@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(3):237-245
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(3):237-245
Effect of 12 Weeks of Intensive Interval and Combined Training on Apolipoprotein A and B, Visfatin and Insulin Resistance in Overweight Middle-Aged Women with Type 2 Diabetes
ARTICLE INFO
Article Type
Original ResearchAuthors
Hosseinian M. (1)Banitalebi E. (*)
Amirhosseini S.E. (1)
(*) Sport Sciences Department, Human Sciences Faculty, University of Shahrekord, Shahrekord, Iran
(1) Sport Sciences Department, Human Sciences Faculty, Yasouj Branch, Islamic Azad University, Yasouj, Iran
Correspondence
Address: Department of Sport Sciences, Human Sciences Faculty, Shahrekord University, Rahbar Street, Shahrekord, Iran. Postal Code: 881754122Phone: +983832326385
Fax: +983832326385
banitalebi.e@gmail.com
Article History
Received: December 10, 2015Accepted: June 8, 2016
ePublished: June 30, 2016
ABSTRACT
Aims
Probabely through improvements in the levels of apolipoproteins (ApoA and ApoB) and visfatin, the sport activities helps to reduce the risks of cardio-vascular diseases in the diabetic persons. The aim of this study was to compare the effects of intensive interval and combined trainings on the levels of ApoA and ApoB, visfatin, and insulin resistance in the middle-aged women with Type II diabetes.
Materials & Methods In the semi-experimental study, 52 middle-aged female patients with Type II diabetes were studied in Shahr-e-Kord in 2015. The subjects, selected by convenience sampling method, were randomly divided into three groups, incluing simultaneous strength-endurance training, interval intensive training, and control groups. 12-week trainings, composed of three endurance training sessions per week with 60% of maximum heart rate and two resistance training sessions per week with 70% of one maximum repetition, were done in strength-endurance group. Three training sessions per week with 4-10 repetition of 30-second Wingate test on the ergometer were conducted in interval intensive training group with maximum effort. Data was analyzed by SPSS 21 software using dependent T test, covariance analysis, and LSD test.
Findings At the post-test stage and following interval intensive trainings, ApoA reduction (p=0.03) and ApoB/ApoA (p=0.01) were significant. However, no significant difference was observed in combined group. The levels of visfatin and serum insulin and insulin resistance index significantly decreased in both training groups (p<0.01).
Conclusion The interval intensive trainings further affect the levels of blood apolipoprotein, visfatin, and insulin resistance in the middle-aged women with Type II diabetes, than the combined endurance-resistance trainings.
Materials & Methods In the semi-experimental study, 52 middle-aged female patients with Type II diabetes were studied in Shahr-e-Kord in 2015. The subjects, selected by convenience sampling method, were randomly divided into three groups, incluing simultaneous strength-endurance training, interval intensive training, and control groups. 12-week trainings, composed of three endurance training sessions per week with 60% of maximum heart rate and two resistance training sessions per week with 70% of one maximum repetition, were done in strength-endurance group. Three training sessions per week with 4-10 repetition of 30-second Wingate test on the ergometer were conducted in interval intensive training group with maximum effort. Data was analyzed by SPSS 21 software using dependent T test, covariance analysis, and LSD test.
Findings At the post-test stage and following interval intensive trainings, ApoA reduction (p=0.03) and ApoB/ApoA (p=0.01) were significant. However, no significant difference was observed in combined group. The levels of visfatin and serum insulin and insulin resistance index significantly decreased in both training groups (p<0.01).
Conclusion The interval intensive trainings further affect the levels of blood apolipoprotein, visfatin, and insulin resistance in the middle-aged women with Type II diabetes, than the combined endurance-resistance trainings.
CITATION LINKS
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[2]Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med. 2008,8(1):21.
[3]Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165(18):2114-20.
[4]Rawal LB, Tapp RJ, Williams ED, Chan C, Yasin S, Oldenburg B. Prevention of type 2 diabetes and its complications in developing countries: A review. Int J Behav Med. 2012;19(2):121-33.
[5]Erqou S, Thompson A, Di Angelantonio E, Saleheen D, Kaptoge S, Marcovina S, et al. Apolipoprotein(a) isoforms and the risk of vascular disease: Systematic review of 40 studies involving 58,000 participants. J Am Coll Cardiol. 2010;55(19):2160-7.
[6]Mashaykhi NR, Sadrneya S, Acherei A, Javaheri J, Ahmadlou M. The correlation between serum Apo lipoprotein A1 and Apo lipoprotein B with coronary artery disease and its severity. Arak Med Univ J. 2013;16(75):82-9.
[7]Boden WE. High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease: Assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. The Am J Cardiol. 2000;86(12A):19L-22.
[8]Fonseca-Alaniz MH, Takada J, Alonso-Vale MIC, Lima FB. Adipose tissue as an endocrine organ: From theory to practice. J Pediatr. 2007;83(Suppl 5):S192-203.
[9]Mazaki-Tovi S, Romero R, Kusanovic JP, Vaisbuch E, Erez O, Than NG, et al. Maternal visfatin concentration in normal pregnancy. J Perinat Med. 2009;37(3):206-17.
[10]Francischetti EA, Genelhu VA. Obesity–hypertension: An ongoing pandemic. Int J Clin Pract. 2007;61(2):269-80.
[11]Earnest CP. Exercise interval training: An improved stimulus for improving the physiology of pre-diabetes. Med Hypotheses. 2008;71(5):752-61.
[12]Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(6):1433-8.
[13]Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: Review, synthesis and recommendations. Sports Med. 2014;44(2):211-21.
[14]Safarzade A, Rohi H, Fathi R, Talebi-Garakani E. Effect of progressive resistance training on serum amyloid A and apolipoprotein AI levels in diabetic Rats. Koomesh. 2013;15(1):22-30. [Persian]
[15]Pourvaghar MJ, Shahsavar A, Bahram ME. The effect of a single bout of severe aerobic exercise on apolipoproteins A, B and some serum lipid profiles. Feyz. 2015;18(6):585-91. [Persian]
[16]Ketabi Poor SM, Koushkie Jahromi M. Effeet of aquatic aerobic training on serum A and B apoproteins and lipoproteins in obese and normal weight menopause women. Arak Med Univ J. 2014;17(8):44-52. [Persian]
[17]Esfarjani F, Rashidi F, Marandi SM. The effect of aerobic exercise on blood glucose, lipid profile and apo. J Ardabil Univ Med Sci. 2013;13(2):132-41. [Persian]
[18]Sadeghi M, Roohafza H, Afshar H, Rajabi F, Ramzani M, Shemirani H, et al. Relationship between depression and apolipoproteins A and B: A case-control study. Clinics. 2011;66(1):113-7.
[19]Habibi N, Marandi SM. Effect of 12 weeks of yoga practice on glucose, insulin and triglycerides serum level in women with diabetes type II. J Gorgan Univ Med Sci. 2014;15(4):1-7. [Perisan]
[20]Smith MJ. Sprint interval training [Internet]. United States: Strength Coach [Updated 2010 December 15; Cited 2008 March 5]. Available From: http://www.strengthcoach.com/public/1665.cfm.
[21]Hurst RA. The effects and differences of sprint interval training, endurance training and the training types combined on physiological parameters and exercise performance [Dissertation]. United Kingdom: University of Hertfordshire Research Archive; 2014.
[22]Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circ. 2003;107(24):3109-16.
[23]Giada F, Zuliani G, Baldo-Enzi G, Palmieri E, Volpato S, Vitale E, et al. Lipoprotein profile, diet and body composition in athletes practicing mixed an anaerobic activities. J Sports Med Phys Fitness. 1996;36(3):211-6.
[24]Behre C, Bergstrom G, Schmidt C. Moderate physical activity is associated with lower ApoB/ApoA-I ratios independently of other risk factors in healthy, middle-aged men. Angiol. 2010;61(8):775-9.
[25]Larose J, Sigal R, Khandwala F, Kenny G. Comparison of strength development with resistance training and combined exercise training in type 2 diabetes. Scand J Med Sci Sports. 2012 Aug;22(4):e45-54.
[26]Gibala MJ, Little JP, Van Essen M, Wilkin GP, Burgomaster KA, Safdar A, et al. Short‐term sprint interval versus traditional endurance training: Similar initial adaptations in human skeletal muscle and exercise performance. J Physiol. 2006;575(Pt 3):901-11.
[27]Hovanloo F, Arefirad T, Ahmadizad S. Effects of sprint interval and continuous endurance training on serum levels of inflammatory biomarkers. J Diabetes Metab Disord. 2013;12:22.
[28]Haider DG, Pleiner J, Francesconi M, Wiesinger GnF, Müller M, Wolzt M. Exercise training lowers plasma visfatin concentrations in patients with type 1 diabetes. J Clin Endocrinol Metab. 2006;91(11):4702-4.
[29]Berndt J, Klöting N, Kralisch S, Kovacs P, Fasshauer M, Schön MR, et al. Plasma visfatin concentrations and fat depot–specific mRNA expression in humans. Diabetes. 2005;54(10):2911-6.
[30]Erdem G, Naharci Mi, Demirtaş A, Erçin Cn, Tapan S, Taşçi İ, et al. Therapeutic lifestyle change intervention in metabolic syndrome decreases plasma visfatin levels. Anatol J Clin Investig. 2008;2(2):58-62.
[31]Seo D, So WY, Ha S, Yoo EJ, Kim D, Singh H, et al. Effects of 12 weeks of combined exercise training on visfatin and metabolic syndrome factors in obese middle-aged women. J Sports Sci Med. 2011;10(1):222-6.
[32]Haus J, Solomon TP, Marchetti CM, O'Leary VB, Brooks LM, Gonzalez F, et al. Decreased visfatin after exercise training correlates with improved glucose tolerance. Med Sci Sports Exerc. 2009;41(6):1255-60.
[33]Choi K, Kim J, Cho G, Baik S, Park H, Kim S. Effect of exercise training on plasma visfatin and eotaxin levels. Eur J Endocrinol. 2007;157(4):437-42.
[34]Brema I, Hatunic M, Finucane F, Burns N, Nolan J, Haider D, et al. Plasma visfatin is reduced after aerobic exercise in early onset type 2 diabetes mellitus. Diabetes Obes Metab. 2008;10(7):600-2.
[35]Wassink AM, Olijhoek JK, Visseren FL. The metabolic syndrome: metabolic changes with vascular consequences. Eur J Clin Invest. 2007;37(1):8-17.
[36]Saddi-Rosa P, Oliveira C, Giuffrida FM, Reis AF. Visfatin, glucose metabolism and vascular disease: a review of evidence. Diabetol Metab Syndr. 2010;2(1):21.
[37]Toruner F, Altinova A, Bukan N, Arslan E, Akbay E, Ersoy R, et al. Plasma visfatin concentrations in subjects with type 1 diabetes mellitus. Horm Res. 2009;72(1):33-7.
[38]Telejko B, Kuzmicki M, Zonenberg A, Szamatowicz J, Wawrusiewicz-Kurylonek N, Nikolajuk A, et al. Visfatin in gestational diabetes: serum level and mRNA expression in fat and placental tissue. Diabetes Res Clin Pract. 2009;84(1):68-75.
[39]MacLaren R, Cui W, Cianflone K. Visfatin expression is hormonally regulated by metabolic and sex hormones in 3T3-L1 pre‐adipocytes and adipocytes. Diabetes Obes Metab. 2007;9(4):490-7.
[40]Lee KJ, Shin YA, Lee KY, Jun TW, Song W. Aerobic exercise training-induced decrease in plasma visfatin and insulin resistance in obese female adolescents. Int J Sport Nutr Exerc Metab. 2010;20(4):275-81.
[41]Kodama S, Miao S, Yamada N, Sone H. Exercise training for ameliorating cardiovascular risk factors-focusing on exercise intensity and amount. Int J Sport Health Sci. 2006;4:325-38.
[42]Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci. 2006;4(1):19-27.
[43]Jorge MLMP, de Oliveira VN, Resende NM, Paraiso LF, Calixto A, Diniz ALD, et al. The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metab. 2011;60(9):1244-52.
[44]Jürimäe J1, Rämson R, Mäestu J, Purge P, Jürimäe T, Arciero PJ, et al. Plasma visfatin and ghrelin response to prolonged sculling in competitive male rowers. Med Sci Sports Exerc. 2009;41(1):137-43.
[45]Kelly AS, Steinberger J, Olson TP, Dengel DR. In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Metab. 2007;56(7):1005-9.
[46]Hansen D, Dendale P, Jonkers R, Beelen M, Manders R, Corluy L, et al. Continuous low-to moderate-intensity exercise training is as effective as moderate-to high-intensity exercise training at lowering blood HbA1c in obese type 2 diabetes patients. Diabetol. 2009;52(9):1789-97.
[47]Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.
[2]Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med. 2008,8(1):21.
[3]Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165(18):2114-20.
[4]Rawal LB, Tapp RJ, Williams ED, Chan C, Yasin S, Oldenburg B. Prevention of type 2 diabetes and its complications in developing countries: A review. Int J Behav Med. 2012;19(2):121-33.
[5]Erqou S, Thompson A, Di Angelantonio E, Saleheen D, Kaptoge S, Marcovina S, et al. Apolipoprotein(a) isoforms and the risk of vascular disease: Systematic review of 40 studies involving 58,000 participants. J Am Coll Cardiol. 2010;55(19):2160-7.
[6]Mashaykhi NR, Sadrneya S, Acherei A, Javaheri J, Ahmadlou M. The correlation between serum Apo lipoprotein A1 and Apo lipoprotein B with coronary artery disease and its severity. Arak Med Univ J. 2013;16(75):82-9.
[7]Boden WE. High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease: Assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. The Am J Cardiol. 2000;86(12A):19L-22.
[8]Fonseca-Alaniz MH, Takada J, Alonso-Vale MIC, Lima FB. Adipose tissue as an endocrine organ: From theory to practice. J Pediatr. 2007;83(Suppl 5):S192-203.
[9]Mazaki-Tovi S, Romero R, Kusanovic JP, Vaisbuch E, Erez O, Than NG, et al. Maternal visfatin concentration in normal pregnancy. J Perinat Med. 2009;37(3):206-17.
[10]Francischetti EA, Genelhu VA. Obesity–hypertension: An ongoing pandemic. Int J Clin Pract. 2007;61(2):269-80.
[11]Earnest CP. Exercise interval training: An improved stimulus for improving the physiology of pre-diabetes. Med Hypotheses. 2008;71(5):752-61.
[12]Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(6):1433-8.
[13]Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: Review, synthesis and recommendations. Sports Med. 2014;44(2):211-21.
[14]Safarzade A, Rohi H, Fathi R, Talebi-Garakani E. Effect of progressive resistance training on serum amyloid A and apolipoprotein AI levels in diabetic Rats. Koomesh. 2013;15(1):22-30. [Persian]
[15]Pourvaghar MJ, Shahsavar A, Bahram ME. The effect of a single bout of severe aerobic exercise on apolipoproteins A, B and some serum lipid profiles. Feyz. 2015;18(6):585-91. [Persian]
[16]Ketabi Poor SM, Koushkie Jahromi M. Effeet of aquatic aerobic training on serum A and B apoproteins and lipoproteins in obese and normal weight menopause women. Arak Med Univ J. 2014;17(8):44-52. [Persian]
[17]Esfarjani F, Rashidi F, Marandi SM. The effect of aerobic exercise on blood glucose, lipid profile and apo. J Ardabil Univ Med Sci. 2013;13(2):132-41. [Persian]
[18]Sadeghi M, Roohafza H, Afshar H, Rajabi F, Ramzani M, Shemirani H, et al. Relationship between depression and apolipoproteins A and B: A case-control study. Clinics. 2011;66(1):113-7.
[19]Habibi N, Marandi SM. Effect of 12 weeks of yoga practice on glucose, insulin and triglycerides serum level in women with diabetes type II. J Gorgan Univ Med Sci. 2014;15(4):1-7. [Perisan]
[20]Smith MJ. Sprint interval training [Internet]. United States: Strength Coach [Updated 2010 December 15; Cited 2008 March 5]. Available From: http://www.strengthcoach.com/public/1665.cfm.
[21]Hurst RA. The effects and differences of sprint interval training, endurance training and the training types combined on physiological parameters and exercise performance [Dissertation]. United Kingdom: University of Hertfordshire Research Archive; 2014.
[22]Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circ. 2003;107(24):3109-16.
[23]Giada F, Zuliani G, Baldo-Enzi G, Palmieri E, Volpato S, Vitale E, et al. Lipoprotein profile, diet and body composition in athletes practicing mixed an anaerobic activities. J Sports Med Phys Fitness. 1996;36(3):211-6.
[24]Behre C, Bergstrom G, Schmidt C. Moderate physical activity is associated with lower ApoB/ApoA-I ratios independently of other risk factors in healthy, middle-aged men. Angiol. 2010;61(8):775-9.
[25]Larose J, Sigal R, Khandwala F, Kenny G. Comparison of strength development with resistance training and combined exercise training in type 2 diabetes. Scand J Med Sci Sports. 2012 Aug;22(4):e45-54.
[26]Gibala MJ, Little JP, Van Essen M, Wilkin GP, Burgomaster KA, Safdar A, et al. Short‐term sprint interval versus traditional endurance training: Similar initial adaptations in human skeletal muscle and exercise performance. J Physiol. 2006;575(Pt 3):901-11.
[27]Hovanloo F, Arefirad T, Ahmadizad S. Effects of sprint interval and continuous endurance training on serum levels of inflammatory biomarkers. J Diabetes Metab Disord. 2013;12:22.
[28]Haider DG, Pleiner J, Francesconi M, Wiesinger GnF, Müller M, Wolzt M. Exercise training lowers plasma visfatin concentrations in patients with type 1 diabetes. J Clin Endocrinol Metab. 2006;91(11):4702-4.
[29]Berndt J, Klöting N, Kralisch S, Kovacs P, Fasshauer M, Schön MR, et al. Plasma visfatin concentrations and fat depot–specific mRNA expression in humans. Diabetes. 2005;54(10):2911-6.
[30]Erdem G, Naharci Mi, Demirtaş A, Erçin Cn, Tapan S, Taşçi İ, et al. Therapeutic lifestyle change intervention in metabolic syndrome decreases plasma visfatin levels. Anatol J Clin Investig. 2008;2(2):58-62.
[31]Seo D, So WY, Ha S, Yoo EJ, Kim D, Singh H, et al. Effects of 12 weeks of combined exercise training on visfatin and metabolic syndrome factors in obese middle-aged women. J Sports Sci Med. 2011;10(1):222-6.
[32]Haus J, Solomon TP, Marchetti CM, O'Leary VB, Brooks LM, Gonzalez F, et al. Decreased visfatin after exercise training correlates with improved glucose tolerance. Med Sci Sports Exerc. 2009;41(6):1255-60.
[33]Choi K, Kim J, Cho G, Baik S, Park H, Kim S. Effect of exercise training on plasma visfatin and eotaxin levels. Eur J Endocrinol. 2007;157(4):437-42.
[34]Brema I, Hatunic M, Finucane F, Burns N, Nolan J, Haider D, et al. Plasma visfatin is reduced after aerobic exercise in early onset type 2 diabetes mellitus. Diabetes Obes Metab. 2008;10(7):600-2.
[35]Wassink AM, Olijhoek JK, Visseren FL. The metabolic syndrome: metabolic changes with vascular consequences. Eur J Clin Invest. 2007;37(1):8-17.
[36]Saddi-Rosa P, Oliveira C, Giuffrida FM, Reis AF. Visfatin, glucose metabolism and vascular disease: a review of evidence. Diabetol Metab Syndr. 2010;2(1):21.
[37]Toruner F, Altinova A, Bukan N, Arslan E, Akbay E, Ersoy R, et al. Plasma visfatin concentrations in subjects with type 1 diabetes mellitus. Horm Res. 2009;72(1):33-7.
[38]Telejko B, Kuzmicki M, Zonenberg A, Szamatowicz J, Wawrusiewicz-Kurylonek N, Nikolajuk A, et al. Visfatin in gestational diabetes: serum level and mRNA expression in fat and placental tissue. Diabetes Res Clin Pract. 2009;84(1):68-75.
[39]MacLaren R, Cui W, Cianflone K. Visfatin expression is hormonally regulated by metabolic and sex hormones in 3T3-L1 pre‐adipocytes and adipocytes. Diabetes Obes Metab. 2007;9(4):490-7.
[40]Lee KJ, Shin YA, Lee KY, Jun TW, Song W. Aerobic exercise training-induced decrease in plasma visfatin and insulin resistance in obese female adolescents. Int J Sport Nutr Exerc Metab. 2010;20(4):275-81.
[41]Kodama S, Miao S, Yamada N, Sone H. Exercise training for ameliorating cardiovascular risk factors-focusing on exercise intensity and amount. Int J Sport Health Sci. 2006;4:325-38.
[42]Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci. 2006;4(1):19-27.
[43]Jorge MLMP, de Oliveira VN, Resende NM, Paraiso LF, Calixto A, Diniz ALD, et al. The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metab. 2011;60(9):1244-52.
[44]Jürimäe J1, Rämson R, Mäestu J, Purge P, Jürimäe T, Arciero PJ, et al. Plasma visfatin and ghrelin response to prolonged sculling in competitive male rowers. Med Sci Sports Exerc. 2009;41(1):137-43.
[45]Kelly AS, Steinberger J, Olson TP, Dengel DR. In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Metab. 2007;56(7):1005-9.
[46]Hansen D, Dendale P, Jonkers R, Beelen M, Manders R, Corluy L, et al. Continuous low-to moderate-intensity exercise training is as effective as moderate-to high-intensity exercise training at lowering blood HbA1c in obese type 2 diabetes patients. Diabetol. 2009;52(9):1789-97.
[47]Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.