Effects of a 9 months exercise training on inflammatory markers in type 2 diabetic patients

Antina Schulze, DDS.2, Joachim Thiery, MD3, Martin Busse, MD1

General Outpatient Ambulance1, Dental Ambulance2 of the Institute of Sports Medicine,
Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnosis3, University of Leipzig
(1Director: Prof. M.W. Busse, MD)
(2Head: A. Schulze, DDS)
(3Director: Prof. J. Thiery, MD)

Summary

Schulze A, Thiery J, Busse M. Effect of a 9 months exercise training on inflammatory markers in type 2 diabetic patients. Clinical Sports Medicine International (CSMI) 2010, 4: 8-11.

Purpose:Desired effects of a rehabilitative training are: Decreases in inflammation and lipid risk factors, decreases in fasting blood glucose and HbA1c, increases in cardiopulmo­nary capacity. Though the beneficial effects of intense training are well established, no statistical relevance of such training regimens has been described. So it is the most important prerequisite for a lasting acceptance, that the intervention is only moderate and not stressing. Therefore a major aim of present life style studies should be the evaluation of the lowest but still effective intensity of rehabilitative training.

Materials and methods:33 type 2 diabetic subjects (17 females, 16 males, 63,8 ± 6,9years, weight 99,2 ± 17,6kg, height 167,6 ± 9,6cm, BMI 35,3 ± 5,3, HbA1c 6,4 ± 0,76%) with insulin regimen exercised two times/week. The first session consisted of 45min endurance training (cycle-, rowing-ergometer, tread mill) and 15min pulley exercises. The second session consisted of 45 minutes of supervised moderate swimming. The program started out with low intensity training and was continuously increased according to the individuals` increasing endurance capacity. The participants frequency of cycle-ergometry training sessions in nine months was 40,5 ± 9,7, and 13 times per each 3 months period. At baseline, after three, six and nine months, fasting blood samples for measurement of inflammatory markers (IL-6, TNF-α, s-CRP) and lipid markers (triglyceride, cholesterol, HDL, LDL) were obtained. Laboratory analyses were performed at 8h after a 12h overnight fast. No health and nutrition intervention was conducted. There was no relevant change in medication throughout the study period. Exclusion criteria were: acute/chronic infections, antibiotic therapy, rheumatoid diseases. No regular physical exercise was done from any patient before the study, most of them did not work.

Results:Rehabilitative training resulted in a significant increase in TNF-α (12,27 ± 7,93 vs. 15,12 ± 9,58pg/l, p<0,002 after 6 months and 14,89 ± 9,25pg/l, p<0,001 after 9 months). Interleukin-6 was reduced, significantly after 3 months (4,3 ± 7,02 vs. 3,92 ± 6,68pg/l), whereas s-CRP remained unaffected. HbA1c (6,4 ± 0,76 vs. 6,51 ± 0,73%) also remained nearly unchanged. Marked changes were seen in endurance capacity (103% increase), and exercise blood pressure (145,3±14,4 : 74,9±6,7 vs. 137,5±17,6:67,2 ± 6,5torr after 9 months), and blood pressure at rest (142,4 ± 19,2:81,6 ± 11,2 vs. 135,6 ± 7:76,7 ± 9,8torr). Circulatory risk factors were also markedly decreased (triglycerides, LDL).

Conclusion: Even moderate and few endurance/resistance training may improve systemic low grade inflammation as represented by s-CRP. This in turn may be a reason for an improvement of insulin resistance. The role of TNF-α for diabetes in contrast remains further unclear.

Keywords: diabetes, exercise training, physical exercise, inflammatory markers, inflammation, s-CRP, TNF-α