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Endurance Exercise and Type 2 Diabetes

A common worldwide health problem is obesity and type 2 diabetes is a metabolic disease associated with obesity.

Because of the high levels of these health concerns, researchers in Iran examined the relationship between endurance exercise and type 2 diabetes in overweight women. 

The immune system and diabetes

Type 2 diabetes is hypothesized to be caused by activated innate immunity. Innate immunity is the first in the line of the body’s defenses against pathogen attacks.

A pathogen could either be a virus, bacteria, parasite, or other foreign particle. When the innate immune system is activated, it acts as a barrier to keep the pathogen out of the body or limits its ability to spread.

The surfactant protein D (SP-D) is a lung-specific protein that has major anti-microbial and anti-inflammatory effects.

In previous studies, high SP-D serum levels were found to be associated with cardiovascular disease-related mortality. In contrast, it has been shown that systemic SP-D decreased in type 2 diabetes and that it is positively associated with insulin sensitivity and negatively associated with obesity.

Decreasing the serum SP-D protein levels in type 2 diabetes might be connected with obesity, inflammation, and insulin resistance. However, the exact mechanisms involved are not clear.

Exercise affects health outcomes

Weight and fat loss, improvement of insulin sensitivity, and glucose metabolism are shown to improve when patients participate in endurance exercises.

This is why physical exercise is considered to be an effective strategy to manage body composition and type 2 diabetes. Typically, obese patients with type 2 diabetes focus on endurance-type exercise training to manage their body fat levels and their diabetes.

A new report, published in Diabetology and Metabolic Syndrome, looked at the relationship between endurance exercises and SP-D in diabetes.

They specifically examined the possible effects of a ten-week endurance exercise training on the serum levels of SP-D, lipid profile, leptin, and insulin resistance in obese women with type 2 diabetes.

The endurance exercise and diabetes study 

Rezaei and colleagues randomly assigned twenty obese women with type 2 diabetes to either exercise training or to a control group.

Originally, 50 individuals were eligible but only 22 agreed to take part in the study. However, one subject from each group dropped out prior to the training.

The exercise training (ET) group underwent a progressive endurance-training program for ten weeks, which includes running on a treadmill for 30-55 min/day at 50-75% measured heart rate.

On the other hand, the control group did not participate in any exercise program.

Then, the blood samples were collected from both groups before and after 72 hours after their last session of exercise training. The blood samples were then used to analyze the serum SP-D, leptin, lipid profile, glucose, and insulin levels.

The results indicated that the serum SP-D levels were decreased after exercise training in the ET group compared to the control group.

Meanwhile, significantly lower serum leptin levels were found in the obese diabetic women in the ET group when compared with women in the control group. The fasting glucose was favorably and significantly affected by the involvement of endurance training.

After ten weeks of endurance exercises training the VO2 max, as an index of aerobic fitness, was significantly increased.

Endurance exercise is helpful for obesity and diabetes

Endurance exercise training significantly reduced SP-D levels in obese women with diabetes.

This was the first-ever study to examine the relationship between SP-D levels and diabetes status and the results have important implications for the treatment of type 2 diabetes. The study showed that training for endurance exercises induced a significant reduction of serum SP-D levels in obese women with type 2 diabetes, along with improvement in aerobic fitness.

There could be other factors that play a role in decreasing the SP-D serum levels, like diet and lifestyle, and future research should account for these factors.

Future studies should also include more participants to achieve a much better sample size for each group.


  1. Rezaei S, Shamsi MM, Mahdavi M, et al. Endurance exercise training decreased serum levels of surfactant protein D and improved aerobic fitness of obese women with type-2 diabetes. Diabetol Metab Syndr. 2017;9:74. Published 2017 Sep 25. doi:10.1186/s13098-017-0273-6

2. Innate immunity (article) | immune system. Khan Academy.


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