The Significance of High-Intensity Interval Training in Alleviating Diabetes Mellitus

Table of Contents

Introduction. 1

The Significance of the Problem.. 2

Review of Literature. 3

Glycemic Control 3

Risk of Cardiovascular Disease (CVD) 6

Anthropometric Variables. 9

Cardiometabolic Risk. 11

Body Composition. 14

Conclusion and Summary. 16

Future Research. 17

References. 18

Introduction

From a medical perspective, physical exercise is a standard recommendation for patients presenting with different lifestyle conditions such as type 2 diabetes mellitus, hypertension. The intervention leads to significant improvements such as enhanced glycemic control and weight management. Many lifestyle conditions are usually comorbid and often involve several disorders occurring at the same time. An inactive lifestyle is a prominent predictor of such illnesses, owing to the strong correlations between type 2 diabetes mellitus (T2DM) and an inactive lifestyle.

Additionally, obesity and being overweight are significant risk factors that increase the chances of a person developing the condition. Physical exercise has numerous advantages such as increasing bone mass, strengthening muscles and joints, as well as enhancing the wellbeing of the participants. Most importantly, the process leads to increased tolerance and encourages the affected patients to engage in strenuous activity longer.

More so, engaging in physical activity leads to multiple effects on different parts of the body. Subsequently, these physical activities play an essential function in reducing cardiovascular risk, cardiometabolic aspects, and enhancing anthropometric variables. Additionally, exercise facilitates improved metabolism rates, helps in lowering blood pressure, and reduced insulin resistance, which contributes to the physiological causes of T2DM. At the same time, physical activities lead to reduced cholesterolemia in the blood, improved mood, better energy rates, and enhanced sleep, aspects that assist in reducing the risk of type 2 diabetes mellitus. Stress management is also crucial as it boosts the health of the affected person and facilitates optimism towards recovery. Moreover, exercise improves anthropometric variables that encompass hip circumference, body mass index, as well as decreased body fat percentage. Therefore, physical activities are crucial in relieving the symptoms presented in T2DM.

The Significance of the Problem

Despite the established benefits of physical intervention in reducing T2DM signs, a standardized prescription is not available. In this regard, the intensity of the activity is a primary source of contention. Subsequently, determining the appropriate level of engagement is crucial in avoiding possible adverse outcomes. Very high intensity of exercise can be harmful if not carried out appropriately, especially if the patient is suffering from health problems like asthma. In such a case of asthma, physical activity can be the trigger of the symptoms (4, 21). As a result, formulating the correct amount of exercise, which is often individualized, is crucial to optimize patient outcomes and augment their health. Although such harmful issues are not common in T2DM patients, it is essential to identify the optimal level of participation to maximize patient outcomes. Generally, there are three levels of physical activity intensity related to how hard our body works while doing that activity. The first one is vigorous or high-intensity activity that emphasizes rigorous activities aimed at attaining fatigue and burning a high number of calories. High-intensity activities lead to harder breathing and panting. Examples of such high-intensity activities include jogging, competitive sports, aerobics, lifting, and carrying loads. Doing high-intensity physical activity can have additional health benefits, especially when well planned (18, 23).

Second, moderate or middle-intensity physical activity may involve various forms of cardiovascular exercise, brisk walking, recreational swimming, social tennis, and demanding chores like cleaning windows at home. In fact, most of the moderate-intensity activities can be achieved through day to day movements and other planned leisure activities and jobs. Lena et al. (2018) states that moderate-intensity physical activities provide substantial benefits to an individual. The low-intensity exercise entails light walking, lifting hand weight, push-ups, and sit-ups, yoga, among other activities. The aim of this research is to establish the benefits of physical exercise in alleviating the symptoms of type 2 diabetes mellitus. Nonetheless, as highlighted, the interventions should be individualized if the best health outcome is to be achieved. At the same time, giving lower prescriptions leads to suboptimal consequences that do not benefit the patient as intended. Manfredini et al. (2017) explains finding the correct participation level is crucial to ensure progress and recovery. Current literature focuses on the benefits of high-intensity interval physical exercises but does not specify the proper routine for the intervention. Standardizing the treatment is useful to allow the use of evidence-based practice that facilitates better improvement rates. Moreover, assessing the correct level of participation in physical activities is essential in mitigating T2DM symptoms as related to glycemic control, the possibility of developing cardiovascular disease, enhanced anthropometric variables, cardiometabolic disorders, as well as body composition.

Review of Literature

Glycemic Control

There is a significant correlation between high-intensity interval training and enhanced glycemic control. In this regard, recent research indicates that the intervention through high-intensity training is safe and effective in enhancing the utilization of lipids in the body and increasing sensitivity to insulin (19, 22). Subsequently, as illustrated, T2DM develops due to peripheral insulin resistance, as well as the dysfunctional regulation of the production of hepatic glucose, leading to an excessive increase in blood sugar levels (2). Moreover, the condition has strong associations with decreased production of insulin. As indicated, (19) the inability of the body to utilize lipids is a significant predictor of T2DM. From such a perspective, HIIT is vital in creating a calorie or energy balance by facilitating the conversion of lipids into glucose. In such cases, patients burn fat that often accumulates in bodies of most peoples with a sedentary lifestyle, increasing the risk associated with T2DM. Therefore, as related to glycemic control, HIIT creates a higher demand for glucose through energy expenditure (15).

There is a consensus by various authors regarding the role of high, as well as middle-intensity continuous training (MICT) in reversing metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur together and increases the risk of type two diabetes mellitus, heart diseases, and stroke. The conditions that cause metabolic syndrome include high blood sugar, abnormal cholesterol levels, and high blood pressure. Sharman et al. (2015) and Wu and coauthors (2015) link different diseases such as high blood pressure, stroke, and excessive body fat to energy imbalances in the body. In addition, a passive lifestyle increases the risk of heart attack, owing to the elevated levels of bad cholesterol in the body. Most studies focus on the necessity of dieting as an essential intervention that plays a crucial role in complementing HIIT (22). The implication is that various forms of exercise, such as running and push-ups, create a high demand for energy that facilitates the consumption of excessive calories in the body. Several authors relate the accumulation of triglyceride levels to low activity, an aspect that leads to high chances of developing abnormally large hip circumference and buildup of excess fat around the waist (2, 13). Therefore, HIIT and MICT are useful in maintaining calorie balance in the body.

There is sufficient evidence indicating HIIT is more effective in alleviating the symptoms associated with T2DM compared to MICT (19, 22, and 25). Most authors, therefore, advocate for high-intensity training in order to increase the benefit from the interventions in addressing various indicators of T2DM. On the other hand, HIIT helped in reducing medication use by 50% compared to MICT in a study involving men affected by T2DM. As shown in many studies, HIIT entails a sustained activity that is close to or exceeds the aerobic capacity of the individual (19). Additionally, the intensity of the action and the time taken to complete it are also vital in differentiating between the two methods. From such a perspective, the implication is that HIIT is more effective due to the more energy-consuming activities that assist in the reduction of adiponectin levels in the body. Compared to MICT, taking shorter periods to complete HIIT may encourage participants to continue with the activity, although the level of fatigue also increases.

MICT is also applicable to enhancing glycemic control and reducing metabolic syndrome. (14, 25) State that the beneficial aspects of both procedures are often patient-specific. In a physiological assessment, various elements such as adiposity, waist circumference, and resting blood pressure improve with intensity in the level of engagement, although the outcomes vary in individual patients (14). Ahmad (2019) highlights the role of patience as an essential element that assists in differentiating the advantages of HIIT and MICT systems (2). Consequently, the level of fatigue is often excessive when participants engage in HIIT compared to MICT. However, the time taken to complete the engagements also differs. In the prescription of exercise in T2DM patients, the level of motivation is critical in encouraging the affected persons to engage in the appropriate intensity of physical activity for the best outcomes.

The uncertainty regarding the most appropriate level of engagement poses risks for the participants. In this regard, (18, 25) explains the prospects of exaggerated acute physiological responses and the need for a standardized process to facilitate consistent outcomes. However, HIIT has higher rates in the increase of adiponectin levels in the body (19). In such cases, the cytokine is useful in reducing the levels of adiposity, as well as inflammatory markers. Diminished adiposity leads to a reduced risk of anthropometric factors, including waist and hip circumference, as well as enhanced insulin sensitivity that improves the utilization of glucose in the body. As indicated by one of the studies, the intervention has impressive rates in controlling hyperglycemia, an essential predictor of T2DM (25).

Risk of Cardiovascular Disease (CVD)

Cardiovascular disease is a condition affecting the heart and blood vessels. CVD is usually associated with the buildup of fatty deposits inside the arteries and damage to arteries in organs such as the kidney, brain, eyes, and heart. The four major types of CVD are coronary heart disease, stroke, peripheral arterial disease, and aortic diseases (17). There is a consensus among various authors regarding the benefits of HIIT in reducing the possibility of CVD (2), (6), (9), (12). There are various studies in regard to CVD that recommend the use of physical training in elevated levels of tolerance to resistance activities (9), (14), (21). However, a combination of HIIT, at least two to three days in a week, as well as MICT thirty minutes every day, indicate better results in the management of T2DM risk factors such as hypertension and obesity (21). In this regard, the aspect of intensity is useful in assessing cardiorespiratory fitness since a higher level of the measure indicates the reduced progression prehypertension and hypertension. At the same time, (9) found a substantial correlation between a passive lifestyle and elevated risks in a cluster of CVD facilitators, including reduced weight management and the development of coronary heart conditions. Therefore, engaging in higher levels of physical activity is vital in reducing the risk of CVD.

Enhanced physical conditioning is crucial in alleviating the symptoms associated with T2DM.  Research has it that patients participating in HIIT have a higher tolerance for sustained activity (9). In such cases, intolerance to exercise, often characterized by extreme fatigue, muscle aches, and shortness of breath, is a significant aspect that reduces the motivation of engaging in physical activity. Additionally, according to various authors, moderate to high-intensity exercise plays an essential function in the reduced risk of heart conditions such as those emanating from the accumulation of deposits in the arteries (14). Reducing adiposity or fat content in the body is useful in avoiding coronary thrombosis and other disorders of the cardiovascular system. The implication is that there is a psychological aspect of motivation in participation in exercise. Subsequently, increasing tolerance through HIIT assists in encouraging the affected patients to continue with the activity and benefit from the reduced risk of developing CVD.

In patients affected by CVD, low-intensity physical engagements assist in reducing the level of low-density lipoproteins (LDL). As indicated by various authors, several activities such as brisk jogging, aerobics, and cycling have a positive outcome on reducing high-density lipoproteins as they facilitate the movement and transportation of cholesterol from other parts of the body to the liver (3, 18). After the process, the liver initiates the process of removing the cholesterol from the body and reducing the harmful effects of excessive lipids. (7) Associates low-intensity physical activity to decreased insulin resistance. As indicated, the pathophysiology of T2DM originates from low levels of uptake of the insulin hormone that facilitates the increase of blood sugar in the system. Engaging in exercise at various intensities helps in the optimized utilization of insulin, reducing the risk associated with T2DM. Moreover, HIIT, as well as low-intensity physical engagements, create more demand for energy and facilitate the burning of excess calories that elevate the development of T2DM.

(11) Explains that HIIT is vital in improving the rate of oxygen supply in the skeletal muscles. Thus, there is a consensus that the use of different levels of training intensity is essential in enhancing cardiorespiratory functions.  Training is essential in increasing the optimum rate at which the heart, lungs, and muscles can effectively use oxygen during exercise (VO₂)_.Research shows that VO₂ has significant correlations with exercise tolerance that plays an essential function in making participation in activity a routine process. As highlighted by a couple of authors, (3,7), the benefits associated with HIIT in alleviating CVD is evidence in aspects such as insulin resistance and diminished waist circumference. In order to boost cardiorespiratory fitness, it is crucial to encourage the affected patients to participate in the exercises for the required period.

Cardiorespiratory endurance reduces the risk of T2DM. As indicated by most statistical studies, participation in high-intensity exercise has strong associations with the diminished possibility of factors that facilitate the occurrence of CVD and T2DM (11). As described by (21), HIIT helps in alleviating essential markers of T2DM, including systolic and diastolic blood pressure, as well as better management of weight. One of the studies found that among patients at a high risk of developing diabetes, only 13.4% of the participants that engaged in HIIT and enhanced their cardiorespiratory endurance had their conditions progress to chronic stages (13). At the same time, the continued participation in physical activities has a positive influence on aging, obesity, and reducing the risk of genetic causes of T2DM. The implication is that HIIT can be used to reduce the effects of non-modifiable factors such as age and heredity in initiating T2DM and CVD.

Anthropometric Variables

There is significant evidence indicating the role of HIIT and MICT in refining the value of life in patients living with T2DM. (4, 23, 26) Emphasizes the part of the intervention in enhancing anthropometric variables such as the percentage of body fat, BMI, and hip circumference. Patients living a sedentary life are at an advanced risk of becoming obese and being overweight, among other aspects that increase the risk of T2DM. Additionally, the risk factors are essential predictors of CVD and a host of other conditions that also enhance the rate of comorbidities. As indicated by one of the studies, body mass index is one of the essential predictors of related risks of T2DM (23). In this regard, participation in high-intensity exercise has substantial effects in reducing adiposity and the overall management of weight. As a result, despite the lack of a standardized regimen concerning the level of engagement in physical exercise, the intervention leads to a positive outcome in improving BMI.

Compared to MICT, HIIT has better efficiency in reducing the percentage of body fat. Studies associates various types of physical training such as cycling a stationary bike followed by a period of slowed activity, rope skipping, slow brisk, then intense jogging to 25%-30% consumption of body calories (26). In such cases, an ideal repetition consisted of twenty seconds of maximum cycling followed by a forty-second break or short cycling. Compared to other interventions such as weight training, HIIT has a substantial effect on increasing the metabolic rate of the body and creating a higher demand for energy and calories (4). Coupled with proper dieting, HIIT is useful in preventing energy imbalances that facilitate the development of obesity, hypertension, and other disorders that co-occur with T2DM. The recommended level of engagement is at least thirty minutes of HIIT, although maximum participation requires brief pauses to promote longevity.

HIIT and MICT have significant rates in reducing waist circumference. As highlighted by different studies, the increased utilization of body fats and the higher conversion rates of lipids to energy are useful in reducing the fat content in the body (15). Additionally, the enhanced use of blood sugar assists in decreasing the rate of conversion to lipids and their derivatives, as well as diminishing the chances of T2DM. In a population of individuals engaging in HIIT for at least twenty minutes, two times a week, the average weight loss after twelve weeks of assessment was 4 pounds (1). Moreover, the changes were independent of any alterations in dietary intakes, underscoring the significance of HIIT in reducing the risks associated with T2DM. At the same time, the intervention has substantial rates in the reduction of visceral fats. Apart from diabetes, the fat surrounding essential organs such as the heart and kidney increases the possibility of various illnesses significantly.

HIIT assists in muscle gain, as indicated in a study where researchers found that high-intensity physical activities lead to better results in muscle gain as compared to weight-lifting (23). As a result, in individuals who engage in repeated weight training with additional exercises such as training and aerobics, the rate of muscle gain is likely to be higher relative to those who participate in weight lifting alone, although patient-specific factors also determine the progress made. At the same time, an increase in muscles leads to reduced body fat, as well as augmented exercise tolerance that motivates participants to engage in more strenuous activities (1). As highlighted, there is a strong correlation between oxygen consumption and HIIT. Compared to the conventional methods of attaining endurance, such as sustained periods of running or cycling, high-intensity activities reduce the time taken to achieve similar effects. Increasing oxygen consumption allows participants to increase their muscle gain for better outcomes in weight management.

Higher demand for energy in the body is essential in maintaining glycemic balance. As indicated by (23, 26)), anthropometric measures that include hip circumference and BMI result from an energy imbalance where the amount of calories generated exceeds those used. In this regard, HIIT increases the metabolic rate significantly, creating a higher demand for energy in the system, an essential aspect of reducing the risk associated with metabolic syndrome. Additionally, another study highlighted the effect of the intervention in improving insulin resistance, compared to traditional forms of exercise (15). In this regard, current evidence indicates HIIT has better results relative to MICT, as well as low-intensity engagements in physical activity. Moreover, HIIT increases the ability to participate in other forms of exercise, although a progressive approach where participants begin with mild to low forms of exercise is advisable to reduce the onset and severity of fatigue. Therefore, as related to T2DM, HIIT improves anthropometric variables that reduce the risk associated with lifestyle conditions.

Cardiometabolic Risk

There is a significant correlation between metabolic syndrome and cardiometabolic risk. In athletes, large body size is a prominent predictor of such conditions, including T2DM. As indicated by the authors in (5,6), HIIT facilitates various beneficial outcomes such as improved heart variability rate (HRV) and aerobic adiposity. In the context of HRV, there is uncertainty regarding the role of HIIT in attaining a healthy state. For example, in patients participating in intensive endurance exercises, the HRV rate reduces significantly (6). However, in high rates of endurance, the measure increases, indicating the body has an increased capacity of handling more intensive engagements for longer hours. As related to T2DM, high-intensity training is essential in augmenting participation to exercise for enhanced outcomes and psychological motivation. In athletes with larger body sizes, endurance is useful in reducing cardiometabolic risks and promoting higher rates of performance.

Dieting patients and athletes can increase their calorie intake significantly when participating in HIIT. In this regard, various authors agree on the essential function of the intervention in diminishing aerobic adiposity and capacity (5,6, 25). The implication is that people who have sedentary lives should reduce their calorie intake as a precaution for preventing energy imbalances. In such cases, HIIT has regulatory effects by increasing energy demand in the body, as well as converting fat to muscle. Attaining better muscle proportion helps improve athletic performance, owing to the concept of augmented oxygen intake and endurance levels. As a result, although the weight may remain constant, the participants will have less aerobic adiposity and more muscles. Individuals who engage in HIIT can increase their daily calorie intake with a decreased risk of cardiometabolic conditions. Most importantly, balancing energy levels in the body has a positive impact on the possibility of developing T2DM.

HIIT rapidly increases plasma lactate levels over short intervals of participation. Various studies by different authors underscore the significance of the outcome in the suppression of symptoms and the promotion of counter-regulation (12, 17, 20). Additionally, the process helps in the preservation and improvement of cognitive functioning. As research indicates, the improved levels of plasma lactate over the short term HIIT have a positive effect on the control of hypoglycemia (17, 20). In such cases, secondary symptoms associated with reduced blood sugar levels such as confusion and the significant loss of cognitive function diminish. At the same time, relative to a group that did not participate in the HIIT intervention, the risk of T2DM as related to the high prevalence of cardiometabolic conditions was significant. From such a context, exercise is an essential fuel for the brain in regards to increasing plasma lactate levels and subsequent cognitive functioning.

In patients engaging in HIIT, there is an elevated suppression of cortisol production, as well as enhanced glucose tolerance. In this regard, (12, 16) identify the significant association between cortisol levels, insulin resistance, as well as chronic complications related to T2DM and its various comorbidities. Although the mechanisms of how increased stress levels lead to a higher risk of developing diabetes are not apparent, there is a consensus regarding the role of excess glucocorticoid in the exacerbation of metabolic control issues. Moreover, it is associated with elevated levels of insulin resistance help in explaining the pathophysiology of T2DM as related to the enhanced secretion of cortisol. In such cases, HIIT shows substantial effects on the utilization of excessive glucose in the body. Research by several authors states that while cortisol is useful in assisting an individual to flee from a stressor, chronic secretion leads to elevated levels of blood sugars (15, 17). HIIT acts as a regulator in creating a higher demand for additional energy that often leads to weight gain and adiposity if not utilized.

High lipid profiles are a significant predictor of T2DM. In obese adults and youths, HIIT is useful in enhancing the measure and diminishing the cardiometabolic risk of developing the disorder (5, 16, 12). In a study involving twenty males, engaging in high-intensity training for twelve weeks resulted in a considerable improvement in various measures, which encompass waist circumference and the percentage of fat mass in the body (12) — moreover, other anthropometric measures, including BMI and an overall enhancement of the lipid profile. However, there were no changes in the LDL or HDL rates for the trial and control groups. In addition to controlling the levels of fats in the body, HIIT and MICT have considerable outcomes in promoting oxygen uptake in the body and optimizing aerobic capacity.

Body Composition

The body physique of an individual determines the ability to participate in HIIT and other physical activities. As indicated by Feito et al. 2018 and Moholdt and colleagues (2009), the intervention has a positive effect on enhancing the athletic performance of participants. The improvement emanates from the positive impact of HIIT on cardiorespiratory, as well as metabolic functions. Moreover, one of the studies relates the intervention to a regulated process of anaerobic glycogenesis that reduces the rate of converting glucose to fat during rest (17). HIIT is vital in increasing neuromuscular reception useful in improving endurance and the regulation of anthropometric variables. HIIT has considerable rates in reducing muscle atrophy and myopathy difficulties associated with a sedentary life. The implication is that enhancing the psychological aspect of participating in strenuous activity is crucial in augmenting the intended health outcomes. Besides, athletes can perform at a higher level with a reduced risk of injury.

Various authors identify the essential role of HIIT in enhancing skeletal muscle mitochondrial content. Different authors underscore the effect of the intervention in improving the number of mitochondria in the muscles to address the increased demand for energy (8, 10). Mitochondria facilitate the conversion of calories in food into utilizable energy and enhance the capacity of the body to produce and utilize power. Prolonged periods of rest result in the declined production of mitochondria in the cells. In such cases, (16) associate the redundant storage of fats in people with sedentary lives to the low energy conversion and use rates in such states. As earlier highlighted, HIIT creates demand for energy, as well as the elevated mitochondrial action that prevents the storage of fats and lipids in the body. The process is critical in addressing anthropometric and metabolic syndrome factors that determine the risk of T2DM.

HIIT helps in enhancing musculoskeletal tension. One of the publications found out that the training process increases endurance rates with a range of 20% to 80% and reduces the risk of injury substantially (24). As a result, athletes and patients on prescription for exercise can participate in the activity for more extended periods and attain optimum benefits. At the same time, one of the studies found that people who participate in high-intensity training are more likely to complete their workouts in shorter times (10). Moreover, other aspects such as cardiorespiratory fitness, improved bone mass ad better management of weight are useful in decreasing the risk of developing T2DM. The intention is to increase performance levels with minimal effects on the levels of stress. In a majority of cases, consistency in the participation the physical activities is crucial in yielding substantial outcomes. Therefore, improved musculoskeletal tension assists in prolonging engagement levels and optimizing the benefits of the prescription.

Conclusion and Summary

There is sufficient evidence supporting the significance of HIIT in alleviating the symptoms of T2DM. As such, various exercises such as intense running followed by brisk jogging and cycling at high resistance show considerable improvement in the indicators of T2DM. As related to the pathophysiology of the illness, HIIT assists in attaining better rates in glycemic control, enhanced utilization of insulin, as well as improved glucose tolerance. These factors are crucial in reducing the symptoms associated with T2DM, increasing the quality of life of the affected patients. Additionally, MICT and HIIT also play an essential function in reversing metabolic syndrome. Participation in high-intensity activities reduces the risk of CVD. Furthermore, the reviewed evidence indicates a substantial effect in diminishing the possibility of arterial conditions, heart diseases, obesity, hypertension, and improved levels of LDL.

HIIT and MICT give remarkable outcomes on anthropometric variables.  Therefore, engaging in at least half an hour of mild to high-intensity physical activity leads to a reduction in waist circumference, enhanced body mass index, and hip circumference, among other factors. Moreover, the intervention facilitates the reduction of body fat percentage, and the augmented absorption of blood sugar, aspects that lead to augmented weight management. Regarding cardiometabolic risk, HIIT contributes to a better heart rate variability, diminished aerobic adiposity, as well as improved muscle strength. Furthermore, increased plasma lactate levels and reduced secretion of cortisol improve glucose tolerance and reduce the chances of developing T2DM. Lastly, HIIT assists in augmenting body composition, such as increased neuromuscular content, cardiorespiratory fitness, and endurance. The elements are critical in promoting sufficient engagement for optimized health outcomes.

Future Research

Although there are many published research on the advantages of HIIT to patients with T2DM (13), (18), (24), (27), very few have analyzed the effectiveness of these activities and their safety levels in glycemic control. With the alarming increase in incidences of T2DM, especially among the middle and older aged people(1), there is a call for more strategic organization of the activities to reach these people. Future studies should, therefore, focus on the long-term effects of HIIT in T2DM patients. More studies are also warranted to form the most efficient procedure for each target patient based on their fitness level and medical characteristics. Although there is increased adoption if HIIT in medical and health fields, its viability and safety should additionally be appraised in the near future. Results concerning the prognosis are T2DM is not sufficient, and thus future studies should also focus on predicting the next course of T2DM.

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