRef
- Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes
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Ji Yeon Jung, Kyung Wan Min, Hee Jung Ahn, Hwi Ryun Kwon, Jae Hyuk Lee, Kang Seo Park, Kyung Ah Han
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Diabetes Metab J. 2014;38(6):439-448. Published online December 15, 2014
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DOI: https://doi.org/10.4093/dmj.2014.38.6.439
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- Background
Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication.
MethodsA total of 35 women with type 2 diabetes (body mass index, 26.6±2.8 kg/m2; age, 56.4±1.9 years; duration of diabetes, 4.7±4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (KITT), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program.
ResultsThe AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA.
ConclusionImprovement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.
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- Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review
Aparna Narendrula, Ellen Brinza, Christine Horvat Davey, Chris T Longenecker, Allison R Webel
BMJ Open Sport & Exercise Medicine.2024; 10(1): e001596. CrossRef - The Effects of Exercise Interventions on Ectopic and Subcutaneous Fat in Patients with Type 2 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Meta-Regression
Fatemeh Kazeminasab, Ali Bahrami Kerchi, Nasim Behzadnejad, Saba Belyani, Sara K. Rosenkranz, Reza Bagheri, Fred Dutheil
Journal of Clinical Medicine.2024; 13(17): 5005. CrossRef - Aerobic Exercise and Weight Loss in Adults
Ahmad Jayedi, Sepideh Soltani, Alireza Emadi, Mahdieh-Sadat Zargar, Ali Najafi
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Min Li, Qidong Zheng, Joshua D. Miller, Panpan Zuo, Xiaodan Yuan, Jitao Feng, Chao Liu, Shan Bao, Qingqing Lou
Diabetes/Metabolism Research and Reviews.2022;[Epub] CrossRef - Effect of aerobic exercise on waist circumference in adults with overweight or obesity: A systematic review and meta‐analysis
Alex Armstrong, Klaus Jungbluth Rodriguez, Angelo Sabag, Yorgi Mavros, Helen M. Parker, Shelley E. Keating, Nathan A. Johnson
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Yasushi Tazawa, Nobuyoshi Mori, Yoshiko Ogawa, Osamu Ito, Masahiro Kohzuki
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- Effect of Treadmill Exercise on Interleukin-15 Expression and Glucose Tolerance in Zucker Diabetic Fatty Rats
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Hee-Jae Kim, Jae Young Park, Seung Lyul Oh, Yong-An Kim, Byunghun So, Je Kyung Seong, Wook Song
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Diabetes Metab J. 2013;37(5):358-364. Published online October 17, 2013
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DOI: https://doi.org/10.4093/dmj.2013.37.5.358
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7,478
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- Background
Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models.
MethodsMale Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles.
ResultsAfter 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04).
ConclusionThe present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.
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Reviews
- Regulation of Muscle Pyruvate Dehydrogenase Complex in Insulin Resistance: Effects of Exercise and Dichloroacetate
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Dumitru Constantin-Teodosiu
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Diabetes Metab J. 2013;37(5):301-314. Published online October 17, 2013
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DOI: https://doi.org/10.4093/dmj.2013.37.5.301
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Since the mitochondrial pyruvate dehydrogenase complex (PDC) controls the rate of carbohydrate oxidation, impairment of PDC activity mediated by high-fat intake has been advocated as a causative factor for the skeletal muscle insulin resistance, metabolic syndrome, and the onset of type 2 diabetes (T2D). There are also situations where muscle insulin resistance can occur independently from high-fat dietary intake such as sepsis, inflammation, or drug administration though they all may share the same underlying mechanism, i.e., via activation of forkhead box family of transcription factors, and to a lower extent via peroxisome proliferator-activated receptors. The main feature of T2D is a chronic elevation in blood glucose levels. Chronic systemic hyperglycaemia is toxic and can lead to cellular dysfunction that may become irreversible over time due to deterioration of the pericyte cell's ability to provide vascular stability and control to endothelial proliferation. Therefore, it may not be surprising that T2D's complications are mainly macrovascular and microvascular related, i.e., neuropathy, retinopathy, nephropathy, coronary artery, and peripheral vascular diseases. However, life style intervention such as exercise, which is the most potent physiological activator of muscle PDC, along with pharmacological intervention such as administration of dichloroacetate or L-carnitine can prove to be viable strategies for treating muscle insulin resistance in obesity and T2D as they can potentially restore whole body glucose disposal.
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SoJung Lee, YoonMyung Kim
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Diabetes Metab J. 2013;37(4):225-232. Published online August 14, 2013
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DOI: https://doi.org/10.4093/dmj.2013.37.4.225
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As with the dramatic increases in childhood obesity over the past decades, the incidence of type 2 diabetes has increased among children and adolescents in the United States. Insulin resistance is a common feature of childhood obesity and increases the risk of type 2 diabetes, metabolic syndrome, and atherogenic lipoprotein profile in obese youth. Although cross-sectional studies report beneficial effects of physical activity or cardiorespiratory fitness on insulin sensitivity, the role of regular exercise alone (e.g., no calorie restriction) as a strategy to reduce the risk of type 2 diabetes is unclear in obese children and adolescents. In this mini review, we examined the independent effects of various exercise on glucose tolerance and insulin sensitivity in obese youth.
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Hayley M. O'Neill
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Diabetes Metab J. 2013;37(1):1-21. Published online February 15, 2013
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DOI: https://doi.org/10.4093/dmj.2013.37.1.1
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AMPK is an evolutionary conserved sensor of cellular energy status that is activated during exercise. Pharmacological activation of AMPK promotes glucose uptake, fatty acid oxidation, mitochondrial biogenesis, and insulin sensitivity; processes that are reduced in obesity and contribute to the development of insulin resistance. AMPK deficient mouse models have been used to provide direct genetic evidence either supporting or refuting a role for AMPK in regulating these processes. Exercise promotes glucose uptake by an insulin dependent mechanism involving AMPK. Exercise is important for improving insulin sensitivity; however, it is not known if AMPK is required for these improvements. Understanding how these metabolic processes are regulated is important for the development of new strategies that target obesity-induced insulin resistance. This review will discuss the involvement of AMPK in regulating skeletal muscle metabolism (glucose uptake, glycogen synthesis, and insulin sensitivity).
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Original Articles
- Effects of Aerobic Exercise Intensity on Abdominal and Thigh Adipose Tissue and Skeletal Muscle Attenuation in Overweight Women with Type 2 Diabetes Mellitus
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Ji Yeon Jung, Kyung Ah Han, Hee Jung Ahn, Hwi Ryun Kwon, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min
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Diabetes Metab J. 2012;36(3):211-221. Published online June 14, 2012
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DOI: https://doi.org/10.4093/dmj.2012.36.3.211
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- Background
We investigated the effects of exercise intensity on abdominal and mid-thigh adipose tissue, attenuation of skeletal muscle, and insulin sensitivity in overweight women with type 2 diabetes mellitus (T2DM).
MethodsTwenty-eight patients were randomly assigned to control (CG, n=12), moderate intensity exercise (MEG, n=8), or vigorous intensity exercise (VEG, n=8) group. Subjects in both exercise groups completed a 12-week exercise program (MEG, 3.6 to 5.2 METs; VEG, ≥5.2 METs) that was monitored by accelerometers. We assessed body mass index (BMI), total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), mid-thigh intramuscular adipose tissue (TIMAT), total skeletal muscle (TTM), low density skeletal muscle (TLDM), and normal density skeletal muscle (TNDM) using computed tomography, and measured insulin sensitivity with an insulin tolerance test (KITT), before and after the intervention.
ResultsAt baseline, the mean age was 53.8±7.9 years, duration of diabetes was 3.8±2.3 years, and BMI was 26.6±2.6 kg/m2. After 12 weeks, the percent change (%C) in BMI, TIMAT, and TLDM were not different among three groups. However, %C in TFA and VFA were significantly reduced in MEG compared to CG (P=0.026 and P=0.008, respectively). %C SFA was significantly reduced in VEG compared to CG (P=0.038) and %C TTM, TNDM, and KITT were significantly increased in VEG compared to the CG (P=0.044, P=0.007, and P=0.016, respectively).
ConclusionAlthough there was no difference in the change in BMI among groups, TFA and VFA were more reduced in MEG, and only VEG increased TTM, TNDM, and insulin sensitivity compared to CG.
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Citations
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- Effects of Resistance Training and Aerobic Exercise on Insulin Sensitivity in Overweight Korean Adolescents: A Controlled Randomized Trial
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Sunghwan Suh, In-Kyong Jeong, Mi Yeon Kim, Yeon Soo Kim, Sue Shin, Sun Sin Kim, Jae Hyeon Kim
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Diabetes Metab J. 2011;35(4):418-426. Published online August 31, 2011
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DOI: https://doi.org/10.4093/dmj.2011.35.4.418
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- Background
Data on the impact of resistance training on insulin resistance in overweight or obese children are inconclusive.
MethodsThirty overweight South Korean adolescents (mean age of 13.10 years) were divided by sex, and then randomly assigned to one of three treatment groups, which were the diet only (DO), diet with aerobic exercise (AE), or diet with resistance training (RT) group. Physiologic and metabolic parameters were assessed at baseline and after 12 weeks of exercise training and diet modification.
ResultsBoth exercise groups (aerobic and resistance) showed significant improvements in their insulin area under the curve and insulin sensitivity index values when compared to their baseline values while the DO group showed no significant changes in these variables. Age-, sex-, and body mass index (BMI)-adjusted intergroup comparison analyses showed a marked reduction in BMI and a significant reduction in muscle mass in the AE group when compared to the RT group and the DO group, respectively.
ConclusionA 12-week exercise training program of either resistance or aerobic activity improved insulin sensitivity in overweight adolescents, although it failed to show superiority over a DO program. Aerobic exercise decreased both body weight and BMI, and it was noted that this group also had a significant reduction in muscle mass when compared to the DO group.
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Hwi Ryun Kwon, Kyung Wan Min, Hee Jung Ahn, Hee Geum Seok, Jae Hyuk Lee, Gang Seo Park, Kyung Ah Han
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Diabetes Metab J. 2011;35(4):364-373. Published online August 31, 2011
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DOI: https://doi.org/10.4093/dmj.2011.35.4.364
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- Background
There is controversy over whether aerobic or resistance exercise is more effective for improving endothelial function in type 2 diabetes mellitus (T2DM). This study was aimed to investigate the effects of an aerobic and resistance training program on endothelial function, and the influences of glycemic control, body weight changes, and aerobic capacity in T2DM.
MethodsTotal 40 overweight women with T2DM were assigned into 3 groups: an aerobic exercise group (AEG, n=13), resistance exercise group (REG, n=12), and control group (CG, n=15), and followed either brisk walking for the AEG or resistance band training for the REG, 60 minutes per day, 5 days per week for 12 weeks with monitoring daily activity using accelerometers. We assessed endothelial function by flow-mediated dilation (FMD), and aerobic capacity by oxygen uptake at anaerobic threshold (AT_VO2) at baseline and following training program.
ResultsThe mean participants' age was 57.0±6.8 years, and body mass index (BMI) was 27.0±2.3 kg/m2. After intervention, FMD increased by 2.2±1.9% in AEG, which differed from REG and CG (P=0.002), despite of decreased body weight (BW) in both AG and RG (2.8±2.5%, P=0.002; 1.6±2.0%, P=0.017, respectively). A significant increased AT_VO2 and decreased HbA1c were found only in AEG. In all participants, FMD was changed with the significant relations to the AT_VO2 (r=0.348, P=0.035), but not to HbA1c levels or BW.
ConclusionAerobic exercise appears to be more beneficial than resistance exercise for improving endothelial function in T2DM. In addition, aerobic capacity could be a better predictor of changes in FMD than BW and glycemic control.
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- Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus
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Mee Kyoung Kim, Ki Hyun Baek, Ki Ho Song, Hyuk Sang Kwon, Jung Min Lee, Moo Il Kang, Kun Ho Yoon, Bong Yun Cha, Ho Young Son, Kwang Woo Lee
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Diabetes Metab J. 2011;35(1):34-40. Published online February 28, 2011
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DOI: https://doi.org/10.4093/dmj.2011.35.1.34
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- Background
The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD).
MethodsA total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT).
ResultsThirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1±9.4 vs. 53.7±10.1 years, P=0.008) and duration of diabetes (16.0±7.5 vs. 5.5±5.7 years, P<0.001). The positive predictive value (PPV) of the ETT was calculated to be 47.8%. The PPV of the ETT increased to 87.5% in elderly patients (≥60 years) with a long duration of diabetes (≥10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%.
ConclusionIn the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes ≥10 years.
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- Duke Treadmill Score Predicts Coronary Artery Disease Severity in Diabetics and Non-Diabetics
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Pakistan Journal of Health Sciences.2023; : 126. CrossRef - Prevalence of Coronary Artery Disease in Asymptomatic type 2 Diabetes Mellitus Patients with Invasive Correlation in North India
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Hwi Ryun Kwon, Kyung Wan Min, Hee Jung Ahn, Hee Geum Seok, Bo Kyung Koo, Ho Chul Kim, Kyung Ah Han
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Korean Diabetes J. 2010;34(1):23-31. Published online February 28, 2010
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DOI: https://doi.org/10.4093/kdj.2010.34.1.23
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- Background
Aerobic exercise can effectively reduce visceral fat. However, few studies have examined the effect of daily physical activity on obesity and cardiopulmonary function in the subjects with diabetes. We examined the effect of moderate intensity of walking in obese diabetes patients by monitoring of daily activity and measuring the change in abdominal fat area, muscle are and maximal muscle strength.
MethodsWe randomly assigned 27 obese women with type 2 diabetes to an aerobic exercise group (AG, n = 13) and control group (CG, n = 14). The AG performed moderate intensity walking for 60 minutes per exercise, 5 times per week, and for 12 weeks. The activity energy expenditure was monitored by a multi-record accelerometer. The CG maintained routine daily activities. At the time of the initiation of the study and after 12 weeks of exercise, the aerobic exercise capacity was assessed using oxygen consumption rate at anaerobic threshold (VO2-AT). The abdominal fat area and the quadriceps muscle area were measured by computed tomography, and the maximum muscle strength of the upper and lower limbs was measured by a chest press and a leg press, respectively.
ResultsThe mean age of the study subjects was 56.6 ± 8.0 years, the mean duration of diabetes was 6.3 ± 6.0 years, and the body weight index (BMI) was 27.3 ± 2.7 kg/m2. The BMI of the AG was significantly decreased (P = 0.003). In the AG, the visceral fat area and subcutaneous fat area were also significantly decreased (P = 0.018 and P < 0.001, respectively) but not in CG. VO2-AT of the AG was significantly improved, while that of the CG did not change (P = 0.009 and P = 0.115, respectively). The quadriceps muscle mass and the maximal muscle strength of the AG did not change, however, the CG showed a significant decrease. Duration of moderate intensity exercise was correlated with the decrease in total abdominal fat area (r = -0.484; P = 0.011) and that of high intensity exercise was correlated with improvement of cardiopulmonary function (r = 0.414; P = 0.032).
ConclusionDaily moderate intensity aerobic exercise is effective at reducing abdominal fat mass, while high intensity exercise improves cardiopulmonary function.
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Amina A. Al-Awadi, Stuart R. Gray, Ebaa Al-Ozairi
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Fatemeh Kazeminasab, Ali Bahrami Kerchi, Nasim Behzadnejad, Saba Belyani, Sara K. Rosenkranz, Reza Bagheri, Fred Dutheil
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P. Moghetti, S. Balducci, L. Guidetti, P. Mazzuca, E. Rossi, F. Schena, P. Moghetti, S. Balducci, L. Guidetti, F. Schena, P. Mazzuca, E. Rossi
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Hwi Ryun Kwon, Kyung Ah Han, Yun Hyi Ku, Hee Jung Ahn, Bo Kyung Koo, Kyung Wan Min
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Korean Diabetes J. 2009;33(6):511-517. Published online December 1, 2009
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DOI: https://doi.org/10.4093/kdj.2009.33.6.511
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- BACKGROUND
Combination fitness regimens (including aerobic and resistance exercises) are effective for improving cardio-respiratory fitness, reducing visceral fat and increasing insulin sensitivity in diabetic patients. The combination exercise intensity that a patient is capable of is limited by his or her aerobic capacity and one repetition maximum (1RM). We investigated the relationships between 1RM, aerobic exercise capacity and body mass index in patients with type 2 diabetes. METHODS: A total of 177 (men: 85, women: 92) diabetic subjects with HbA1c < or = 10% were enrolled. Muscle strength and 1RM were assessed bychest press (upper body) and leg press (lower body). We assessed aerobic capacity by VO2max and muscle mass by bioimpedance analysis. RESULTS: There was no correlation between 1RM and VO2max in type 2 diabetic patients (upper: P = 0.122, lower: P = 0.138 for men, and upper: P = 0.952, lower: P = 0.570 for women). However, 1RM was significantly correlated with muscle mass both in men and women (upper: r = 0.493, P < 0.001, r = 0.315, P = 0.002 lower: r = 0.437 P < 0.001, r = 0.307, P =0.003, respectively). There was also a significant correlation between 1RM and BMI. In obese male subjects with BMI > or = 25 kg/m2, we observed a significant correlation between muscle mass and BMI (r = 0.374, P = 0.032), but this correlation was not observed in women. CONCLUSION: Clinicians treating Korean type 2 diabetic subjects should recommend resistance exercise to their patients. In particular, obese women with diabetes may receive greater benefits by increasing muscle mass through resistance exercises.
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Kyung Wan Min
Journal of Korean Diabetes.2011; 12(1): 6. CrossRef - The Effects of Resistance Training on Muscle and Body Fat Mass and Muscle Strength in Type 2 Diabetic Women
Hwi Ryun Kwon, Kyung Ah Han, Yun Hyi Ku, Hee Jung Ahn, Bo-Kyung Koo, Ho Chul Kim, Kyung Wan Min
Korean Diabetes Journal.2010; 34(2): 101. CrossRef
Randomized Controlled Trial
- Effects of Aerobic Exercise Intensity on Insulin Resistance in Patients with Type 2 Diabetes Mellitus.
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Yun Hyi Ku, Bo Kyung Koo, Hee Jung Ahn, Ji Yun Jeong, Hee Geum Seok, Ho Chul Kim, Kyung Ah Han, Kyung Wan Min
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Korean Diabetes J. 2009;33(5):401-411. Published online October 1, 2009
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DOI: https://doi.org/10.4093/kdj.2009.33.5.401
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Abstract
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- 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 (deltaBMI: -1.1 +/- 0.7, -0.8 +/- 0.5, deltaTF: -4,647 +/- 3,613 mm2, -2,577 +/- 2,872 mm2, deltaSF: -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.
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Citations
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- Effects of different exercise types on vascular endothelial function in individuals with abnormal glycaemic control: a systematic review and network meta-analysis
Zongxiang Li, Shengyao Luo, Xuebing Bai, Lu Huang, Hongyan Guo, Song Chen, Dan Wang
PeerJ.2025; 13: e19839. CrossRef - Different intensities of aerobic training for patients with type 2 diabetes mellitus and knee osteoarthritis: a randomized controlled trial
Chi Su, Lihua Huang, Shaochen Tu, Shengdi Lu
Frontiers in Endocrinology.2024;[Epub] CrossRef - The anti-inflammatory effects of aerobic exercise training in patients with type 2 diabetes: A systematic review and meta-analysis
Georgia Papagianni, Chrystalla Panayiotou, Michail Vardas, Nikolaos Balaskas, Constantinos Antonopoulos, Dimitrios Tachmatzidis, Triantafyllos Didangelos, Vaia Lambadiari, Nikolaos P.E. Kadoglou
Cytokine.2023; 164: 156157. CrossRef - Effects of Exercise on Inflammatory Cytokines in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials
Xiaoke Chen, Xinzheng Sun, Chenghao Wang, Hui He, Jos L. Quiles
Oxidative Medicine and Cellular Longevity.2020; 2020: 1. CrossRef - Effect of Diabetic Dietary Education Program on Diabetes Knowledge and Dietary Behaviors of Elderly Diabetic Patients
Ji Young Ye, Sung Hee Min, Min June Lee
Korean Journal of Food & Cookery Science.2017; 33(5): 601. CrossRef - Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials
Yilina Liubaoerjijin, Tasuku Terada, Kevin Fletcher, Normand G. Boulé
Acta Diabetologica.2016; 53(5): 769. CrossRef - Letter: Effects of Aerobic Exercise Intensity on Insulin Resistance in Patients with Type 2 Diabetes Mellitus (Korean Diabetes J 33(5):401-411, 2009)
Dong-Lim Kim
Korean Diabetes Journal.2009; 33(6): 547. CrossRef - Response: Effects of Aerobic Exercise Intensity on Insulin Resistance in Patients with Type 2 Diabetes Mellitus (Korean Diabetes J 33:(5)401-411, 2009)
Yun Hyi Ku, Bo-Kyung Koo, Kyung-Wan Min
Korean Diabetes Journal.2009; 33(6): 549. CrossRef
Original Article
- Pedometer-Determined Physical Activity in Type 2 Diabetes in Korea.
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Sang Ah Chang, Jung Min Lee, Tae Seo Sohn, Hyun Shik Son, Sung Woo Park, Sei Hyun Baik, Jae Myung Yu, Yeon Ah Sung, Chul Woo Ahn, Kyung Wan Min, Kyung Ah Han
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Korean Diabetes J. 2007;31(1):83-88. Published online January 1, 2007
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DOI: https://doi.org/10.4093/jkda.2007.31.1.83
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Abstract
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- BACKGROUND
Walking is a popular, convenient and relatively safe form of exercise. However, there is few objective data for walking exercise. The aim of this study was to evaluate pedometer-determined physical activity defined as steps/day in type 2 diabetes mellitus. Therefore, it could be the basic data for programming walking exercise in diabetes mellitus. METHODS: Participants with type 2 diabetes who visited in 6 university hospitals on February, 2006 in Seoul and Kyung-gi area were recruited. The participants were asked their ambulatory activity with the given pedometer and calorimeter for 1 week. Total 240 (Male 122, Female 118) subjects who walked above 1000 steps/day were analyzed. We also collected their biochemical data from the medical records. RESULTS: Participants took 8532 +/- 4130 steps for day (step/day) and energy expenditure were 320 +/- 161 Cal/day. Steps/day was not significantly different between male and female, but energy expenditure was higher in male than female ( P < 0.05). Steps/day was significantly lower in obese patients than non-obese patients (P < 0.001). BMI (r = -0.325, P < 0.001), waist circumference (r = -0.287, P < 0.001), triglyceride (r = 0.164, P < 0.018) showed significant inverse correlation with steps/day, but BUN (r = 0.165, P = 0.019) and HDL-cholesterol (r = 0.164, P = 0.018) were positive correlated with steps/day significantly. BMI (r = -0.14, P < 0.032) and cholesterol (r = -0.139, P < 0.041) showed significantly inverse correlation with energy expenditure and BUN (r = 0.187, P = 0.008) and HDL cholesterol (r = 0.145, P < 0.037) positively correlated with energy expenditure. Pedometer-determined steps/day was positively associated with energy expenditure (r2 = 0.824, P < 0.001). CONCLUSION: This study showed the objective quantification of physical activity measured by simple and inexpensive pedometers. It could be used to recommend walking exercise since the practitioners can estimate steps/day for required energy expenditure.
Randomized Controlled Trial
- The Effects of Aerobic Training Versus Resistance Training in Non-obese Type 2 Diabetics.
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Keun Hee An, Kyung Wan Min, Kyung Ah Han
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Korean Diabetes J. 2005;29(5):486-494. Published online September 1, 2005
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Abstract
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- BACKGOUND: The purpose of this study was to explore the influence of the low intensity resistance exercise training and aerobic exercise training on body composition, physical fitness, and metabolic profiles in non-obese type 2 diabetic patients. METHODS: Participants(N:26) had been randomly assigned to resistance exercise(resistance, N:10), aerobic exercise(aerobic, N:9) and control group(control, N:7). Resistance exercise was carried out at 15~20RM(1RM 60%) and aerobic exercise was carried out at anaerobic threshold(AT). Each exercise group was scheduled to implement the training for twelve weeks, two times per day and five days per week. RESULTS: Body mass index, waist to hip ratio, %fat, FBS, PP2, HbA1c and low-density lipoprotein cholesterol(LDL-C) were significantly decreased after the training period in resistance and aerobic exercise group. Strength endurance, agility and flexibility were significantly improved after the training period in resistance and aerobic exercise groups. There were significant differences in BMI, percent fat, FBS, PP2, METs and HR at anaerobic threshold after the training period in aerobic and control groups. Total cholesterol was significantly decreased after the training period in aerobic exercise groups. Load, heart rate and METs at AT significantly increased after the training period in aerobic group. High-density lipoprotein cholesterol(HDL-C) and balance significantly increased after the training period in resistance group. There were significant differences in strength endurance and agility between two exercise groups and control group. CONCLUSION: This study suggested circuit type resistance exercise might have nearly comparable effects on weight control, body composition, blood glucose control and improvement of insulin resistance in non-obese type 2diabetic patients.
Original Articles
- The Long-term Effect of a Structured Diabetes Education Program for Uncontrolled Type 2 Diabetes Mellitus Patients-a 4-Year Follow-up.
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Min Sun Song, Ki Ho Song, Seung Hyun Ko, Yu Bai Ahn, Joon Sung Kim, Jin Hee Shin, Yang Kyung Cho, Kun Ho Yoon, Bong Youn Cha, Ho Young Son, Dong Han Lee
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Korean Diabetes J. 2005;29(2):140-150. Published online March 1, 2005
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Diabetes mellitus is a chronic illness with many metabolic complications. The prevalence of diabetes mellitus has markedly increased. Until now, however, little data have been presented for the long-term evaluation of a structured diabetes education program (SDEP) for patients with type 2 diabetes mellitus. The aim of this study was to examine the effects of the SDEP on glycemic control, lipid profiles, and self-care behavior over a four-year follow-up period. METHODS: A total of 248 diabetic patients completed the SDEP from December 1999 to September 2000. Ninety-eight patients were followed-up for more than four years and 75 of them were selected for the study, after those subjects having a baseline glycated hemoglobin(HbA1c) levels below 7.9% were excluded. The laboratory data included the glycemic control status(fasting blood sugar and HbA1c), serum creatinine, and lipid profiles. Compliance with their diet, self monitoring of blood glucose, and their exercise frequency were monitored with a questionnaire that was completed by the patients when they visited the hospital. The data were analyzed by using repeated ANOVA measures and chi2 testing for detecting trends. RESULTS: There were no significant decreases in the fasting blood glucose, creatinine, total cholesterol, triglycerides or low density lipoprotein cholesterol for the SDEP group compared with the control group. The self-care behavior of the SDEP group was much better than that of the control group and it was well maintained. Although the self-care behavior tended to deteriorate with time in the SDEP group, the exercise frequency did not change. The HbA1c level was much improved in the SDEP group(HbA1c: SDEP, 7.9+/-1.2% vs. 8.9+/-1.6% for the control; P =0.009). High density lipoprotein(HDL) cholesterol was also relatively improved in the SDEP group(HDL cholesterol: SDEP, 1.1+/-0.2 mmol/L vs. 1.0+/-0.3mmol/L for the control; P=0.006). CONCLUSIONS: The glycemic control status of diabetic patients who undertook the SDEP was satisfactory for one year after the program, although all the habitual compliance measures decreased gradually with time over the total four years. These results demonstrate that the SDEP for patients with diabetes is useful in improving their long-term glycemic control and self-care behavior. Regular and sustained reinforcement with encouragement will be required for the diabetic patients to maintain their self-care
- Maximal Oxygen Uptake (VO2max) and Metabolic Syndrome.
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Mira Kang, Ji Dong Sung, Byung Chul Yoo, Yoon Ho Choi, Sae Young Jae, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Kwang Won Kim, Moon Kyu Lee
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Korean Diabetes J. 2005;29(1):65-71. Published online January 1, 2005
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Abstract
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A number of studies have demonstrated an inverse relationship between cardiorespiratory fitness and metabolic syndrome. However, whether the maximal oxygen uptake (VO2max) is dependent on the number of metabolic components or on particular metabolic component remains to be assessed. METHODS: A total of 1,432 Korean subjects were studied. Each individual was assessed for the presence of metabolic syndrome using the modified NCEP-ATP III criteria. All subjects underwent a graded symptom-limited maximal exercise test to determine their VO2max, using a treadmill according to the Bruce protocol. RESULTS: The age-adjusted prevalence of metabolic syndrome in all subjects was 20.4%. The odds ratios for metabolic syndrome were higher in men, the elderly, the obese and those with a lower VO2max. The difference in the VO2max was dependent only on the presence of metabolic syndrome, not on the number of components. CONCLUSION: There were no significant differences in the VO2max according to the presence of particular metabolic components. These results suggest that the VO2max reflects the metabolic syndrome state, rather than the metabolic components, and might be a factor in determining metabolic syndrome
- Exercise and Fenofibrate Reduces Body Adiposity Synergistically in OLETF Rats.
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Young Jun An, Hre Jeong Lee, Mi Kyoung Park, Kyung Il Lee, In Young Koh, Dong Sik Jung, Ah Young Kang, Duk Kyu Kim
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Korean Diabetes J. 2004;28(2):131-138. Published online April 1, 2004
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Abstract
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- BACKGROUND
The PPAR alpha activator, Fenofibrate, is a pharmacological ligand, which induces beta-oxidation of long chain fatty acids in the mitochondria of hepatocytes. The beta-oxidation induced by exogenous PPAR alpha activators may be operated maximally when the sustained production of energy substrate in the liver is required by working muscles due to continued exercise. The aim of this study was to determine whether the combination therapy of exercise and Fenofibrate could synergistically reduce body adiposity in OLETF rats. METHODS: Twenty-eight male OLETF rats(13 wk old) were divided into four groups. The diet(n=7) and exercise groups(n=7) were fed with chow for 12 weeks. The Fenofibrate(n=7) and combined treatment(exercise and Fenofibrate) groups (n=7) were fed with Fenofibrate(32mg/kg/day) mixed chow for 12 weeks. The animals in the exercise and combined treatment groups were exercised by running on a treadmill for 12 weeks. At 24 weeks of age, all the rats were sacrificed, and examined by biochemical tests and had their adipose tissue weight measured. RESULTS: There were no significant changes in the retroperitoneal and subcutaneous fats between the diet and Fenofibrate groups, but there were between the diet and combined treatment groups(P<0.05). CONCLUSION: Exercise combined with Fenofibrate synergistically reduces body adiposity in OLETF rats
- Clinical Characteristics of Diabetic Patients Controlled by Diet and Exercise.
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Kil Sang Wang, Sung Bae Lee, Hyun Suk Lee, Jae Suk Jeon, Kyung Wan Min, Kyung Ah Han, Eung Jin Kim
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Korean Diabetes J. 1999;23(1):98-107. Published online January 1, 2001
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Abstract
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In order to rnaintain blood glucose in ao acceptable range, some patients with type 2 diabetes mellitus may be able to their level manage with diet and exercise alone, but others require oral agents or insulin. To assess which factors gave important influences on therapeutic methocls, we investigated clinical characteristics and life-style in the type 2 diabetic patients who could be managed with diet and exercise alone. METHODS: We recruited patients with type 2 diabetes mellitus from Eulji Medical College Diabetes Center, who had dieted and exercised for over 3 years (99; group 1) and compared them with patients who were managed with oral agents (130; group 2) or insulin (47; group 3). We conducted the retrospective evaluation of age, sex, duration of DM, initial and recent BM1 (body mass index), serial HbA 1c, skipped period ratio of hospital follow-up, self monitoring of blood glucose (SMBG) or urine sugar, diet and exercise and educational chance for diabetes with dependency of folk remedies. RESULTS: The duration of the DM was significantly shorter in group 1 than in group 2 or 3 (p<0,05). Initial BMI and HbA. were not different among these three groups, but HMI reduction was more decreased in group 1 (p<0.05). The mean HbA, during follow-up was lower in group 1 (p<0.05). The skipped period ratio of hospital follow-up was lower in group 1 (p<0.05). SMBG was less frequent, the meal-time was more regular, extra-snacks were less frequent and folk remedies were rarely tried in group 1. CONCLUSION: This study suggests that the duration of DM, BMI reduction and mean HbA 1c, were associated with the therapeutic method in patients with type 2 diabetes mellitus. We would like to a]so emphasize the importance of SMBG, meal-time regularity, extra-snacks and folk remedies in the education of patients with type 2 diabetes mellitus.
- Effect of Exercise Training on Insulin Sensitivity and Intracellular Glucose Metabolism in Skeletal Muscle of High Fat-fed Rats.
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Chul Hee Kim, Joong Yeol Park, Sung Kwan Hong, Kyong Soo Park, Hong Kyu Lee, Ki Up Lee
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Korean Diabetes J. 1998;22(2):231-242. Published online January 1, 2001
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Abstract
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Insulin resistance is a major characteristic of non-insulin-dependent diabetes mellitus and obesity. Many studies have indicated that increased intake of fat are associated with obesity and insulin resistance. On the other hand, chronic exercise is known to improve insulin sensitivity. However, the mechanisms by which high fat diet induces insulin resistance and exercise trainmg improves insulin sensitivity are not established. This study was undertaken to examine the mechanisms by which high fat diet and exercise training affect the insulin sensitivity in the whole body and in skeletal muscles. METHODS: Male Sprague-Dawley rats were divided into three groups: high fat sedentary group, high fat exercise group, and control(low fat sedentary) group. High fat diet consists of 66.5% fat and 12.5% carbohydrate, and control(low fat) diet consists of 12 5% fat and 66.5% carbohydrate. Exercise training was performed by swimming three hours per day. After 3 weeks, animals underwent hyperinsulinemic euglycemic clamp study to measure whole body glucose metabolic fluxes. Glycogen synthase activity and glucose-6-phosphate (G-6-P) levels were measured in skeletal muscle at the end of the clamp study. RESULTS: In the high fat diet group, whole body glycolysis and glycogen synthesis were decreased. Exercise training reversed the insulin resistance induced by high fat diet by increasing both glycolysis and glycogen synthesis. Glycogen synthase activity in skeletal muscle was reduced in high fat diet group, and it was partially reversed by exercise training. G-6-P level in skeletal muscle was increased in high fat diet group, and it was further increased by exercise training. CONCLUSION: These results suggested that the insulin resistance in high fat diet-fed rats is due to the impairment in glucose metabolism at sites distal to G-6-P, i.e. glycolysis and glycogen synthesis. In contrast, the improvement in insulin sensitivity by exercise training in high fat-fed rats is primarily due to the increased glucose metabolic flux proximal to G-6-P, i.e. glucose transport and phosphorylation.