@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(4):285-292

Background
Type 2 diabetes is the most common type of diabetes that is rapidly increasing due to increased obesity and decreased physical activity [1]. Chronic inflammation in the body can be considered as a stimulant for insulin resistance and type 2 diabetes [2].
Previous Studies
Prospective studies have shown that increased C-reactive protein (CPR) is associated with the prediction and development of diseases such as type 2 diabetes and cardiovascular disease [3]. Also, some fatty hormones like interleukin-10 can significantly stop gene expression and synthesis of pro-inflammatory cytokines [4, 5]. … [6-11].In some studies, after exercise, increased levels of anti-inflammatory cytokines such as interleukin-10 and reduction of inflammatory cytokines have been reported [12, 13]. While in some other studies, after a training period, significant change was not reported in the levels of inflammatory and anti-inflammatory cytokines [14, 15]. … [16-21].
Aim(s)
Given the limited research findings and lack of definite results on the effect of aerobic and resistance training on the levels of inflammatory and anti-inflammatory markers, and that the possible effect and mechanisms of these two exercise in these indices are different, the purpose of this study is comparing the effect of two types of exercise protocols (aerobic and resistance) on interleukin-10, CRP and insulin resistance index in type 2 diabetic women.
Research type
This is a quasi-experimental study with pretest and posttest design.
Research society, place and time
This research was conducted in 2015 among women with type 2 diabetes who had referred to diabetes control centers in Tehran.
Sampling method and number
Criteria for entering the research included: inadequate regular sport during the last 6 months, having a history of type 2 diabetes for more than 6 months, not having any other illness other than diabetes, lack of insulin, weight loss of more than 5% over the past 2 months, the lack of urine protein more than 1 g/dl and no change in blood glucose lowering drugs. From among the subjects with the mentioned conditions, 24 people were selected by random sampling and randomly divided into three groups of eight: aerobic training (experimental group 1), resistance training (experimental group 2) and control groups.
Used devices&materials
The required information was obtained through the completion of medical history forms whose contents were related to diseases, hospitalization or surgical procedures performed in the past, in which there were also questions about the heredity history of diseases. To assess the history of exercise, a daily physical activity questionnaire was used [22-24]. Before the study, anthropometric indices including height, weight, body mass index (BMI) and waist to hip ratio (WHR) were measured in individuals. The weight of the subjects without shoes with the minimum dress was calculated using Scorpio scale (SKA, Germany) with a precision measurement of 0.1 kg. Height was measured using a wall hologram (model 44440, Kaveh Co., Iran) with a precision of ±0.1 centimeter in standing position beside the wall without shoes and while the shoulders were in normal condition. Body mass index (BMI) was calculated by dividing the weight of a person (in kg) by height squared (in m) and the ratio of waist circumference to hip circumference was obtained by dividing waist circumference in the narrowest to the hip circumference in the broadest part. To measure the thickness of the subcutaneous fat, caliper (Lafayet; USA) and to calculate body fat percentage, the Jackson-Pollack seven-point formula (chest, abdomen, thigh, under the shoulder, crown and armpit) were used. Exercise in aerobic group was carried out with 50-65% maximal oxygen demand (VO2 max) and in the resistance group it was carried out with intensity of 60-70%, one maximal repeat (1RM) for 10 weeks (3 60-minute sessions per week). Before the beginning of the exercise, the mean rest heart rate was calculated based on the mean of three-time measurement in the morning. HRrest and HRmax were used to determine the intensity of exercise. The values of 1RM of movement used in the resistance training group was determined using the following formula [25]: IRM=(weight (kg))/(1.0278-(repititionx0.0278)) Resistance training program included foot press, chest press, large back muscle tufts, rowing for the back muscles, sit-ups, and knee presses with 60-70% intensity of one maximum repletion. After 1 maximal repletion test, exercises were started with 60% of 1MR and with 10-times two repetitions. Every two weeks, a new maximum repetition of the subjects was calculated and the weight values were adjusted again. The rate of increase in repetition for each of subject was such that by the end of period, it was upgraded up to 70% of a maximal repetition. The number of repetitions at the end of the course of resistance training reached 4 repetitions of 10. The aerobic exercise program included running on treadmill. At first, the exercise began with an intensity of 50% of the maximal heart rate due the lack of readiness of the subjects and increased to 65% of the maximal heart rate. To measure the maximum oxygen consumption, an incremental test was used that the subjects were running at first at a speed of 3 km/h and zero gradient on the treadmill (MED150 COSMED, Italy), while it was being measured and recorded by the gas analyzer (COSMED s.r.1, Italy). Then every minute, one kilometer per hour was quickly added to the treadmill until the subjects got exhausted. Blood samples were collected in laboratory conditions after 12 hours of fasting, before and 48 hours after the last training session and at 8:00 am, in amount of 10 cc from the left ventricle of the subjects. Blood samples were centrifuged for 15 minutes at a rate of 3000 rpm, stored at -80 ° C for further analysis. Interleukin-10 level was measured by ELISA using the commercial kit (Boster Co., USA). To measure CPR, also, the human kit (Glory, Biotech, USA) was used with a sensitivity of 4 pg/ml. The fasting glucose level was measured by glucose oxidase enzyme, using a kit (Parsazmoon Co., Iran) and measured by an auto analyzer (902 Hitachi, Germany). The insulin concentration was also measured by sandwich ELISA using the research kit (Mercodia, Sweden), and the sensitivity of the mentioned method was 0.75 micro-unit per milliliter. The used device, was ELISA Reader (Sunrise model, Tecan Co., Austria). The index of insulin resistance (Homa-IR) was also calculated using the homeostasis model according to the following formula [26]: HOMA-IR= (Fasting Glucose Concentration (liters per millimol) x insulin concentration (micro unit per milliliter))/22.5 Data were analyzed using SPSS 20 software. To investigate the natural distribution of data, Shapiro-Wilk test was used and to assess the consistency of variances, Levine test was used. Then, the variance analysis with repeated measures was used to compare intra-group and intergroup variance.  
Findings by Text
Participants in the study had the mean age of 51.7±7.5 years and the mean BMI of 27.6±4.2 kg/m2. Interleukin-10 levels in aerobic (p=0.048) and resistance (p=0.013) groups increased significantly in posttest compared to the pretest. Also, interleukin-10 changes in both experimental groups were significantly higher than control group (p<0.05). However, no significant difference was seen between the two experimental groups (p>0.05). CRP concentration had significant decrease compared to the pretest only in the resistance training group (p=0.006; Figure 1). Insulin, fasting glucose, and HMA-IR levels were significantly decreased in the two experimental groups in the post-test compared to the pretest. However, no significant difference was observed between the two experimental groups. Weight, body mass index, and waist to hip ratio did not change significantly in any of the groups (p>0.05). The percentage of body fat decreased only in the resistance training group (p=0.034). None of the studied variables were changed in the control group for 10 weeks (p>0.05, Table 1).
Main comparison to the similar studies
… [27-29]. Soheili et al. reported significant changes in IL-10 values after 12 weeks of endurance and resistance training protocol in inactive women, and no difference was observed between the two types of protocols in this domain [30]. Dongx et al. in their investigation of the effect of resistance and aerobic exercises on CPR level, observed the decrease in the level of CPR only after resistance exercises [31]. … [32-39]. Also, the studies done by Sue et al. [40] and Shamseldinini et al. [41] showed improvement in fasting glucose level, insulin and insulin resistance index after 10 weeks of aerobic and resistance training.
Suggestions
It is suggested that the mentioned issues be considered by the researchers in the following studies.
Limitations
The lack of control of the levels of interleukin-6 and TNF-α, the lack of control of the physical activity of the study groups outside the study time, the lack of control of the genetic characteristics affecting diabetes and the lack of complete control of the psycho-mental conditions of the subjects during the research were the limitations of the research.
Conclusions
10 weeks of exercise activity of two types of resistance and aerobic improves the levels of fasting glucose, insulin, insulin resistance index, and increased IL-10 anti-inflammatory cytokines in type 2 diabetic women. Also, resistance training with an intensity of 60-70% of a maximal repeat in these individuals reduces CPR.
Acknowledgments
We appreciate all the subjects who helped us with our research.
Conflict of interest
Non-declared
Ethical Permissions
The volunteers completed the written consent form and expressed their readiness to participate in the study.
Funding Sources
The study was conducted without financial support.

TABLES and CHARTS

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