Effects of Aerobic Exercise on Type 2 Diabetes

Introduction

Diabetes as a condition has greatly contributed to the continuous increase of mortality and morbidity in the world. Diagnoses in relation to this particular condition have significantly increased to date. The rising numbers, consequently, cause an alarm to professionals in both the medical and scientific fields and as a result, research has to be conducted on various ways and methods which may aid in the management of the condition (Yavari et al, 2012).

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This research has ultimately analyzed the metabolic effects and factors that relate to aerobic exercise. Together with prescribed medication and diets, exercise and training has in most cases been considered a cornerstone of treatment for patients with type 2 diabetes. Cardio exercise, also known as aerobic exercise, is a form of physical exercise that ultimately depends on aerobic energy- generating methods. Such exercise involves work outs or movements of low to high intensities. The effectiveness of exercise in the improvement and management of type 2 diabetes is well documented. Much research has more specifically focused on the effects in relation to aerobic exercise. Chertoff (2018) has also referred aerobic exercise to be any kind of cardiovascular conditioning. The physical component is usually a very important part of the treatment plan when It comes to type 2 Diabetes treatment. The key to achieving a healthy and controlled life is and has always been to exercise and to stay fit. The result of this is the maintenance of an optimum blood sugar level, hence prevention of long term conditions and complications (Lisa, 2019). In general terms, exercise has been prescribed widely in the day to day lifestyle of persons as a way to control blood pressure and glucose in type 2 Diabetes patients.

Therefore, this research has particularly assessed and analyzed the effects of both aerobic and resistance exercise and training and has even went forth to identify the predictors of any form of improvement as may be realized in the process. The research has based its results and findings on various validated research and report articles in the United Kingdom on the same issue. Many articles have looked at Diabetes as a condition in general, others have separately tackled type 2 Diabetes and distinguished it from type 1 Diabetes. A number of articles have even looked at aerobic exercise in its own stance, and quite a number further analyze the effects of this kind of exercise in both metabolic and general physical processes; which is directly relevant to the research question. Literature review provides vivid and evidence- based findings and results from surveys on scholarly articles, reports, library books or any other sources with topics relevant to the research question at hand (Aveyard, 2010). In the process of achieving validated and verified information, this research has acknowledged works and writings of different researchers and arranged the same vividly and chronologically.

Methodology- Literature Review

This research has comprehensively and interpretatively looked at literature that have addressed the specific topic of aerobic exercise in relation to Type 2 Diabetes management. The method particularly used in this context is the systematic review under literature. This article has systematically searched, critiqued and further collected and combined various articles and research reports so as to be able to identify and demonstrate gaps in the existing articles and bases. This research has also, in the process, clearly demonstrated and depicted, in the dissemination of various gathered information, avid and vivid understandings of both the methodologies and research used in previous articles (Aveyard, 2010). Additionally, a comprehensive and extensive survey on the research question in this context has been done and reflected in this research. This is referred to as meta- analysis. This research has attempted to analyze, evaluate and interpret all identified research evidences that are relevant to the research question. The systematic review is verifiably a good comparison method in quantitative research and article writing.

Various articles and reports have been published on various topics. There are quite a number of articles written on Aerobic exercise itself. Also, there are various articles that intensively look at the pathophysiology behind Diabetes and the types of Diabetes; Quite a number have focused on respective types of diabetes, their causes, effects, preventions, treatment and suggestions. So as to increase the accuracy and quality of the results on information relevant to the research question, this research has ultimately collected data and information from 10 sources which enabled the pinpointing of information on both aerobic exercise and its direct relationship with type 2 diabetes. The research method ought to be as specific as the research topic, hence the 10 articles focused on. The 10 articles below provided narrower and more relevant information on the research question and in critical terms and analysis, the data extraction table provides for their basic understandings.

Most of the articles looked at have a definite origin of the United Kingdom. However, the few articles of a different origin directly relate to issues and factors that still affect the United Kingdom. The information disseminated from these articles are verified and therefore reliable in the United Kingdom.

The data extraction table has particularly and chronologically arranged the articles as researched (See appendix 1). The table has specifically looked at the content data and the validity of the information in the articles and reports used in the conduction of this research. The requirements of the table have enabled the eminence of both significant and verified information. The table has even further depicted additional comments and criticisms based on both other articles and the reasoning of the researcher. The extraction table has further been accompanied by the theming table, which has specifically grouped and classified the evidence- based information and derived the relevant general themes of the articles reviewed (See appendix 2).

Results

In very basic terms, insufficient secretion of insulin and abnormal secretion of glucagon in the body characterize the bihormonal metabolic disorder; Type 2 Diabetes. In 2013, the estimated prevalence in relation to diabetes was 382 million people, followed with a projection of around 500 million people who would be suffering from this bihormonal metabolic disorder in the year 2030 (Madsen et al, 2015). Type 2 diabetes is considered one of the biggest global health problems and one that leads among the causes of mortality and morbidity for around 90% of all diabetic cases. The increasing prevalence of sedentary lifestyle and obesity is what can be associated with the increasing type 2 diabetes prevalence (Yavari et al, 2012).

These statistical findings have called forth new methods and ways in which the management and control of Type 2 Diabetes may be effected. Both aerobic exercise and resistance training have been reported, in many instances, to improve the cardiovascular and metabolic parameters of the body, and not only to patients with type 2 diabetes, but also the healthy subjects (Bacchi et al, 2012). From the 10 articles, four main themes were distinguishable. These results have, on that note, been divided into four main thematic points.

Glycaemic control and Insulin sensitivity

Type 2 diabetes is mostly associated with impaired insulin sensitivity and endocrine function. Equivocally, existing research has in many articles displayed the importance of regular exercise in relation to insulin sensitivity. Further, some studies have also gone forth to show the importance of both regular moderate intensity exercise and high intensity training or exercise. It is only in few circumstances that insulin sensitivity has been demonstrated to remain unaltered at the end of the study. Various studies have found improved insulin sensitivity in sedentary healthy subjects. A particular study has further demonstrated that continuously prescribed days of exercise depict an improvement in glucose concentration curve in a type 2 diabetes population (Madsen et al, 2015).

This theme has been derived from three main articles:

Bacchi, et al. (2012) Differences in the Acute effects of aerobic and resistance exercise in subjects with type 2 Diabetes: Results from the RAED2 Randomized trial

Jyotsna, A., Sharma, S. (2016) Effects of Aerobic Exercise on blood glucose levels and lipid profile in Diabetes Mellitus type 2 subjects.

Madsen, et al. (2015) High Intensity Interval Training improves Glycaemic control and pancreatic beta cell function of type 2 diabetes patients

Sigal, et al. (2009) Effects of aerobic training, resistance training, or both on glycaemic control in type 2 diabetes: a randomized trial.

Other articles have however also found the same resulting theme. The importance of exercise in insulin sensitivity is founded on the oral glucose tolerance tests indices which potentially reflect different outcomes. These indices are applied in the elucidation of any potential changes in the absence of hyperinsulinemia euglycemic glucose clamp, which measures insulin sensitivity directly, the insulin sensitivity of the whole body, peripheral insulin sensitivity and the hepatic insulin sensitivity (Jyotsna, 2016).

The benefits of aerobic exercise in associated with glycaemic control are significant. Glycated hemoglobin refers to a form of hemoglobin which is compounded covalently with glucose. This results from the exposure of hemoglobin to glucose in the blood. Through the glycation process, they are bound together (Shubrook & Shubrook, 2010). Glycated hemoglobin concentration is a gold standard in regards to glycaemic control because of its direct reflection of such control over a lengthy period of time. Clinically, patients with type 2 Diabetes usually possess poor glycaemic control. This increases the morbidity and mortality risk in the population. High concentrations of the same also increase the risk of development of Diabetic peripheral neuropathy and also diabetic retinopathy in the long run.

In relation to the management of type 2 diabetes, upon the conduction of various researches on ethical bases of human test subjects, it has been concluded that aerobic exercise, and resistance training, both play a very significant role in the improvement of insulin sensitivity. In this regard, the beta- cell function and insulin sensitivity are the most direct determinants of glucose control (Bacchi et al, 2012).

An adequate and controlled prescription of exercise is necessary in order to achieve an excellent glycemic control in patients with type 2 Diabetes. In other terms, physical activity/ exercise plays a great role in the improvement of the regulation of glucose homeostasis. This is applicable to both healthy individuals and Type 2 Diabetes patients. Madsen (2015) has in his non- invasive study demonstrated the improvement of glycaemic control through the addition of low volume High Intensity Interval Trainings in the treatment of Type 2 Diabetes patients. The improvement in glycaemic control has been determined by the reduction of average fasting venous concentration of glucose in the body.

From the experiments conducted, derived surrogate indices have been carefully interpreted to provide for a pivotal and detailed information which would have a very significant change in terms of management, treatment and control of Type 2 Diabetes. Foundationally, lower basal levels of insulin are associated with physical exercise. In addition, such exercise attenuates the response of insulin when it comes to the glucose load, which suggests the increasing sensitivity of peripheral insulin in the body.

On glycaemic control, glucose levels lower significantly after weeks of high intensity interval training. Further findings indicated fasting venous glucose in blood concentrations and low 1st phase concentration curves in the type 2 diabetes patients. The significant decrease in the levels of glycated hemoglobin in the type 2 diabetes patients depicts clinical importance (Madsen et al, 2015)

Metabolism

Aerobic training or otherwise referred to as physical exercise has been proved to significantly improve metabolic features in regards to the management of type 2 Diabetes. Results obtained also suggest that the inclusion of aerobic exercise in addition to a dietary weight reduction program also improves the metabolic syndrome ratios (Okura et al, 2007). Metabolic syndrome refers to a variety of conditions that collectively occur in the body hence increasing the chances of stroke, heart conditions and type 2 Diabetes. The conditions referred to include excess abdominal fat, high blood sugar levels, increased blood pressure, and excess abdominal cholesterol and triglyceride levels.

This theme has been mainly derived from:

Jyotsna, A., Sharma, S. (2016) Effects of Aerobic Exercise on blood glucose levels and lipid profile in Diabetes Mellitus type 2 subjects.

Marwick, et al. (2009) Exercise Training for type 2 Diabetes Mellitus. Impact on Cardiovascular Risk.

Although just one of the aforementioned conditions does not guarantee having the metabolic syndrome, there is still risk of the development of complications. Aerobic exercise, in this context, helps in the improvement of metabolism, hence the prevention and management of type 2 Diabetes, which is one of the resultant conditions. Meta- analyses have proposed that the improvement of metabolic parameters to both pre- diabetes and type 2 Diabetes patients is significantly dependent on high and moderate- intensity exercises. One the same note, the increased risk of incidences of type 2 diabetes is associated with low physical activity. As an important mechanism in the management of type 2 diabetes, aerobic exercise is a key player in the beneficial effects brought about on both cardiovascular and metabolic parameters. This kind of exercise has notably proved to have beneficial effects in the metabolic profiles in patients with type 2 diabetes. Endurance exercise, in particular, increases capitalization of the skeletal muscles and the blood flow (Yavari et al, 2012).

Weight and fat reduction

Principally, aerobic exercise achieves improvements on glucose control, insulin sensitivity and metabolism in type 2 diabetes patients. In addition to that, the process also reduces abdominal fat which is essential in the management of type 2 diabetes. These changes after training and even this reduction in truncal fat are the basic determinants of the metabolic improvement induced by the exercise (Dixit et al, 2017).

Two main articles have been specific to this theme:

Dixit, et al. (2017) Effect of moderate- intensity aerobic exercise on glycosylated hemoglobin among elderly patients with type 2 diabetes & peripheral neuropathy

Yan, et al. (2014) Effect of aerobic training on glucose control and blood pressure in type 2 diabetics

In both groups; healthy control subjects and type 2 diabetes subjects, aerobic exercise and progressive resistance training significantly lowers the abdominal fat and the circumference of the waist. Bone Density scans, however, in distinguishing between subcutaneous and intra- abdominal fat stores, are limited. Findings have shown that both high intensity and moderate intensity exercise cause a reduction in weight and waist circumference (Bacchi et al, 2012).

Improvements in cognitive and pancreatic Beta-cell function

From various research articles, supervised low volume high intensity interval training and exercise ameliorates the function of the pancreatic beta-cell function significantly. The improved pancreatic beta- cell function mechanisms to increase insulin action may be multifaceted (Madsen et al, 2015). The process may include an improved and coordinated feedback loop between the pancreas and liver and the muscles. The mechanisms behind this improved pancreatic beta- cell function could decrease the hepatic gluconeogenesis; in relation to the liver, attenuate insulin resistance; in relation to the muscles and slowly awaken the beta islets towards the secretion of insulin; in relation to the pancreas. In type 2 diabetes patients, however, more mechanisms could be involved. This is because the condition is characterized by perturbations in several organs. Both the myocytes and the adipocytes secrete the anti- inflammatory cytokines which could be involved in the whole improvement (Bacchi et al, 2012).

This thematic issue has been derived from:

Bacchi, et al. (2012) Metabolic effects of aerobic training and resistance training in type 2 diabetes subjects: a randomized controlled trial

Cindy, et al. (2010) Minimal difference between aerobic and progressive resistance exercise on metabolic profile and fitness in older adults with diabetes mellitus: a randomized trial

Discussion

In the conduction of clinical research, there are certain factors which have to be considered. In order to establish credibility and acceptable standards, there is a critique and appraisal process that looks at the research evidence. Such processes enable the determination of whether the methodological quality of the study has a possibility of bias in its process; from the design to the analysis (Tufanaru et al,2017).

From this actual systematic literature review, it can be concluded that acceptable standards were met. In the determination of validity and this acceptance, the following issues have been adequately answered in all the main ten articles used in the conduction of this research. The tool used in the determination of these crucial aspects were the Joanna Briggs Institute Critical Appraisal tools.

There has been true randomization in the assignment of human participants in the treatment groups. In this effect, there is always risk that the allocation of participants with certain known characteristics to different treatment groups may affect the results of the whole research. There should be a randomized selection of participants to random treatment plans/ treatment groups. In this case, patients with Type 2 Diabetes are selected random. Systematically, I checked the details of the randomized procedures used in the ten articles. The assignment was truly randomized and therefore the data collected validated.

The allocation to the groups was concealed. The allocation to the randomized groups has to be concealed because if those allocating participants are aware of the groups during the process, there is an obvious risk of deliberately intervening in the allocation by preferentially allocating the patients to particular treatment groups. From this fact, the allocation to the groups have to be concealed. From all articles used in literature review of this research, the concealment of the allocation groups has been essential to achieve conclusive results.

The treatment groups were similar at the baseline and the participants have to be blind to the treatment assignment. The internal validity of clinical studies exploring causal relationships is threatened if there are differences between the participants when it comes to comparing the groups. The participants should not also be made aware of the treatment group or he control group they are in. Methodologically, this may affect the behavior and response of the participants to the treatment. In lay terms, if the participants are made aware of their control or treatment groups, there is an obvious risk that they may react or respond in a different way to the control intervention respectively or to the interest intervention, compared to the way they would behave if they would not be aware. The lack of awareness is therefore a very crucial aspect when it comes to the significant reduction of the risks associated with the validity of the results.

Articles systematically reviewed in this research have met all the accepted standards and qualities in clinical research. The collection and interpretation of all these information has been justified and systematically controlled. The above justifications had to be criticized and closely analyzed so as to ensure that indeed there is an achievement of desirable and verified results.

Implimentation Of Findings

Scope of the Research

The results obtained were notably based on the extensive review of literature on the subject matter: which has been provided for by the research question. Results obtained have essentially been verified and validated through the accepted ethical and research standards.

As depicted, both resistance and aerobic training and exercise have a great impact in the improvement of metabolic features and the sensitivity of insulin in the body of type 2 diabetes patients. The same results have also generally provided for the reduction in abdominal fat in the patients (Bacchi et al, 2012).

The Glycated hemoglobin (A1C) test is the basic diagnosis of type 2 diabetes. The average blood sugar level is usually indicated in this tests for a certain period of time. Normally, the blood sugar levels are below 5.7%. Because of this, 5.7 to 6.4% levels usually point to pre diabetes. Very high concentrations, as indicated in the results, mean the presence of diabetes. In case of absence of the Glycated hemoglobin (A1c) test, certain other tests act as alternatives: These tests include the random blood sugar test, fasting blood sugar tests or the oral glucose test for tolerance.

Even though greatly advised and highly advocated for in the treatment of type 2 Diabetes, the strategies and efforts that have existed face big challenges and shortcomings. These challenges include the lack of the time and motivation to follow the instructions and guidelines, and the lack of adherence by the Type 2 Diabetes patients.

In the United Kingdom, doctors and other clinical professionals have called for action in a bid to curb and control type 2 diabetes because of the rising figures in diagnoses in both children and young adults. The new figures show that around 7000 young adults and children in the United Kingdom are being treated every day for type 2 diabetes (Lacobucci, G, 2018). Additionally, 90% of the more than 3.8 million people living with diabetes in the UK are people with type 2 diabetes. These are according to the updated figures (Charity, 2019).

This research has effectively collected information on type 2 diabetes in particular. The research has also put a focus on aerobic exercise, which forms the basis of the main question. The research question in this research wants the effects and the impact of aerobic exercise in relation to the management and control of type 2 diabetes. Although most articles pretty much looked at the effects and impacts of both progressive resistance training and aerobic exercise, information on the effect and changes associated with aerobic exercise has been clearly disseminated. There is no much difference between the effects of the two to management of type 2 diabetes. This research is however only limited to the number of articles analyzed and interpreted. In as much as this research has based its arguments and information from as many articles as possible, not all the articles in relation to the research topic have been looked at.

The only other difficulty that arose from the conduction of the research is the restriction in regards to place and time. This research has greatly focused on the effects and impact of aerobic exercise in management of type 2 diabetes in the United Kingdom. Extensive research has been conducted in regards to the United Kingdom, and only a few articles have been systematically analyzed to siphon information relevant and applicable in the United Kingdom.

Recommendations and Limitations

From the statistical findings, it has been severally recommended that in regards to the management and control of Type 2 Diabetes, the type 2 Diabetes patients should add at least 150 minutes in a week of moderately conducted intensity aerobic exercises which corresponds to around 60% of the maximum frequency of the heart (Madsen et al, 2015). It is also clear from the findings that all participants did fulfill the intervention caused by High Intensity Interval Training sessions therefore displaying the fact that the practice could be continued as a positive strategy in inactive Type 2 Diabetes patients and other groups.

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The inclusion of physical exercise could significantly improve the treatment of type 2 diabetes and even further help in its control and management. The management of type 2 diabetes is utterly easy and controllable. If only people would be made aware of the risks and the methods in which they could reduce the risks, the management of millions of these cases would be possible. The creation of awareness is therefore the best way in which management of type 2 diabetes is possible. Regardless of the fact that it is more likely that older people would acquire it, it is never too early to be made aware and to understand the risk of it and to make effective changes that would help in its management.

Conclusion

Both aerobic exercise and resistance training have positive impacts towards the clinical improvement of patients with type 2 diabetes. Physical exercise has generally impacted positively on the health status with a positive correlation with the clinical significance of treatment and management of Type 2 Diabetes. There is generally not much difference when it comes to the long term effects of aerobic exercise and progressive resistance training in the treatment of type 2 diabetes (Whye, C et al, 2011). Although similar long term effects, aerobic exercise lowers, to a greater extent, the blood glucose concentration levels. This therefore increases the risk of exercise- induced hypoglycaemia. Further research should however be conducted to assess the mechanisms that underlie the short term difference in effects of aerobic and resistance training. Further research could also aid in the assessment of acute metabolic changes that may be witnessed or achieved, as a result of the combination of the two: aerobic and resistance exercise.

From the results, it has been proved that aerobic exercise significantly plays a role in the improvement of the treatment and control of type 2 diabetes. The inclusion of this method of treatment into the already existing treatment plans clinically improves the treatment. Most type 2 diabetes cases can evidently be prevented and controlled. Regular exercise is essential to everyone, both healthy and type 2 diabetes individuals. Essentially, physical exercise lowers the levels of sugar in the blood.

The results of all of the above indicate that more emphasis should be given for the specific needs of individuals, along with continued supervision of oral hypoglycaemic treatments. The findings also indicate and suggest that adjustments of medications and the insulin intakes in the type 2 diabetes patients should also consider the type of exercise scheduled.

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Refrences

Aveyard, H. (2010) Doing a literature review in health and social care: A practical guide. 2nd Ed. Berkshire, Great Britain

Bacchi, E., Negri, C et al. (2012) Metabolic effects of aerobic training and resistance training in type2 diabetes subjects: a randomized controlled trial. University of Verona. Italy

Baharlouei, K. (2010) The effect of aerobic training on selected variables in patients with diabetes mellitus. British Journal of Sports Medicine

Cammisuli, D., Innocenti, A et al. (2014) Aerobic Exercise Effects upon cognition in Mild Cognitive Impairment: A systematic Review of Randomized Controlled Trials. University of Parma. Italy

Charity. (2019) New figures show type 2 rates continue to soar (Accessed on 5th August, 2019)

Chertoff, J. (2018) 10 Aerobic Exercise Examples: How to, Benefits, and More (Accessed on 29th July, 2019)

Jyotsna, A., Sharma, S., Jain, A., Sarkar, A. (2016) Effects of aerobic exercise on blood glucose levels and lipid profile in diabetes mellitus type 2 subjects. New Delhi, India

Lacobucci, G. (2018) Type 2 diabetes affects 7000 young people in England and Wales, analysis shows. BMJ (Accessed on 6th August, 2019)

Lisa, M. (2019) Type 2 Diabetes and Exercise: Exercise Makes It Easier to Control your Diabetes. Endocrineweb (Accessed on 29th July, 2019)

Lukacs, A., Barkai, L. (2015) Efffects of aerobic and anaerobic exercises on glycaemic control in type 1 diabetics. Faculty of Health Care, University of Miskolc. Hungary

Madsen, S., Thorup, A., Overgaard, K., Jeppesen, P. (2015) High Intensity Interval Training Improves Glycaemic Control and Pancreatic Beta Cell Function of Type 2 Diabetes Patients. PLoS ONE 10 (8): e0133286

Marwick, T., Hordern, D., Miller, T., Chyun, D., Bertoni, A., Blumenthal, S., Philippides, G., Rocchini, A. (2009) Exercise Training for type 2 Diabetes Mellitus. Impact on Cardiovascular Risk.

Miyazaki, Y., DeFronzo, R. (2009) Visceral fat dominant distribution in male Type 2 diabetic patients is closely related to hepatic insulin resistance of body type. Cardiovascular Diabetology. Vol 8.

Okura, T., Nakata, Y., Ohkawara, K., Numao, S., Katayama, Y., Matsuo, T., Tanaka, K. (2007) Effects of aerobic exercise on metabolic syndrome improvement in response to weight reduction. University of Tsukuba. Japan

Shubrook, H., Shubrook, J (2010) Risks and benefits of attaining HbA (1c) goals: Examining the evidence. The journal of the American Osteopathic Association

Sigal, R., Kenny G., Boule, N., Wells, G., Fortier, M., Reid, R., Tulloch, H (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. University of Ottawa

Thent, Z., Das, S., Joseph, L. (2013) Role of Exercise in the Management of Diabetes Mellitus: The Global Scenario. Malasyia.

Thomas, D., Elliott, E., Naughton, G. (2009) Exercise for type 2 Diabetes Mellitus. Cochran Database of Systematic Reviews. Issue 3.

Tunafanaru, C., Munn, Z., Aromataris, E., Campbell, J., Hopp, L. (2017) Chapter 3: Systematic Reviews of effectiveness. Joanna Briggs Institute Reviewers Manual

Whye, C., Shyong, E., Goh, S., Wee, H. (2011) Health status of older adults with type 2 diabetes mellitus after aerobic or resistance training: A randomized trial. Vol 9. Health and Quality of Life Outcomes.

Yan, H., Prista, A., Ranadive, S., Damasceno, A., Caupers, P., Kanaley, J., Fernhall, B. (2014) Effect of Aerobic Training on Glucose Control and Blood Pressure in Type 2 Diabetics. USA

Yanai, H., Adachi, H., Masui, Y., Katsuyama, H., Kawaguchi, A., Hakoshima, M., Waragai, Y., Harigae, T., Hamasaki, H., Sako, A. (2018) Exercise Therapy for Patients with Type 2 Diabetes: A Narrative Review. National Center for Global Health and Medicine. Japan

Yavari, A., Niafar, M., Najafipour, F. (2012) Effect of aerobic exercise, resistance training or combined training on glycaemic control and cardio- vascular risk factors in patients with type 2 diabetes. Biology of Sport

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