title: Improving Adiponectin Levels in Individuals With Diabetes and Obesity: Insights From Look AHEAD Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. Effects of long-term exercise and diet intervention on plasma adipokine concentrations. Concurrent Aerobic and Resistance Training Has Anti-Inflammatory Effects and Increases Both Plasma and Leukocyte Levels of IGF-1 in Late Middle-Aged Type 2 Diabetic Patients Exercise training can modify the natural history of diabetic peripheral neuropathy. Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes. Lifestyle Intervention and Adipokine Levels in Subjects at High Risk for Type 2 Diabetes The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. Effect of Diet or Diet Plus Physical Activity Versus Usual Care on Inflammatory Markers in Patients with Newly Diagnosed Type 2 Diabetes: The Early ACTivity In Diabetes (ACTID) Randomized, Controlled Trial Improvement in Depressive Symptoms Is Associated with Reduced Oxidative Damage and Inflammatory Response in Type 2 Diabetic Patients with Subsyndromal Depression: The Results of a Randomized Controlled Trial Comparing Psychoeducation, Physical Exercise, and Enhanced Treatment as Usual Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus. Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Exercise training is not associated with improved levels of C-reactive protein or adiponectin. Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes Physical Activity/Exercise and Type 2 Diabetes The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus Exercise-Induced Dose-Response Alterations in Adiponectin and Leptin Levels Are Dependent on Body Fat Changes in Women at Risk for Breast Cancer Absence of exercise-induced variations in adiponectin levels despite decreased abdominal adiposity and improved insulin sensitivity in type 2 diabetic men. Resistance Exercise Did Not Alter Intramuscular Adipose Tissue but Reduced Retinol-binding Protein-4 Concentration in Individuals with Type 2 Diabetes Mellitus Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels.
abstract: OBJECTIVE This study investigated whether fitness changes result ing from lifestyle interventions for weight loss may independently contribute to the improvement of low adiponectin levels in obese individuals with diabetes . RESEARCH DESIGN AND METHODS Look AHEAD ( Action for Health in Diabetes ) r and omized overweight/obese individuals with type 2 diabetes to intensive lifestyle intervention ( ILI ) for weight loss or to diabetes support and education ( DSE ) .  Total and high – molecular weight adiponectin ( adiponectins ) , weight , and cardiorespiratory fitness ( submaximal exercise stress test ) were measured in 1,397 participants at baseline and at 1 year , when ILI was most intense . Regression analyses examined the associations of 1-year weight and fitness changes with change in adiponectins . RESULTS ILI result ed in greater improvements in weight , fitness , and adiponectins at 1 year compared with DSE ( P < 0.0001 ) . Weight loss and improved fitness were each associated with changes in adiponectins in men and women ( P < 0.001 for all ) , after adjusting for baseline adiponectins , demographics , clinical variables , and treatment arm . Weight loss contributed an additional 4–5 % to the variance of change in adiponectins than did increased fitness in men ; in women , the contributions of improved fitness ( 1 % greater ) and of weight loss were similar . When weight and fitness changes were both accounted for , weight loss in men and increased fitness in women retained their strong associations ( P < 0.0001 ) with adiponectin change . CONCLUSIONS Improvements in fitness and weight with ILI were favorably but distinctly associated with changes in adiponectin levels  in overweight/obese men and women with diabetes . Future studies need to investigate whether sex-specific biological determinants contribute to the observed associations Recent guidelines on exercise for weight loss and weight maintenance include resistance training as part of the exercise prescription . Yet few studies have compared the effects of similar amounts of aerobic and resistance training on body mass and fat mass in overweight adults . STRRIDE AT/RT , a r and omized trial , compared aerobic training , resistance training , and a combination of the two to determine the optimal mode of exercise for obesity reduction . Participants were 119 sedentary , overweight or obese adults who were r and omized to one of three 8-mo exercise protocol s : 1 ) RT : resistance training , 2 ) AT : aerobic training , and 3 ) AT/RT : aerobic and resistance training ( combination of AT and RT ) . Primary outcomes included total body mass , fat mass , and lean body mass . The AT and AT/RT groups reduced total body mass and fat mass more than RT ( P < 0.05 ) , but they were not different from each other . RT and AT/RT increased lean body mass more than AT ( P < 0.05 ) . While requiring double the time commitment , a program of combined AT and RT did not result in significantly more fat mass or body mass reductions over AT alone . Balancing time commitments against health benefits , it appears that AT is the optimal mode of exercise for reducing fat mass and body mass , while a program including RT is needed for increasing lean mass in middle-aged , overweight/obese individuals BACKGROUND In a r and omized , controlled , 2 x 2 factorial trial on the effect of long-term changes in diet and exercise , a significant reduction in body weight and fat mass was observed . Alterations in leptin and plasminogen activator inhibitor-1 concentrations were previously reported from this study . OBJECTIVE We examined the separate and combined effects of a 1-y exercise and diet intervention on several adipokines ; adiponectin , interleukin-6 and -8 , tumor necrosis factor-alpha , monocyte chemoattractant protein-1 , hepatocyte growth factor , nerve growth factor , C-reactive protein , and resistin . DESIGN One hundred eighty-eight men with several risk factors for diabetes and cardiovascular disease were r and omly allocated to 4 groups : diet , exercise , combined diet and exercise , and control . RESULTS Plasma adiponectin concentrations remained unchanged , whereas body mass index and fat mass decreased after dietary changes and an increase in physical activity . In the control group , adiponectin concentrations were reduced . Analyzed according to the factorial design , only diet intervention had a significant ( P = 0.03 ) positive effect on plasma adiponectin relative to control , and this effect was largely explained by changes in fat mass . After adjustment for change in percentage body fat , there were significant positive effects on tumor necrosis factor-alpha in all 3 intervention groups ( P = 0.01 for the diet group , 0.03 for the exercise group , and 0.05 for the combined diet and exercise group ) . Minor changes were observed for the other adipokines . Neither baseline concentrations of nor changes in adiponectin and plasminogen activator inhibitor-1 were significantly correlated to the other adipokines , whereas concentrations of and changes in the other adipokines were significantly correlated . CONCLUSION Diet intervention had a significant positive effect on adiponectin concentrations , which is largely explained by a reduction in fat mass Type 2 diabetes ( T2D ) is an age-related chronic disease associated with metabolic dysregulation , chronic inflammation , and activation of peripheral blood mononuclear cells ( P BMC ) . The aim of this study was to assess the effects of a concurrent exercise training program on inflammatory status and metabolic parameters of T2D patients . Sixteen male patients ( age range 55–70 ) were r and omly assigned to an intervention group ( n = 8) , which underwent a concurrent aerobic and resistance training program ( 3 times a week ; 16 weeks ) , or to a control group , which followed physicians ' usual diabetes care advices . Training intervention significantly improved patients ' body composition , blood pressure , total cholesterol , and overall fitness level . After training , plasma levels of adipokines leptin ( −33.9 % ) and RBP4 ( −21.3 % ) , and proinflammatory markers IL-6 ( −25.3 % ) , TNF-α ( −19.8 % ) and MCP-1 ( −15.3 % ) decreased , whereas anabolic hormone IGF-1 level increased ( + 16.4 % ) . All improvements were significantly greater than those of control patients . Plasma proteomic profile of exercised patients showed a reduction of immunoglobulin K light chain and fibrinogen as well . Training also induced a modulation of IL-6 , IGF-1 , and IGFBP-3 mRNAs in the P BMC s. These findings confirm that concurrent aerobic and resistance training improves T2D-related metabolic abnormalities and has the potential to reduce the deleterious health effects of diabetes-related inflammation BACKGROUND Diabetes is the most important cause of peripheral neuropathy ( DPN ) . No definitive treatment for DPN has been established , and very few data on the role of exercise training on DPN have been reported . AIM OF THE STUDY We sought to examine the effects of long-term exercise training on the development of DPN in both Types 1 and 2 diabetic patients . PARTICIPANTS AND METHODS Seventy-eight diabetic patients without signs and symptoms of peripheral DPN were enrolled , r and omized , and subdivided in two groups : 31 diabetic participants [ 15 f , 16 m ; 49+/-15.5 years old ; body mass index ( BMI ) = 27.9+/-4.7 ] , who performed a prescribed and supervised 4 h/week brisk walking on a treadmill at 50 % to 85 % of the heart rate reserve ( exercise group : EXE ) , and a  control group of 47 diabetic participants ( CON ; 24 f , 23 m ; 52.9+/-13.4 years old ; BMI = 30.9+/-8.4 ) .  Vibration perception threshold ( VPT ) , nerve distal latency ( DL ) , nerve conduction velocity ( NCV ) , and nerve action potential amplitude ( NAPA ) in the lower limbs were measured . RESULTS We found significant differences on Delta ( delta ) in NCV for both peroneal and sural motor nerve between the EXE and CON groups during the study period ( P<.001 , for both ) . The percentage of diabetic patients that developed motor neuropathy and sensory neuropathy during the 4 years of the study was significantly higher in the CON than the EXE group ( 17 % vs. 0.0 % , P<.05 , and 29.8 % vs. 6.45 % , P<.05 , respectively ) . In addition , the percentage of diabetic patients who developed increased VPT ( 25 V ) during the study was significantly higher in the CON than the EXE group ( 21.3 % vs. 12.9 % , P<.05 ) . Change on Hallux VPT from baseline to the end of the study was significantly different between the EXE and CON groups ( P<.05 ) ; no significant change in Malleolus VPT between the two groups occurred . CONCLUSIONS This study suggests , for the first time , that long-term aerobic exercise training can prevent the onset or modify the natural history of DPN This study examined the independent and combined effects of diet and exercise on adipocytokine and inflammatory cytokines in postmenopausal women with type 2 diabetes . Using a r and omized , controlled design , 33 women ( age , 50 - 70 years ) were assigned to diet alone ( D ) , exercise alone ( EX ) , or diet + exercise ( D + E ) for 14 weeks . Before and after the interventions , blood sample s for adipocytokines and inflammatory markers were drawn , a meal test was performed , and abdominal fat distribution was measured by magnetic resonance imaging ( MRI ) . Body weight decreased approximately 4.5 + /- 0.6 kg ( P < .05 ) after the D and D + E interventions , whereas only small changes in body weight were found with the exercise-alone intervention . Plasma C-reactive protein levels were decreased by approximately 15 % with all 3 interventions , whereas leptin levels were reduced with the D and D + E intervention ( D : pre = 48.7 + /- 6.0 , post = 38.9 + /- 5.0 ng/mL ; D + E : pre = 38.5 + /- 6.0 , post = 22.9 + /- 5.0 ng/mL ; P < .05 ) with no differences between groups . There was a trend for leptin levels to decrease in the EX group ( P = .06 ) . Plasma resistin levels were not altered by the 3 interventions from pre- to posttreatment ( D : pre = 6.9 + /- 0.6 , post = 6.2 + /- 0.4 ng/mL ; D + E : pre = 5.6 + /- 0.6 , post = 5.7 + /- 0.4 ng/mL ; E : pre = 6.2 + /- 0.6 , post = 5.9 + /- 0.6 ng/mL , P > .05 ) , and no differences in adiponectin and tumor necrosis factor alpha ( TNF- alpha ) levels were found . Visceral adipose tissue and tumor necrosis factor alpha were the only predictors of calculated insulin resistance ( P < .05 ) , explaining 43 % of the variability . A typically prescribed weight loss program with lifestyle changes result ed in few changes in adipocytokines and inflammatory cytokines in older women with type 2 diabetes , suggesting that dramatic weight loss or clinical interventions are needed OBJECTIVE —We investigated whether circulating adipokine concentrations can be altered by lifestyle intervention according to general recommendations in subjects at risk for diabetes as well as the potential of leptin , adiponectin , and resistin as biomarkers for lifestyle-induced improvements in glucose metabolism and insulin resistance . RESEARCH DESIGN AND METHODS —In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht , 147 men and women with impaired glucose tolerance ( IGT ) were r and omized to either a combined diet- and -exercise intervention or a control program . At baseline and after 1 year , an oral glucose tolerance test , an exercise test , and anthropometric measurements were performed . After 1 year , complete data of 103 subjects ( 50 intervention and 53 control subjects ) were obtained . RESULTS —Lifestyle intervention reduced plasma leptin concentrations ( −14.2 % ) in IGT subjects but did not alter plasma adiponectin ( −0.3 % ) or resistin ( −6.5 % ) concentrations despite marked improvements in glucose tolerance and insulin resistance . CONCLUSIONS —Changes in leptin concentration were related to improvements in insulin sensitivity independent of changes in body composition Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination . OBJECTIVE To examine the benefits of aerobic training alone , resistance training alone , and a combination of both on hemoglobin A(1c ) ( HbA(1c ) ) in individuals with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c ) levels of 6.5 % or higher were enrolled in the 9-month exercise program between April 2007 and August 2009 . INTERVENTION Forty-one participants were assigned to the nonexercise control group , 73 to resistance training 3 days a week , 72 to aerobic exercise in which they expended 12 kcal/kg per week ; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week . Main Outcome Change in HbA(1c ) level . Secondary outcomes included measures of anthropometry and fitness . RESULTS The study included 63.0 % women and 47.3 % nonwhite participants who were a mean ( SD ) age of 55.8 years ( 8.7 years ) with a baseline HbA(1c ) level of 7.7 % ( 1.0 % ) . Compared with the control group , the absolute mean change in HbA(1c ) in the combination training exercise group was -0.34 % ( 95 % confidence interval [ CI ] , -0.64 % to -0.03 % ; P = .03 ) . The mean changes in HbA(1c ) were not statistically significant in either the resistance training ( -0.16 % ; 95 % CI , -0.46 % to 0.15 % ; P = .32 ) or the aerobic ( -0.24 % ; 95 % CI , -0.55 % to 0.07 % ; P = .14 ) groups compared with the control group . Only the combination exercise group improved maximum oxygen consumption ( mean , 1.0 mL/kg per min ; 95 % CI , 0.5 - 1.5 , P < .05 ) compared with the control group . All exercise groups reduced waist circumference from -1.9 to -2.8 cm compared with the control group . The resistance training group lost a mean of -1.4 kg fat mass ( 95 % CI , -2.0 to -0.7 kg ; P < .05 ) and combination training group lost a mean of -1.7 ( -2.3 to -1.1 kg ; P < .05 ) compared with the control group . CONCLUSIONS Among patients with type 2 diabetes mellitus , a combination of aerobic and resistance training compared with the nonexercise control group improved HbA(1c ) levels . This was not achieved by aerobic or resistance training alone . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00458133 Background Inflammation plays a major role in diabetes‐associated cardiovascular disease ( CVD ) . There is uncertainty whether diet and physical activity interventions can be successfully integrated into healthcare setting s and reduce markers of inflammation and risk of CVD in patients with type 2 diabetes ( T2D ) . Methods and Results Systemic markers of inflammation were determined in a 12‐month , real‐world , multicenter , r and omized , controlled trial that investigated the effect of diet , diet plus physical activity , and usual care in 593 individuals with newly diagnosed T2D . During the first 6 months , serum C‐reactive protein ( CRP ) improved by −21 ( −36 to −1.4)% and −22 ( −38 to −3.1)% in diet and diet plus physical activity arms versus usual care . There were also improvements in adiponectin and soluble intercellular adhesion molecule‐1 ( sICAM‐1 ) . Though medication‐adjusted CRP was improved between 6 and 12 months for usual care , both interventions were more successful in reducing the relative risk of a high‐risk CRP level of > 3 mg/L ( risk ratios of 0.72 [ 0.55 to 0.95 ] for diet versus usual care and 0.67 [ 0.50 to 0.90 ] for diet plus activity versus usual care  ) . Furthermore , sICAM‐1 ( a marker of vascular risk ) , remained substantially lower than usual care in both intervention arms at 12 months . Conclusions Motivational , unsupervised diet and /or diet plus physical activity interventions given soon after diagnosis in real‐world healthcare setting s improve markers of inflammation and cardiovascular risk in patients with T2D , even after accounting for the effect of adjustments to medication to try and control blood pressure , glycated hemoglobin , and lipids . Clinical Trial Registration URL : http://www.controlled-trials.com/. Unique identifier : IS RCT N92162869 Aims . To examine one-year changes in oxidative damage and inflammation level in type 2 diabetic patients undergoing behavioral treatment for subsyndromal depression . Material s and Methods . A r and omized controlled comparison of psychoeducation ( A ) , physical exercise ( B ) , and enhanced treatment as usual ( C ) was performed in 209 eligible subjects in a tertiary diabetes care setting .  Depressive symptoms ( primary outcome ) and selected biomarkers of oxidative damage and inflammation ( secondary outcomes ) were assessed at baseline and six- and twelve-month follow-up . Results . Out of the 74 , 67 , and 68 patients r and omised into groups A , B , and C , respectively , 201 completed the interventions , and 179 were analysed . Participants in all three groups equally improved in depressive symptoms from baseline to one-year follow-up ( repeated measures ANOVA ; F = 12.51 , p < 0.0001 , η 2 = 0.07 ) . Urinary 8-oxo-deoxyguanosine ( u-8-oxodG ) decreased ( F = 10.66 , p < 0.0001 , η 2 = 0.06 ) , as did sialic acid and leukocytes ( F = 84.57 , η 2 = 0.32 and F = 12.61 , η 2 = 0.07 , resp . ; p < 0.0001 ) , while uric acid increased ( F = 12.53 , p < 0.0001 , η 2 = 0.07 ) in all subjects during one year . Improvement of depressive symptoms at 6 months significantly predicted one-year reduction in u-8-oxodG ( β = 0.15 , p = 0.044 ) . Conclusion . Simple behavioral interventions are capable not only of alleviating depressive symptoms , but also of reducing the intensity of damaging oxidative/inflammatory processes in type 2 diabetic patients with subsyndromal depression . This trial is registered with IS RCT N05673017 Hispanics are at increased risk of morbidity and mortality due to their high prevalence of diabetes and poor glycemic control . Strength training is the most effective lifestyle intervention to increase muscle mass but limited data is available in older adults with diabetes . We determined the influence of strength training on muscle quality ( strength per unit of muscle mass ) , skeletal muscle fiber hypertrophy , and metabolic control including insulin resistance ( Homeostasis Model Assessment –HOMA-IR ) , C-Reactive Protein ( CRP ) , adiponectin and Free Fatty Acid ( FFA ) levels in Hispanic older adults . Sixty-two community-dwelling Hispanics ( > 55 y ) with type 2 diabetes were r and omized to 16 weeks of strength training plus st and ard care ( ST group ) or st and ard care alone ( CON group ) . Skeletal muscle biopsies and biochemical measures were taken at baseline and 16 weeks . The ST group show improved muscle quality ( mean±SE : 28±3 ) vs CON ( -4±2 , p<0.001 ) and increased type I ( 860±252µm2 ) and type II fiber cross-sectional area ( 720±285µm2 ) compared to CON ( type I : -164±290µm2 , p=0.04 ; and type II : -130±336µm2 , p=0.04 ) . This was accompanied by reduced insulin resistance [ ST : median ( interquartile range ) -0.7(3.6 ) vs CON : 0.8(3.8 ) , p=0.05 ] ; FFA ( ST : -84±30µmol/L vs CON : 149±48µmol/L , p=0.02 ) ; and CRP [ ST : -1.3(2.9)mg/L vs CON : 0.4(2.3)mg/L , p=0.05 ] . Serum adiponectin increased with ST [ 1.0(1.8)µg/mL ] compared to CON [ -1.2(2.2)µg/mL , p<0.001  ] . Strength training improved muscle quality and whole-body insulin sensitivity . Decreased inflammation and increased adiponectin levels were related with improved metabolic control . Further studies are needed to underst and the mechanisms associated with these findings . However , these data show that strength training is an exercise modality to consider as an adjunct of st and ard of care in high risk population s with type 2 diabetes OBJECTIVES This study assessed the effect of a 12-week sports-based exercise intervention on glucose regulation , anthropometry and inflammatory markers associated with the prevalence of type 2 diabetes mellitus ( T2DM ) in Indigenous Australian men . DESIGN Twenty-six inactive Indigenous Australian men ( 48.6±6.6 years ) were r and omized into exercise ( n=16 ) or control (n=10)conditions . METHODS Training included ∼2 - 3 days/week for 12 weeks of sports and gym exercises in a group environment , whilst control participants maintained normal activity and dietary patterns . Pre- and post-intervention testing included : anthropometry , peak aerobic capacity , fasting blood chemistry of inflammatory cytokines , adiponectin , leptin , cholesterol , glucose , insulin and C-peptide . An oral glucose tolerance test measured glucose , insulin and C-peptide 30 , 60 , 90 and 120min post 75 g glucose ingestion . RESULTS The exercise condition decreased insulin area under the curve ( 25±22 % ) , increased estimated insulin sensitivity ( 35±62 % ) and decreased insulin resistance ( 9±35 % ; p<0.05 ) , compared with control ( p>0.05 ) . The exercise condition decreased in body mass index , waist circumference and waist to hip ratio ( p<0.05 ) , compared to control ( p>0.05 ) . Leptin decreased in the exercise group , with no changes for adiponectin ( p>0.05 ) or inflammatory markers ( p>0.05 ) in either condition . Aerobic fitness variables showed significant increases in peak oxygen consumption for the exercise condition compared to no change in control ( p>0.05 ) . CONCLUSIONS Findings indicate positive clinical outcomes in metabolic , anthropometric and aerobic fitness variables . This study provides evidence for sport and group-based activities leading to improved clinical risk factors associated with T2DM development in clinical ly obese Indigenous Australian men AIM The effects of exercise intervention and to assess its long-term efficacy in preventing subsequent cardiovascular events in patients with type 2 diabetes were little known on r and omized controlled trial . METHODS Thirty-eight type 2 diabetic patients ( 21 men and 17 women ) were assigned to either the exercise group ( n=21 ) or the control group without exercise training ( n=17 ) by simple r and omization . The exercise training group was scheduled for aerobic and resistance exercise programs for 3 months . After the 3-month , we investigated endothelial function , insulin resistance , adipocytokines and inflammatory markers . The endothelial function was evaluated by examining a flow-mediated endothelium-dependent vasodilatation ( FMD ) . Furthermore , we followed the incidence of cardiovascular events for 24 months . RESULTS After 3-month , HbA1C was decreased significantly in both groups . FMD was increased from 7.3+/-4.7 % to 10.9+/-6.2 % only in the exercise group ( p<0.05 ) . Long-term follow-up data showed that the control group developed cardiovascular events more frequently than did the exercise group ( p<0.05 ) . CONCLUSIONS Exercise improves endothelial dysfunction independently of glycemic control and insulin sensitivity in patients with type 2 diabetes . The beneficial effects of 3-month exercise to reduce cardiovascular events persist for 24 months BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin The purpose of this study was to determine the effect of exercise training on the levels of C-reactive protein ( CRP ) and adiponectin , and to assess whether exercise-induced changes in insulin resistance could be explained in part by changes in these inflammation markers . Study participants included 51 middle-aged ( 45.3+/-8.3 years ; mean+/-SD ) , overweight ( 33.7+/-4.8 BMI ) , insulin-resistant , nondiabetic individuals . Subjects had their insulin sensitivity , body fat , CRP , and adiponectin levels measured , and their predicted maximal fitness calculated before and after 16 weeks of moderate , intense , or no exercise training . Modest improvements in fitness , body composition , and insulin sensitivity were observed , but these changes were not associated with decreased CRP or increased adiponectin levels , even when subjects were stratified by their change in fitness or obesity . Regression analysis demonstrated that the change in percentage of body fat was significantly related to changes in insulin sensitivity , whereas changes in VO2 MAX , CRP , and adiponectin were not . Participation in moderate to intense exercise was not associated with improved measures of chronic inflammation markers , as measured by CRP and adiponectin . Moreover , improvements in insulin sensitivity result ing from exercise or modest weight loss did not appear to be related to changes in these markers Aims /hypothesisAdipokines may be important in mediating signals from adipocytes to insulin-sensitive tissue and vasculature . We studied the effect of different glucose-lowering therapies on serum levels of plasminogen activator inhibitor-1 ( PAI-1 ) , high-sensitivity C-reactive protein ( hs-CRP ) , TNF-α , leptin , adiponectin and ghrelin in patients with type 2 diabetes . Subjects and methods Twenty-eight patients with poorly controlled type 2 diabetes who were receiving oral hypoglycaemic agents  were allocated to one of the following groups , and treated for 1 year : ( 1 ) lifestyle intervention ( L ) ; ( 2 ) insulin treatment ( I ) ; and ( 3 ) combined treatment ( L+I ) . Results Similar improvements in glycaemic control occurred in all three groups . There was a reduction in body weight of 3.0 kg ( median ) ( 95 % CI −5.9 to −2.0 ) in group L , whereas in groups L+I and I body weight increased by 3.5 kg ( 95 % CI 1.5–4.9 ) and 4.9 kg ( 95 % CI −3.1 to 8.2 ) , respectively . By trend analyses , group L had reduced levels of PAI-1 ( p=0.002 ) , hs-CRP ( p<0.0001 ) and TNF-α ( p=0.006 ) , while no significant changes were observed in the levels of leptin or adiponectin . In group I , the median levels of PAI-1 ( p=0.008 ) , TNF-α ( p=0.058 ) and leptin ( p=0.004 ) increased . In the L+I group there was a reduction in PAI-1 levels ( p=0.014 ) and an increase in levels of leptin ( p<0.001 ) . The differences in changes in the levels of PAI-1 , hs-CRP , TNF-α and leptin between groups were also significant ( all p<0.01 ) . Conclusions /interpretationImprovement of glycaemic control through lifestyle intervention in type 2 diabetes had more beneficial effects on adipokine levels than when the same lowering of HbA1c was achieved with insulin treatment For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C Background Diabetes mellitus ( DM ) and chronic inflammation are strongly related to increased cardiovascular risk . The purpose of this study was to evaluate whether an aerobic training programme would ameliorate inflammatory and anti-inflammatory markers in patients with type 2 DM . Design Interventional study . Methods A total of 60 overweight individuals with type 2 DM , but without vascular complications , were r and omly assigned to either a 6-month aerobic exercise training programme ( four times/week , 45 - 60 min/session ) , design ated as exercise group , or to the control group .  All participants were on an oral antidiabetic regimen and none was receiving lipid-lowering medications . Anthropometric parameters , cardiorespiratory fitness , glycaemic and lipid profiles , high sensitivity C-reactive protein ( hs CRP ) , adiponectin , interleukin (IL)-10 , IL-18 , tumour necrosis factor (TNF)-a , insulin , reciprocal index of homoeostasis model assessment ( HOMA-IR ) , body fat and blood pressure ( BP ) were measured at baseline and at the end of the study . Results In comparison with baseline and control group , exercise-treated patients improved glucose control , lipid profile , exercise capacity ( Vo2 peak ) and exhibited decreased insulin resistance and systolic BP considerably ( P < 0.05 ) . Plasma adiponectin , TNF-α and body weight changed slightly across treatment ( P > 0.05 ) , whereas diastolic BP and fat mass tended to decrease ( P = 0.071 and 0.061 , respectively ) . Exercise training  reduced hs CRP ( from 0.48 ± 0.16 to 0.29 ± 0.2 mg/dl ; P = 0.04 ) and IL-18 ( from 315.19 ± 122.76 to 203.77 ± 96.02 pg/ml ; P = 0.02 ) . Moreover , exercise  provided anti-inflammatory protection through IL-10 increment ( P = 0.039 ) and IL-18/IL-10 ratio downregulation ( P = 0.014 ) . In multiple regression analysis , alteration in IL-18 was independently correlated with hs CRP and Vo2 peak changes ( P < 0.05 ) . Conclusion Aerobic exercise training without significant weight loss improves metabolic profile and exerts anti-inflammatory effects in patients with type 2 DM . Eur J Cardiovasc Prev Rehabil 14 : 837 - 843 © 2007 The European Society of Background : Dysregulation of adipokines , such as adiponectin and leptin , is associated with a variety of chronic diseases , including cancer . Physical activity protects against breast cancer and one of the mechanisms which may underlie this association is exercise-induced changes in adipokine levels . The WISER Sister Trial was a three-armed r and omized controlled trial in premenopausal women ( n = 137 ) with an elevated risk for breast cancer . Methods : A 5-menstrual-cycle-long dosed aerobic exercise intervention compared low-dose exercise ( 150 min/wk ; n = 44 ) or high-dose exercise ( 300 min/wk ; n = 48 ) with a control group asked to maintain usual activity levels ( n = 45 ) . Exercise intensity progressed to and was maintained at 70 % to 80 % of age predicted heart rate max . Body composition and adipokine levels were measured at baseline and follow-up . Results : We observed significant linear trends for increased fitness capacity ( Δ% : −2.0 % control , 10.1 % low dose , 13.1 % high dose ) , decreased fat tissue-to-total tissue mass ( Δ% : 0.7 % control , −2.9 % low dose , −3.7 % high dose ) , increased body fat adjusted adiponectin ( Δ% : −0.6 % control , 0.6 % low dose , 0.9 % high dose ) , and decreased body fat adjusted leptin ( Δ% : 0.7 % control , −8.2 % low dose , −10.2 % high dose ) . Conclusions : In this r and omized clinical trial of premenopausal women at risk for breast cancer , we demonstrate a dose – response effect of exercise on adiponectin and leptin and that dose response is dependent on changes in body fat . Impact : Improved adipokine levels , achieved by aerobic exercise training-induced decreases in body fat , may decrease breast cancer risk for high-risk premenopausal women . Cancer Epidemiol Biomarkers Prev ; 25(8 ) ; 1195–200 . © 2016 AACR OBJECTIVE We investigated the effect of an intensive training program on fasting leptin and adiponectin levels . METHODS Sixteen middle-aged men with type 2 diabetes were r and omly assigned to either a training or control group . The training program consisted of 8 weeks of supervised endurance exercise ( 75 % VO(2peak ) , 45 min ) twice a week , with intermittent exercise ( five 2 min exercises at 85 % VO(2peak ) separated by 3 min exercises at 50 % VO(2peak ) ) once a week , on an ergocycle . RESULTS Training decreased abdominal fat by 44 % , increased mid-thigh muscle cross-sectional area by 24 % , and improved insulin sensitivity by 58 % without significant change in body weight . Compared with controls , no significant variation in leptin or adiponectin levels was observed . However , in the trained group , change in adiponectin correlated with change in body weight ( Spearman rank correlation , r(s):-0.76 , P=0.03 ) but not with insulin sensitivity or abdominal adiposity variations . CONCLUSIONS An 8 week intensive training program inducing a marked reduction in abdominal fat and increase in insulin sensitivity does not affect adiponectin and leptin levels in men with type 2 diabetes Lipid accumulation in muscle is associated with diminished insulin sensitivity . It was hypothesized that resistance exercise decreases muscular adipose tissue and reduces the level of retinol-binding protein-4 ( RBP4 ) , which is linked to adipose tissue and insulin sensitivity in diabetics . Forty-four women with type 2 diabetes were r and omly assigned to three groups for a period of 12 weeks : control ( asked to maintain a sedentary lifestyle ) ; resistance exercise ( elastic b and exercise at moderate intensity five times per week ) ; and aerobic exercise ( walking for 60 min at moderate intensity five times per week ) . Subcutaneous ( SCAT ) , subfascial ( SFAT ) and intramuscular ( IMAT ) adipose tissues at mid-thigh level were assessed using computed tomography , and RBP4 level and insulin sensitivity ( fractional disappearance rate of insulin , k ITT ) were assessed before and after intervention . Changes in SCAT , SFAT , IMAT , RBP4 and k ITT were similar among the three groups . Within-group analysis revealed that body mass index and waist circumference decreased significantly in both exercise groups , but RBP4 decreased significantly only with resistance exercise . Resistance exercise did not alter muscular adipose tissue or improve insulin sensitivity BACKGROUND Excess body weight and a sedentary lifestyle are associated with the development of several diseases , including cardiovascular disease , diabetes and cancer in women . One proposed mechanism linking obesity to chronic diseases is an alteration in adipose-derived adiponectin and leptin levels . We investigated the effects of 12-month reduced calorie , weight loss and exercise interventions on adiponectin and leptin concentrations . METHODS Overweight/obese postmenopausal women ( n = 439 ) were r and omized as follows : ( i ) a reduced calorie , weight-loss diet ( diet ; N = 118 ) , ( ii  ) moderate-to-vigorous intensity aerobic exercise ( exercise ; N = 117 ) , ( iii ) a combination of a reduced calorie , weight-loss diet and moderate-to-vigorous intensity aerobic exercise ( diet + exercise ; N = 117 ) , and ( iv ) control ( N = 87 ) . The reduced calorie diet had a 10 % weight-loss goal . The exercise intervention consisted of 45 min of moderate-to-vigorous aerobic activity 5 days per week . Adiponectin and leptin levels were measured at baseline and after 12 months of intervention using a radioimmunoassay . RESULTS Adiponectin increased by 9.5 % in the diet group and 6.6 % in the diet + exercise group ( both P ≤ 0.0001 vs. control ) . Compared with controls , leptin decreased with all interventions ( diet + exercise , -40.1 % , P < 0.0001 ; diet , -27.1 % , P < 0.0001 ; exercise , -12.7 % , P = 0.005 ) . The results were not influenced by the baseline body mass index ( BMI ) . The degree of weight loss was inversely associated with concentrations of adiponectin  ( diet , P-trend = 0.0002 ; diet + exercise , P-trend = 0.0005 ) and directly associated with leptin ( diet , P-trend < 0.0001 ; diet + exercise , P-trend < 0.0001 ) . CONCLUSION Weight loss through diet or diet + exercise  increased adiponectin concentrations . Leptin concentrations decreased in all of the intervention groups , but the greatest reduction occurred with diet + exercise . Weight loss and exercise exerted some beneficial effects on chronic diseases via effects on adiponectin and leptin
target: As for physical exercise modalities , aerobic exercise , but not other modalities , increased adiponectin and reduced leptin levels .
  In conclusion , physical exercise and , specifically , aerobic exercise , leads to higher adiponectin and lower leptin levels  in prediabetic and diabetic adults .
background: It is speculated that lifestyle interventions known to improve diabetic metabolic state may exert their effects via adipokines .
  The aim of this systematic review and meta- analysis was to evaluate the chronic effects of physical exercise on adiponectin and leptin levels in adult prediabetic and diabetic individuals .