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| NARRATIVE REVIEW |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 24-31 |
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Effect of exercise on regulation of adipokine and sedentary lifestyle diseases: A narrative review
Ahmad Merajul Hasan Inam1, Mohd Javed Iqbal1, Ashfaque Khan1, Abdur Raheem Khan1, Mohammad Mustufa Khan2
1 Department of Physiotherapy and Integral Institute of Allied Health Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
2 Department of Basic Medical Sciences, Integral Institute of Allied Health Sciences and Research; Department of Biochemistry, Integral Institute of Medical Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
| Date of Submission | 19-Mar-2022 |
| Date of Decision | 28-Sep-2022 |
| Date of Acceptance | 06-Dec-2022 |
| Date of Web Publication | 11-Aug-2023 |
Correspondence Address:
Dr. Mohammad Mustufa Khan
Department of Basic Medical Sciences, Integral Institute of Allied Health Sciences and Research, Lucknow 226 026, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijptr.ijptr_29_22
Currently, a large number of the global population are physically inactive or engaged in insufficient physical activity. A sedentary lifestyle and physical inactivity disturb normal human body functions such as metabolic activity, insulin, immune response, adipokine functions, and vascular and endothelial functions. A sedentary lifestyle is the leading cause of insulin resistance, obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, atherosclerosis, and cardiovascular disease. The purpose of this narrative review is to evaluate the effect of exercise on the regulation of adipokine and sedentary lifestyle diseases. A total of 1218 articles were reviewed. Articles were searched by various databases such as Pubmed, Chinhal, Medline, Scopus, and Google Scholar. Eligibility criteria for including the articles: abstract, free full-text, and full-text articles and books were searched from January 01, 2004 to March 01, 2022. For this review, randomized control trial study, narrative and systematic review published in the English language were included. This review indicated that regular exercise either aerobic or resistance are improved the circulatory levels of various adipokines. Aerobic exercise for 1 week helps to improve the anti-inflammatory adipokine leptin and adiponectin and diminished the pro-inflammatory adipokine visfatin and resistin. Regular exercise along with dietary restrictions may play a significant role to reduce sedentary lifestyle diseases. Acute and chronic exercise may be an effective therapy to reduce the risk factors for chronic disease and its complications. Combined aerobic and resistance training are more effective to regulate adipokine.
Keywords: Adipokine, Aerobic exercise, Resistant training, Sedentary lifestyle diseases
How to cite this article:
Hasan Inam AM, Iqbal MJ, Khan A, Khan AR, Khan MM. Effect of exercise on regulation of adipokine and sedentary lifestyle diseases: A narrative review. Indian J Phys Ther Res 2023;5:24-31 |
How to cite this URL:
Hasan Inam AM, Iqbal MJ, Khan A, Khan AR, Khan MM. Effect of exercise on regulation of adipokine and sedentary lifestyle diseases: A narrative review. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:24-31. Available from: https://www.ijptr.org/text.asp?2023/5/1/24/383676 |
| Introduction | |  |
The global population aged ≥15 years engages in insufficient physical activity approximately 31%. It is contributed to approximately 3.2 million deaths every year.[1] In India, large numbers of people are physically inactive and only <10% are engaged in some kind of physical activity.[2] A sedentary lifestyle disturbs the normal human body functions in various aspects. It reduces the lipase enzyme activity, uptake of glucose by myocytes, activities of transporter protein, and impairs carbohydrate and lipid metabolism. It reduces insulin sensitivity and vascular and endothelial functions.[3]
A sedentary lifestyle is the leading cause of obesity,[4] hypertension,[5] dyslipidemia,[6] type 2 diabetes mellitus (T2DM),[7] atherosclerosis,[8] and cardiovascular disease (CVD).[9]
This is needed to find the effect of exercise on the regulation of adipokine and sedentary lifestyle disease because dietary habits and sedentary lifestyles are increasing the risk factors for obesity, hypertension, dyslipidemia, T2DM, and CVD in the general population. Various types of exercise may be helpful to reduce the risk of sedentary lifestyle diseases.
The purpose of this narrative review is to evaluate the effect of exercise on the regulation of adipokine and sedentary lifestyle diseases.
| Methodology | | |
A total of 1218 articles were searched from various databases such as Pubmed, Chinhal, Medline, Scopus, and Google Scholar search engine. Abstract, free full-text, and full-text articles and books were searched from January 01, 2004 to March 01, 2022. For this review, randomized control trial study, narrative and systematic review published in the English language were included. Articles were included based on the research questions; is there any association between the type of exercise and the regulation of adipokine and sedentary lifestyle diseases?
The following keywords were used to search the articles; “Exercise + Adipokine,” “Exercise + Sedentary lifestyle diseases,” “Adipokine + Sedentary lifestyle diseases.” “Adipokine + Aerobic Exercise,” “Adipokine + Resistance Training + Metabolic Syndrome,” “Physical activity + Adipokine + Sedentary lifestyle diseases.”
PRISMA flowchart of review search yield [Figure 1]
| Prevalence of Sedentary Lifestyle Diseases | | |
The prevalence of sedentary lifestyle diseases such as obesity, diabetes, CVDs, dyslipidemia, hypertension, and insulin resistance (IR) is increased many folds in the last few decades and these are still increasing. Increment in sedentary lifestyle diseases is mainly due to dietary habits and physical inactivity. It is important to know the current status of sedentary lifestyle diseases and their predictive value to understand the seriousness of their impact on the general population.
Obesity
According to the ICMR-INDIAB study 2015, the prevalence rate of central obesity is ranged from 16.9% to 36.3%. It has been proven that central obesity is the most common risk factor for CVD in India. Several studies have reported that the prevalence of obesity in women is significantly higher than in men.[10],[11]
Diabetes
According to the International Diabetes Federation, it is estimated that 74.2 million diabetic patients are currently in India and that is further projected to be 124.9 million by 2045. In India, the current prevalence of diabetes is 9.6% and by 2045 it will be 10.8%.[12],[13] However, the overall prevalence of diabetes was 7·3% and prediabetes was 10.3% in all 15 states of India.[14] Several studies reported that Indians are at high risk for diabetes.[15],[16]
Cardiovascular disease
Because of the changes in lifestyle and dietary habits, CVD is getting the most common cause of morbidity and ultimately leads the mortality in the world. According to some studies, it has been estimated that approx. 17.9 million people died because of CVD in 2019. It is affected a large population which is about 32% of all worldwide death. Out of 32%, approximately 85% were affected by stroke and heart attack.[17] In India, the total mortality and morbidity were estimated at 28% and 14%, respectively, due to CVD in the year 2016.[18] In addition, the overall self-reported prevalence of diagnosed CVD was 29.4% (≥45 years) in India.[19]
Dyslipidemia
A recent study reported that the prevalence of dyslipidemia was found to be 76.7% among the study population of South African adults. This study further reported that females have shown the highest prevalence of dyslipidemia 75.79% among the study population. Among the other lipid profile, triglyceride (TG) was elevated at 62.21%.[20] In India, the prevalence of dyslipidemia was reported 25%–30% and 15%–20% in urban and rural populations, respectively.[21] In addition, the prevalence of dyslipidemia in children under the age of 10 years was found 47.2%.[22]
Hypertension
The prevalence of hypertension is estimated at approximately 46% in the ≥45 years aged Indian population.[23] However, the overall prevalence of hypertension was found approximately 31% in the Indian population.[24]
Insulin resistance
It has been found that the inappropriate biological response results in IR. It is strongly associated with hypertension, dyslipidemia, obesity, T2DM, inflammation, endothelial dysfunction, and adipokine dysregulation.[25],[26] Chronic inflammation plays a significant role in the development and progression of IR, obesity, and T2DM through regulating multiple metabolic pathways.[27],[28]
| Adipokine and Sedentary Lifestyle Diseases | | |
The increasing prevalence of sedentary lifestyle diseases due to physical inactivity, sitting work culture, and unhealthy dietary habits is continuously disturbing metabolic activities. Metabolic dysfunction further imbalances the level of cytokines and adipokines such as adiponectin, leptin, resistin, and visfatin. The regulation of adipokines is strongly associated with sedentary lifestyle diseases. It is important to understand the adipokine alteration patterns to predict sedentary lifestyle diseases and their complications.
Adiponectin
Adiponectin is a 30 kDa adipokine. It is present in multimeric isoforms in the circulatory system.[29] Anti-diabetic, anti-inflammatory, and anti-atherogenic are the important functions of adiponectin. It raised the sensitivity of insulin and regulates both the homeostasis of energy and glucose levels in the blood. It also has anti-inflammatory properties and acts as an antagonist of tumor necrosis factor-alpha (TNF-α).[30],[31] Adiponectin gene variants are linked to low levels of adiponectin, IR, and diabetes.[32],[33] T-cadherin is the receptor of adiponectin that binds with low-density lipoprotein. It has a cardioprotective effect.[34]
Leptin
Leptin is a 16 kDa adipokine. Its secretion depends on the volume of adipocytes.[35] It plays an important role in body mass regulation. It is reported that leptin resistance is considered to increase over intake of nutrients and body mass index which is the leading cause of obesity.[36] Many physiological processes are regulated by leptin such as thermogenesis, reproduction, angiogenesis, arterial pressure control, and body homeostasis along with neuro-endocrine immune function.[37],[38] Leptin levels were found highest in the mild obesity-related diabetes study group.[39]
Resistin
Resistin belongs to the cysteine-rich proteins family.[26] It has a stable and multimeric structure. It circulates in an oligomeric and trimeric form. It has pro-inflammatory properties and has a positive association with other inflammatory markers such as TNF-α, interleukin (IL)-6, and C-reactive protein in chronic disease conditions.[40] It acts as a biomarker for IR. It is further suggested that human resistin plays a significant role in IR-mediated obesity and T2DM.[41] Resistin levels were found to increase in the severe insulin-resistance diabetes study group and were strongly linked to diabetic nephropathy.[39]
Visfatin
Visfatin is a 52 kDa macrophage-secretory adipokine.[42] It is also secreted by adipose tissue. It has pro-atherogenic properties. The various observational studies demonstrated that plasma visfatin levels were elevated in overweight/obesity, T2DM, metabolic syndrome (MetS), or CVD. It was further suggested that visfatin may act as a predictive biomarker for MetS.[26] It is summarized in [Figure 2]. | Figure 2: Association of Adipokine and sedentary lifestyle diseases (Created in Biorender.com)
Click here to view |
| Effect of Exercise on the Regulation of Adipokine and Sedentary Lifestyle Diseases | | |
Physical activity is a modifiable risk factor for various sedentary lifestyle diseases.[43] Physical activity and exercise change the overall body adaptation and metabolic patterns. These improve glucose homeostasis and the uptake of glucose by skeletal muscle and adipose tissue.[44] Physical activity and exercise increased the glycogen storage in skeletal muscle and increased the enzyme activity required for glucose metabolism. Physical activity and exercise increased the sensitivity of adipose tissue, and enhanced the enzyme activity required for β-oxidation and lipolysis resulting in the oxidation of TGs in the intra-muscular region, and reducing fat storage in the visceral body. Physical activity and exercise also reduce low-grade inflammation and risk factors for various inflammation-associated chronic diseases.
Regular exercise and physical activity regulate the adipokine and inflammatory markers.[45],[46] Long-term physical activity regulates the various pro-inflammatory such as (TNF-α and IL-6) and anti-inflammatory markers such as (adiponectin and leptin).[44]
Various kinds of exercise are suggested to improve the overall body metabolic activity and energy utilization. Aerobic exercise and resistance training are mostly used for the rehabilitation of cancer and CVD patients.[47],[48] It is suggested that resistance training has shown better regulating effects of insulin, blood glucose, lipids, and adipokine than aerobic exercise. However, long-term aerobic exercise has shown significant positive effects to regulate the biochemical parameters than resistance training. The combined application of aerobic exercise and resistance training is suggested to achieve significant output.[49]
A randomized controlled intervention study indicated that resistance training over 15 weeks significantly reduced the pro-inflammatory markers such as resistin and lipocalin-2 adipokines in elderly postmenopausal females.[50] However, this study further indicated significantly reduced levels of anti-inflammatory markers such as adiponectin. Siemińska et al. explained the possible reason for reduced adiponectin in postmenopausal women that the increased levels of free testosterone and low sex hormone-binding globulin in postmenopausal women were negatively associated with adiponectin.[51]
It has been proved that anti-inflammatory response is induced by adipokines secretion which occurs in response to anaerobic exercise.[52] A 30 s supramaximal exercise and anaerobic exercise elevated the circulatory adiponectin levels in both males and females.[53] Regular resistance training could improve muscle mass which leads to good muscular strength and a decrease in fat percentage. Regular resistance training also improved the levels of adipokines by reducing the fat percentage in women.[54] Acute exercise training regulates the release of various cytokines from myocytes, hepatocytes, osteocytes, and immune cytokines. However, chronic exercise training changes the circulatory levels of adipokines and immune cytokines.[55]
It is suggested that individuals should engage in sufficient exercise that should be a minimum of 150–300 min of moderate physical activity per week. The study suggested that sufficient exercise can reduce the harmful effects of a sedentary lifestyle.[54] A 12-week combined exercise (aerobic and resistance) program increases the anti-inflammatory adiponectin levels and decreases the pro-inflammatory resistin levels in obese girls. It is further suggested that children should do regular exercise to prevent fat accumulation and excessive weight gain.[56] In addition, Wen et al. found that all causes of mortality could be reduced by around 14% with the help of a moderate physical training program that will be of 15 min/day.[57]
It is reported that physical activity for 2 weeks along with dietary restrictions increases the rate of weight loss. However, it is observed that decreased physical activity and increased sedentary time reduce the rate of weight loss and regain of weight at a greater rate.[58] It is suggested that resistance exercise should be included during the therapeutic intervention to reduce obesity in individuals along with calorie restriction.[59] The effect of exercise on the circulatory level of adipokine and sedentary lifestyle diseases is summarized in [Table 1] and the effect of exercise on the regulation of adipokine and sedentary lifestyle diseases is illustrated in [Figure 3]. Combined aerobic and resistance training are more effective to regulate adipokine. Consistent chronic exercises are more effective to regulate adipokine levels than acute exercises.[55] Different types of exercises are regulating the adipokine levels which are summarized in [Table 2]. | Table 1: The effect of exercise in the circulatory level of adipokine and sedentary lifestyleassociated diseases
Click here to view |
 | Figure 3: Effect of exercise in the regulation of adipokine and sedentary lifestyle diseases (Created in Biorender.com)
Click here to view |
| Discussion | | |
This narrative review supported the hypothesis that exercise plays a significant role in the regulation of adipokines and sedentary lifestyle diseases. Aerobic exercise for 1 week, 3 sessions (30 min each) elevated the levels of adiponectin in abdominally obese men. Elevated adiponectin acts as a protective marker for obesity, T2DM and metabolic diseases.[61] Similarly, moderately intense aerobic exercise for 1 week (2–3 bouts), elevated the levels of adiponectin by 260% from the baseline.[62] In addition, a study showed that combined exercise therapy (aerobic training + resistance training) for 1 year (3 times/week and set of 30 min aerobic training and 30 min resistance training in each session) significantly improved the levels of adiponectin and leptin as compared to aerobic training alone.[63] However, a study reported that a single synchronized training session is not adequate to improve sudden changes in levels of leptin and cortisol in overweight young adults.[64] Another study reported that 4 weeks rehabilitation program (6 h of rehabilitation per day, 5 days/week) including a combination of exercises such as 1-h aerobic training and 1-h stretching along with muscle strengthening exercises and occupational therapy was significantly regulated the leptin and adiponectin levels and improves the insulin sensitivity in obese and chronic pain patients.[65] A study reported that a moderate amount of regular exercise (twice a week for 1 year) decreased low-grade inflammatory markers such as resistin and IL-6. This study further reported that regular exercise showed overall health benefits and was effective on cardiometabolic risk factors such as obesity, hypertension, and dyslipidemia.[68] Another study reported that endurance training for the duration of 8 week (3 days/week, maximum heart rate 65%–80% for 20–34 min) significantly decreased plasma visfatin along with the percentage of body fat and waist-to-hip ratio in middle-aged men.[69] It is summarized in [Table 2].
In this review, some articles have a small sample size to report their findings. Few articles have not defined the exercise training protocols properly.
| Conclusion | | |
This review indicated that regular exercise either aerobic or resistance or combined improves the circulatory levels of various adipokines. Regular exercise helps to improve the anti-inflammatory adipokine leptin and adiponectin and diminished the pro-inflammatory adipokine visfatin and resistin. Regular exercise along with dietary restrictions may play a significant role to reduce sedentary lifestyle diseases. Acute and chronic exercise may be an effective therapy to reduce the risk factors for chronic disease and its complications. Combined aerobic and resistance training are more effective to regulate adipokine.
Acknowledgment
We are grateful to Prof. M. Z. Idris, Dean, IIMSR, Integral University, Lucknow, India for the invaluable help and encouragement to carry out this review article without any hindrance.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
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