Improve insulin sensitivity through exercise -
Moreover, the link between physical activity and insulin was stronger in male individuals. Conclusion: This study shows that physical activity can significantly lower insulin levels, and high-intensity physical activity still has additional potential benefits for insulin levels, even in the condition of dyslipidemia and hyperuricemia.
Insulin resistance IR is defined as an impaired biologic response to glucose disposal and insulin stimulation of target tissues mainly the liver, muscle, and adipose tissue , leading to a compensatory increase in beta-cell insulin production and hyperinsulinemia.
IR can result in a series of metabolic consequences, such as dyslipidemia, hyperglycemia, visceral adiposity, hyperuricemia, hypertension, endothelial dysfunction, a prothrombotic state, and elevated inflammatory response Freeman and Pennings, Fasting hyperinsulinemia was observed to precede the development of other characteristics of the syndrome, such as hypertension, hypertriglyceridemia, and low high-density lipoprotein cholesterol HDL-c by Haffner et al.
Barnard et al. It is worth noting that IR is a key metabolic feature of obesity, type 2 diabetes mellitus T2DM , and even type 1 diabetes mellitus T1DM , and is associated with an increased risk of micro- and macro-vascular problems.
It is increasingly becoming apparent that, even in the absence of diabetes, there is a link between IR and cardiovascular disease CVD; Howard et al. Therefore, improving insulin sensitivity is an important part of preventing insulin resistance, diabetes, and CVD.
Physical activity PA improves insulin sensitivity in both normal and insulin-resistant people. Evidence suggests that insulin resistance i.
Thus, PA has been proposed for treating diabetes mellitus Aune et al. Several recent epidemiological studies have found a link between PA and the occurrence of T2DM Eriksson and Lindgarde, ; Manson et al. Through numerous changes in glucose transport and metabolism, PA enhances the effect of exercise on insulin sensitivity Borghouts and Keizer, Therefore, aerobic exercise is generally considered the most adequate mode of exercise for improving insulin sensitivity.
It is well known that, in addition to controlling blood glucose levels, insulin regulates lipid metabolism by promoting lipid synthesis in the liver and fat cells while inhibiting lipolysis. Notably, PA may cause beneficial changes in lipid metabolism as well as improvements in hepatic glucose output regulation.
Based on pathophysiological and metabolic studies, hyperuricemia and IR are likely to interact. Hyperuricemia plays a role in the pathogenesis of T2DM, and insulin resistance by increasing inflammation recreation and oxidative stress Lanaspa et al. IR, on the other hand, decreases uric acid excretion by increasing renal tubular sodium reabsorption and so producing hyperuricemia Ter Maaten et al.
Longitudinal studies on this issue have yielded inconsistent results. Increased uric acid levels have been linked to an increased risk of IR in several studies Krishnan et al. Alternatively, IR might be a risk factor for later hyperuricemia on its own Nakamura et al.
According to the findings of these studies, the dynamic of the temporal relationship between hyperuricemia and IR is likely complex, as changes in one may precede those in the other. Indeed, multiple studies in recent decades have demonstrated that increasing PA and cardiorespiratory fitness has a positive impact on each of the metabolic syndrome components high waist circumference, dyslipidemia, hypertension, and insulin resistance; Duncan, ; Church, ; Zhang et al.
However, there are currently no relevant studies evaluating the effect of PA on insulin levels under different levels of lipid indices TG, LDL-c, and HDL-c and SUA. This study explored the association between PA and insulin under different levels of lipid indices and SUA using a representative sample from the National Health and Nutrition Examination Survey NHANES.
The National Health and Nutrition Examination Study NHANES , which is a representative survey of the national population in the United States, was conducted by the Centers for Disease Control and Prevention CDC.
Using a complicated, multistage, and probabilistic sampling approach, this study provides a wealth of information about the nutrition and health of the overall US population Curtin et al. This cross-sectional study analyzed the data collected from to , representing five cycles of the NHANES.
Notably, signed informed consent had been obtained from each participant during data collection. The physical activity the exposure variable of participants between and was based on the Global Physical Activity Questionnaire GPAQ; Hallal et al.
PA was then categorized into three levels low, moderate, and high according to the suggested MET score Ainsworth et al. Insulin, the outcome variable, was measured by human insulin immunoassay using ROCHE ELECSYS at the Fairview-University Medical Center University Campus Collaborative Studies Clinical Laboratory Minneapolis, Minnesota between and The immunoenzymometric assay TOSOH AIA Chemistry Analyzer was then used to measure insulin between and at the University of Missouri Columbia.
Extensive quality control processes were performed by the analytical laboratory. External calibration was performed using whole-blood resources from the National Institute of Standards and Technology. The primary outcome was to determine the association between PA and insulin levels.
Therefore, the results of the adjusted potential confounders model analyses were presented based on the recommendations of the STROBE statement von Elm et al. All statistical analyses were performed using Empower Stats 2.
Participants were divided into three groups based on the intensity of PA. In the association analyses, a weighted multivariate logistic regression model was used to explore the relationship between PA and insulin. The weighted multivariate regression model also analyzed the association between the SUA, lipid indices LDL-c, HDL-c, and TG , and PA predictor , and insulin levels outcome , and SUA, LDL-c, HDL-c, and TG were all analyzed as categorical variables and classified into three groups tertiles.
SUA T1, T2, and T3 , LDL-c T1, T2, and T3 , TG T1, T2, and T3 , and HDL-c T1, T2, and T3 have different cut-off values indicated at the footnote of each table. Subgroup analyses were also performed based on sex. To further explain the association between PA predictor and insulin levels outcome.
The participants were classified into diabetes and non-diabetes subgroups according to clinical diagnoses. Sensitivity analysis was performed based on participants without diabetes status.
The nonlinear link between SUA, LDL-c, HDL-c, TG, and insulin was further evaluated using smooth curve fits and generalized additive models. Results showed that the mean values of HbA1c, glucose, BMI, WC, TG, creatinine, insulin, BUN, and SBP were significantly lower in the high-intensity PA group than in the other two groups.
However, the mean values of HDL-c, AST, ALT, and DBP levels were significantly higher in the high-intensity PA group than in the other two groups.
Table 2 shows the results of the multivariate regression analyses. Forest plot showed the crude subgroup analyses on the effect of PA on insulin Figure 1. In the unadjusted analyses, negative associations were observed between PA and insulin in all stratified analyses. Figure 1. Crude subgroup analyses on effect of physical activity on insulin.
Supplementary Figure S1A shows that there was a positive correlation between SUA level and insulin, and the level of insulin decreased as the intensity of PA improved under the same SUA level Supplementary Figure S1B.
Table 3 shows the interactive analyses between SUA and PA on the level of insulin. Table 3. The association between physical activity and insulin grouped by SUA, LDL-c, HDL-c, and TG tertiles. There was a negative correlation between LDL-c and insulin, and the level of insulin decreased as the intensity of PA improved under the same LDL-c level Supplementary Figure S2.
Table 3 shows the β values of insulin associated with diverse levels of PA among participants grouped based on LDL-c tertiles.
After adjusting for potential confounders, a similar significant decrease in the level of insulin was observed among male participants in the lower and the upper tertiles. However, in females Supplementary Table S1 , the multivariate logistic regression confirmed that only participants in the upper LDL-c tertile had a significant decrease in the level of insulin, with a gradual decrease as the intensity of physical exercise increased.
There was also a negative correlation between HDL-c and insulin, and the level of insulin decreased as the intensity of PA improved under the same HDL-c level Supplementary Figure S3.
Table 3 shows the β value of insulin associated with an increase in PA among participants grouped by HDL-c tertiles. Similarly, the β value of insulin gradually decreased across male participants in the first HDL-c tertile. Meanwhile, in second HDL-c tertile, only participants in the high-intensity PA group had a significant decrease in the level of insulin.
Notably, there was no significant statistical difference in the third HDL-c tertile. In females Supplementary Table S1 , the β value of insulin only reduced for participants in the high-intensity PA group under the third HDL-c tertile.
Furthermore, there was a positive correlation between TG and insulin, and the level of insulin decreased as the intensity of PA improved under the same TG level Supplementary Figure S4. Table 3 shows the β value of insulin associated with an increase in PA among participants grouped based on TG tertiles.
Similarly, the β value of insulin gradually decreased across male participants in the first and second TG tertiles. However, there was no significant difference in the third TG tertile. In females Supplementary Table S1 , the β value of insulin only decreased in the high-intensity PA group under the first TG tertile.
It is necessary to consider DM as an important confounding factor. A sensitivity analysis was performed based on whether the participant was diagnosed with diabetes, and the relationship between PA and insulin was observed in participants without diabetes.
Multivariate logistic regression showed that PA was also negatively correlated with insulin levels in participants without diabetes. When grouped by SUA tertiles, LDL-c tertiles, HDL-c tertiles, and TG tertiles, respectively, high-intensity PA significantly decreased insulin levels in three tertiles of SUA, HDL-c, TG, and in T2 and T3 of LDL-c Figure 2 and Supplementary Table S2.
Moreover, the link between PA and insulin was also stronger in males Table 4 and Supplementary Table S2. Table 4. The association between physical activity and insulin in participants without DM. Figure 2. Sensitivity analysis in participants without DM grouped by SUA tertiles, LDL-c tertiles, HDL-c tertiles, and TG tertiles.
A—C The association between physical activity and insulin grouped by SUA tertiles in participants without DM. D—F The association between physical activity and insulin grouped by LDL-c tertiles in participants without DM.
G—I The association between physical activity and insulin grouped by HDL-c tertiles in participants without DM. J—L The association between physical activity and insulin grouped by TG tertiles in participants without DM.
In subgroup analysis stratified by SUA, HDL-c, LDL-c, and TG tertiles, the model is not adjusted for SUA, HDL-c, LDL-c, and TG, respectively. It is well known that PA improves IR Sampath Kumar et al. Herein, our logistic regression analyses showed that increased intensities of PA could significantly reduce insulin levels, and this tendency persisted in different stratified analysis.
The link between PA and insulin persisted even after adjusting for confounding factors, independent of gender. High-intensity PA significantly lowered insulin levels in the lower and higher SUA tertiles, and in three tertiles of lipid indices LDL-c, HDL-c, and TG in the general population.
In addition, the association between PA and insulin was stronger in male individuals than in females, and sensitivity analysis observed similar link between PA and insulin in participants without DM. Collectively, these results revealed that different intensities of PA had different effects on insulin under different lipid indices LDL-c, HDL-c, and TG and SUA levels.
To the best of our knowledge, this is the first study to show the association between PA and insulin under different levels of SUA and lipid indices LDL-c, HDL-c, and TG. Insulin is the only hormone in the body that reduces blood glucose while also promoting the production of glycogen, fat, and protein.
Insulin resistance occurs when the pancreas secretes a substantial amount of insulin to maintain glucose levels in the normal range. Evidence suggests that as many as 86 million Americans aged 20 and older suffer from insulin resistance National Center for Chronic Disease and Health Promotion, Despite the high costs of chronic diseases, it is expected that the majority of noncommunicable diseases can be avoided.
Physical inactivity is a big risk factor, and hence, PA is an obvious remedy, in addition to a poor diet, cigarette use, and problematic alcohol consumption. This study found that increased intensities of PA can considerably reduce insulin levels, with high-intensity PA exhibiting the best results.
Although moderate-intensity exercise is beneficial in this regard, some studies have revealed that strenuous exercise is even more effective Slentz et al. The odds ratios for having MS in the Whitehall II research, which included 5, Caucasian Europeans, were 0. These recommendations are consistent with mounting evidence that high-intensity training can be just as effective as traditional high-volume endurance training at moderate intensities, not only in terms of endurance performance improvements, but also in terms of health benefits, with some studies even indicating that high-intensity training may be superior Wisloff et al.
The above recommendations, undoubtedly, better support our results. This study confirmed that SUA and insulin were positively correlated. The strong intercorrelation between hyperuricemia and IR has been well demonstrated in previous studies.
Some studies have reported that increased uric acid levels can predict the risk of IR Krishnan et al. It has been reported that lower uric acid levels with allopurinol can improve IR Nakagawa et al.
In this study, results obtained in the lower and higher SUA tertiles also showed that high-intensity PA could significantly reduce insulin levels. The underlying mechanism of this association may be clarified from the aspect of redox in the body.
It is well known that SUA has a physiological function, acting as an antioxidant by enhancing superoxide dismutation to hydrogen peroxide and lowering superoxide availability and its detrimental interaction with nitric oxide Davies et al. When the level of uric acid gradually rises, it will produce pro-oxidant properties.
Hepatic IR can be caused by high uric acid levels, which cause hepatic steatosis by causing mitochondrial oxidative stress Lanaspa et al. Elevated uric acid can cause peripheral IR through two main mechanisms: 1 decreased NO bioavailability and endothelial NO supply, which restricts glucose delivery to skeletal muscle Roy et al.
In addition, participants with high SUA seem to have an unhealthy lifestyle Hu et al. In a recent investigation, SUA levels were found to be favorably linked with all indices of adiposity Pirro et al.
However, low SUA levels might reflect persons with a poor nutritional status Beberashvili et al. Therefore, low SUA levels represent reduced total antioxidant capacity.
Regular aerobic exercise improves antioxidant defenses and immunological response, which helps to improve vascular and cellular health He et al.
Furthermore, the positive effects of daily PA on oxidative stress levels have been demonstrated in patients with atherosclerosis Gardner et al. To reduce oxidative damage, cells increase de novo synthesis of antioxidant enzymes during persistent exercise training.
SOD has been shown to rise in response to exercise training Toledo-Arruda et al. Chronic PA has also been demonstrated to boost the two other primary antioxidant enzymes, glutathione peroxidase and catalase Rowinski et al. These results obtained in this study suggested that high-intensity PA still reduced insulin levels under conditions of oxidative stress of the body, possibly because PA can not only reduce weight, but also stabilize oxidative stress levels in the body, thereby increasing insulin sensitivity and reducing insulin levels.
It is well known that both insulin resistance and insulin secretion defects are two core mechanisms during the development of DM. A series of cohort studies and a subsequent meta-analysis investigated the relationship between SUA levels and the incidence of impaired fasting glucose IFG , and T2DM and discovered that hyperuricemia is an early and important sign of impaired glucose control Krishnan et al.
Therefore, sensitivity analysis was performed in participants without DM. Interestingly, we observed that high-intensity PA reduced insulin levels at all levels of SUA. This may be related to the antioxidant of SUA itself and the complicated relationship between SUA and IR and DM, but the specific mechanism needs further epidemiological research and basic experimental studies to confirm.
In this study, we found a positive correlation between TG and insulin, and a negative correlation between LDL-c, HDL-c, and insulin. It is widely recognized that insulin resistance IR plays a critical role in the pathogenesis of dyslipidemia. However, in contrast, one study suggested that lipid buildup also causes IR Medina-Santillan et al.
Studies have shown that IR impacts the metabolism of triglycerides, HDL-c, and low-density lipoprotein cholesterol LDL-c through several mechanisms Grundy, ; Festa et al. Increased levels of hepatic triglyceride lipase HTGL have also been associated with IR, which may result in faster HDL-c clearance and lower HDL-c levels Baynes et al.
It should be noted that IR and dyslipidemia are risk factors for CVDs and DM. Recent research on the relationship between physical inactivity and CVD has yielded sobering results, showing that physical inactivity is a potential risk factor that considerably increases susceptibility to CVD Erlichman et al.
In an RCT study, which the overall effects of PA were analyzed by quartiles of daily steps of all subjects, there were significant reductions in total and LDL cholesterol and visceral fat area between the highest daily steps over 6, and the lowest quartile —2, daily steps and they confirmed that habitual and structured PA with the acceleration levels of 0.
Furthermore, PA has been used as a therapeutic strategy for the prevention of CVD and DM Pearson et al. Previous studies have focused on that PA not only improves IR, but also improves lipid homeostasis Herzig et al.
In our study, however, the high-intensity PA effects on insulin were statistically significant regardless of changes in lipid indices TG, HDL-c, and LDL-c levels and other confounding factors.
The improvement in the insulin levels of our participants appeared to be mostly an independent outcome and is not affected by lipid levels.
Our new results in sensitivity analysis also confirmed that the change in PA had an independent effect on insulin levels regardless of the levels of lipid indices TG, HDL-c, and LDL-c in participants without DM, and these results may reflect the effects of PA on insulin signaling in the skeletal muscle Despres et al.
Interestingly, we found that the relationship between PA and insulin was more pronounced in men. According to numerous research conducted predominantly in male populations Lehtonen and Viikari, ; Huttunen et al. Recent studies have revealed that sex hormones may play a role in the control of insulin receptors Bertoli et al.
In addition, there are gender differences in substrate utilization during exercise Ruby and Robergs, However, the role of sex hormones in this pathway is unclear, and thus further methodological studies should be conducted.
However, the study had some limitations. To begin with, the cross-sectional study design did not rule out the possibility of a causal link between SUA, lipid, and insulin levels. Second, we were unable to rule out the impact of underlying disorders and medications, particularly hypoglycemic medicines, on the outcomes.
Further basic mechanism research and a large population-based sample should be conducted in a prospective manner to solve these constraints. In conclusion, this study shows that PA can significantly lower insulin levels, and high-intensity PA still has additional potential benefits for insulin levels, even in the condition of dyslipidemia and hyperuricemia.
When properly programmed, regular PA can not only reduce risk factors for a range of noncommunicable diseases, such as CVD, sarcopenia, metabolic syndrome, osteoporosis, and depression, but also increase physical performance strength, power, and endurance , physical, and mental health.
Unlike medication, PA typically has no adverse effects, is inexpensive, cures multiple health concerns at once, and may have extra potential advantages.
The datasets presented in this study can be found in online repositories. YL and RF: conceptualization. YL, RF, ZH, and JL: methodology. YX: validation, resources, and project administration. YL, RF, and JL: formal analysis.
YX and XY: investigation. YL, RF, and ZH: writing — original draft preparation. YX, YZ, and XY: writing — review and editing. YX and YZ: funding acquisition. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. The authors appreciate the time and effort given by participants during the data collection phase of the NHANES project. Ainsworth, B. Compendium of physical activities: a second update of codes and MET values.
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Differences in insulin receptors between men and menstruating women and influence of sex hormones on insulin binding during the menstrual cycle.
Bird, S. The study, recently published in JCI Insight , found that 8 weeks of exercise improved insulin sensitivity in the brain among adults with obesity. Excess abdominal fat visceral adipose tissue is one of the main risk factors for developing insulin resistance.
For the study, researchers observed 14 women and 7 men between the ages of 21 and 59 years with a body mass index BMI of They used an MRI to measure insulin sensitivity in the brain during pre-endurance training and post-endurance training.
In addition, improved insulin sensitivity in the brain boosted metabolism , reduced feelings of hunger, and reduced abdominal fat. According to Kullman, aerobic training improved insulin sensitivity in the brain, which was related to lower feelings of hunger and visceral adipose tissue.
Endurance exercises, like those performed in the study, are effective when it comes to improving insulin resistance. Nancy Mitchell , RN, a geriatric nurse, explained that endurance exercises work to keep your heart rate up for prolonged periods, even after a workout.
Muscle is highly metabolic tissue because it demands high energy to recover from exercise. Mitchell added that weighted exercises, swimming, or brisk walking are enough to activate your muscles and elevate your heart rate.
Rekha Kumar, endocrinologist and head of medical affairs at Found , a weight management program. Another health concern of insulin resistance is the risk of developing type 2 diabetes. Healthy insulin activity in sedentary adults with obesity can be achieved after 8 weeks of exercise, according to a new study.
The findings also show a link between restored insulin sensitivity and improved metabolism, decreased hunger, and weight loss. The results are encouraging, which could point health experts toward effective therapies to help treat obesity and type 2 diabetes.
Despite the promising findings, however, study authors noted that more vigorous research is still needed. You may wish to talk with your healthcare professional for more guidance. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
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