Want to effectively control sugar by exercise?

*It is only for medical professionals to read for reference.
Exercise methods and exercise time are also exquisite! Life lies in movement
.

Exercise is not only an important way for people to keep fit, but also one of the "five carriages" in the treatment of diabetes
.

As an important part of the comprehensive treatment of type 2 diabetes (T2DM), mastering the time and method of exercise may allow exercise to play the greatest role in the treatment of T2DM
.

 At this year's European Association for the Study of Diabetes (EASD) annual meeting, Professor Juleen Zierath from Sweden explained the effects of exercise on skeletal muscle based on exercise physiology, and then summarized the methods for maximizing the benefits of exercise on the body's metabolism
.

 Figure 1 Professor Juleen Zierath and the theme of his speech.
Exercise may improve blood sugar levels.
Most of the body's organ systems are affected by exercise.
When we move, we will trigger multiple steady-state responses to supply high-demand organ systems (Figure 1)
.

 Figure 2 Exercise triggers multiple homeostatic responses to supply high-demand organ systems.
In T2DM, insulin resistance impairs the ability of skeletal muscles to take up and use glucose
.

Researchers at Washington Medical School found that skeletal muscle contraction can even promote glucose uptake in diabetic rats, independent of insulin
.

Does this prove that exercise is also an effective way to treat T2DM? As early as 1988, John O.
Holloszy and others recruited a group of patients with mild non-insulin-dependent diabetes mellitus (NIDDM), and asked the experimental group to measure the changes in glucose tolerance after 1 week of exercise.
The results showed that they insisted on exercising.
The blood glucose levels of patients with mild NIDDM are lower than those who do not exercise (Figure 2), indicating that exercise has a certain effect on NIDDM
.

Figure 3 Exercise has a certain effect on NIDDM.
In 2006, the study of Donal O'Gorman et al.
included 7 obese middle-aged men and 8 obese middle-aged men with T2DM.
Both groups received the same intensity of physical training.
Through related testing methods, it is found that exercise training can enhance insulin-mediated glycolysis and the activity of glucose transporter (GLUT4) in patients with T2DM (Figure 3)
.

This effect is more obvious after 1 week of exercise: Compared with 16h after exercise, the transport rate and cell surface distribution density of GLUT4 are significantly increased one week after exercise
.

 Figure 4 Exercise training can enhance insulin-mediated glycolysis and GLUT4's active aerobic exercise combined with anaerobic exercise to improve the IR effect.
Exercise can be divided into anaerobic exercise and aerobic exercise.
Anaerobic exercise is based on a 100-meter sprint.
Representative, and aerobic exercise is represented by marathon running
.

 When a person is doing a 100-meter sprint, the main function of skeletal muscle can quickly glycolytic fiber.
This muscle cell contains fast-type myosin ATPase and a higher concentration of glycolytic enzyme to provide explosive action The skeletal muscle that plays a major role in running a marathon is slow-oxidized fibers.
This muscle cell contains slow-rate myosin ATPase, which has a high oxidizing ability and enhances the sensitivity of cells to insulin.
Maintain long-term repetitive activities
.

 Therefore, the greatest plasticity of skeletal muscle is not the characteristic of voluntary contraction, but the mechanism of metabolism
.

Aerobic exercise enhances the sensitivity of skeletal muscle cells to insulin, which provides a new treatment idea for patients with T2DM
.

 Interestingly, Savikj et al.
found that when aerobic exercise and anaerobic exercise are combined, there is a synergistic effect
.

Anaerobic exercise, such as weightlifting, can make muscle cells compensatory hypertrophy, increase muscle fiber strength and lactic acid metabolism, and play a beneficial effect on the above-mentioned effects of aerobic exercise
.

It can be seen that aerobic combined anaerobic exercise is the best exercise combination for patients with T2DM
.

 Studies in recent years have found that skeletal muscle metabolism is regulated by multiple pathways, such as the adenylate-activated protein kinase (AMPK) pathway, the R225Qγ3 pathway, and the calcineurin pathway (Figure 5)
.

Figure 5 The metabolism of skeletal muscle is regulated by multiple pathways.
Researchers have also found that environmental factors can directly affect the epigenetics of metabolism, such as environmental pollution, nutrient supply, and exercise frequency
.

The afternoon is the best time of the day to exercise.
To make the exercise exert its effects including promoting the sensitivity of skeletal muscles to insulin, in addition to choosing effective exercises, you should also pay attention to the time of exercise
.

Many researchers such as Paolo Sasspme-Corsi have come to a consistent conclusion: exercise during the day conforms to the body's metabolic rhythm and is beneficial to the body; while exercise at night cannot exert its due effect
.

Why is this so? We all know that humans have a biological clock that is active during the day and rest at night
.

Such a biological clock is controlled by the regular signals sent by neurons, and at the same time, such signals are transmitted to peripheral organs and tissues, so that skeletal muscle, adipose tissue, liver and other organs have a circadian rhythm.
For example, skeletal muscle cells consume oxygen during the day.
More and stronger glycolytic activity (Figure 6)
.

Figure 6 The rhythm of the body's metabolism is determined by the molecular circadian rhythm.
The biological clock participates in many aspects of the complex biology of the body.
Multicellular organisms, including humans, use similar mechanisms to control the circadian rhythm.
The biological clock can regulate the expression of a large portion of genes
.

 For example, a special protein called PER encoded by the period gene accumulates in cells at night and degrades during the day.
Therefore, the level of PER protein fluctuates in a 24-hour cycle and is the same as the circadian rhythm.
Clocks occur synchronously, which is the molecular circadian rhythm, the ultimate mechanism for regulating metabolic rhythm
.

 A carefully calibrated circadian rhythm will promote the body's physiological mechanisms to adapt to the different stages of the day, which is vital to the body's health
.

Shogo Sato et al.
found that exercise during the day can "amplify" the impact on metabolism, such as promoting the uptake and utilization of glucose, and increasing the sensitivity of skeletal muscle to insulin
.

 Some readers may ask, when do exercises benefit the body the most during the day? Savikj and others have also thought about this problem, so they compared the blood sugar lowering effects of exercising at different times of the day and found that the blood sugar reduction of T2DM patients was more obvious when exercising at 3 to 5 pm, so they chose to exercise at this time.
It's the best
.

 Figure 7 The degree of blood sugar reduction in T2DM patients during afternoon exercise is more obvious.
Summary Most organ systems of the body are affected by exercise, including skeletal muscles
.

Researchers have found that aerobic combined with anaerobic exercise enhances the sensitivity of skeletal muscle cells to insulin, which provides a new treatment idea for patients with T2DM
.

In addition, exercise during the day (especially in the afternoon) can maximize the above-mentioned benefits of exercise, and its mechanism is closely related to the molecular circadian rhythm
.

 Reference: [1]Saviki and Zierath Diabetoloaia.
63:1491-1499, 2020[2]Karlsson HK.
Diabetes 54:1692-1697, 2005[3]Deshmukh A.
Diabetes 55:1776-1782, 2006[4]Diabetes Care 11:613-618, 1988[5]O'Gorman DJ, et al.
Diabetologia 49:2983-92, 2006