Journal Article

Exercise and type 2 diabetes: focus on metabolism and inflammation

Karstoft, Kristian, Pedersen, Bente Klarlund

2016

Overview

Type 2 diabetes mellitus (T2DM) is associated with metabolic dysregulation and chronic inflammation, and regular exercise may provide a strong stimulus for improving both. In this review, we first discuss the link between inflammation and metabolism. Next, we give an update on the clinical metabolic effects of exercise in T2DM patients with special focus on which parameters to consider for optimizing metabolic improvements. We then discuss the mechanisms whereby exercise exerts its anti‐inflammatory and related metabolic effects. Evidence exists that interleukin (IL)‐1β is involved in pancreatic β‐cell damage, whereas tumor necrosis factor (TNF)‐α appears to be a key molecule in peripheral insulin resistance. Mechanistic studies in humans suggest that moderate acute elevations in IL‐6, as provoked by exercise, exert direct anti‐inflammatory effects by an inhibition of TNF‐α and by stimulating IL‐1ra (IL‐1 receptor antagonist), thereby limiting IL‐1β signaling. In addition, IL‐6 has direct impact on glucose and lipid metabolism. Moreover, indirect anti‐inflammatory effects of exercise may be mediated via improvements in, for example, body composition. While waiting for the outcome of long‐term randomized clinical training studies with hard end points, it should be emphasized that physical activity represents a natural strong anti‐inflammatory and metabolism‐improving strategy with minor side effects. The February 2016 issue contains a Special Feature on the Effects of exercise on the immune system and metabolism coming into the Olympic year. The role of the immune system in exercise is complex and challenging. Too little exercise can depress the immune system. In contrast, too much exercise can also lead to a compromised immune system. This is a challenge that athletes face as they prepare for competition. Immunology & Cell Biology thanks the coordinators of this Special Feature ‐ Mark Febbraio and Graeme Lancaster ‐ for their planning and input.

• Publisher: Nature Publishing Group,Blackwell Science Ltd
• Subject: Animals / Diabetes Mellitus, Type 2 - immunology / Diabetes Mellitus, Type 2 - metabolism / Diabetes Mellitus, Type 2 - therapy / Exercise - physiology / Exercise Therapy / Humans / Inflammation - immunology / Inflammation - metabolism / Inflammation - therapy / Interleukin 1 Receptor Antagonist Protein - metabolism / Interleukin-1beta - metabolism / Tumor Necrosis Factor-alpha - metabolism