The primary outcome was to determine the association between PA and insulin levels. Therefore, the results of the adjusted potential confounders model analyses were presented based on the recommendations of the STROBE statement von Elm et al.

All statistical analyses were performed using Empower Stats 2. Participants were divided into three groups based on the intensity of PA.

In the association analyses, a weighted multivariate logistic regression model was used to explore the relationship between PA and insulin. The weighted multivariate regression model also analyzed the association between the SUA, lipid indices LDL-c, HDL-c, and TG , and PA predictor , and insulin levels outcome , and SUA, LDL-c, HDL-c, and TG were all analyzed as categorical variables and classified into three groups tertiles.

SUA T1, T2, and T3 , LDL-c T1, T2, and T3 , TG T1, T2, and T3 , and HDL-c T1, T2, and T3 have different cut-off values indicated at the footnote of each table. Subgroup analyses were also performed based on sex.

To further explain the association between PA predictor and insulin levels outcome. The participants were classified into diabetes and non-diabetes subgroups according to clinical diagnoses. Sensitivity analysis was performed based on participants without diabetes status.

The nonlinear link between SUA, LDL-c, HDL-c, TG, and insulin was further evaluated using smooth curve fits and generalized additive models. Results showed that the mean values of HbA1c, glucose, BMI, WC, TG, creatinine, insulin, BUN, and SBP were significantly lower in the high-intensity PA group than in the other two groups.

However, the mean values of HDL-c, AST, ALT, and DBP levels were significantly higher in the high-intensity PA group than in the other two groups. Table 2 shows the results of the multivariate regression analyses.

Forest plot showed the crude subgroup analyses on the effect of PA on insulin Figure 1. In the unadjusted analyses, negative associations were observed between PA and insulin in all stratified analyses.

Figure 1. Crude subgroup analyses on effect of physical activity on insulin. Supplementary Figure S1A shows that there was a positive correlation between SUA level and insulin, and the level of insulin decreased as the intensity of PA improved under the same SUA level Supplementary Figure S1B.

Table 3 shows the interactive analyses between SUA and PA on the level of insulin. Table 3. The association between physical activity and insulin grouped by SUA, LDL-c, HDL-c, and TG tertiles.

There was a negative correlation between LDL-c and insulin, and the level of insulin decreased as the intensity of PA improved under the same LDL-c level Supplementary Figure S2.

Table 3 shows the β values of insulin associated with diverse levels of PA among participants grouped based on LDL-c tertiles.

After adjusting for potential confounders, a similar significant decrease in the level of insulin was observed among male participants in the lower and the upper tertiles. However, in females Supplementary Table S1 , the multivariate logistic regression confirmed that only participants in the upper LDL-c tertile had a significant decrease in the level of insulin, with a gradual decrease as the intensity of physical exercise increased.

There was also a negative correlation between HDL-c and insulin, and the level of insulin decreased as the intensity of PA improved under the same HDL-c level Supplementary Figure S3. Table 3 shows the β value of insulin associated with an increase in PA among participants grouped by HDL-c tertiles.

Similarly, the β value of insulin gradually decreased across male participants in the first HDL-c tertile. Meanwhile, in second HDL-c tertile, only participants in the high-intensity PA group had a significant decrease in the level of insulin.

Notably, there was no significant statistical difference in the third HDL-c tertile. In females Supplementary Table S1 , the β value of insulin only reduced for participants in the high-intensity PA group under the third HDL-c tertile. Furthermore, there was a positive correlation between TG and insulin, and the level of insulin decreased as the intensity of PA improved under the same TG level Supplementary Figure S4.

Table 3 shows the β value of insulin associated with an increase in PA among participants grouped based on TG tertiles. Similarly, the β value of insulin gradually decreased across male participants in the first and second TG tertiles. However, there was no significant difference in the third TG tertile.

In females Supplementary Table S1 , the β value of insulin only decreased in the high-intensity PA group under the first TG tertile. It is necessary to consider DM as an important confounding factor.

A sensitivity analysis was performed based on whether the participant was diagnosed with diabetes, and the relationship between PA and insulin was observed in participants without diabetes.

Multivariate logistic regression showed that PA was also negatively correlated with insulin levels in participants without diabetes. When grouped by SUA tertiles, LDL-c tertiles, HDL-c tertiles, and TG tertiles, respectively, high-intensity PA significantly decreased insulin levels in three tertiles of SUA, HDL-c, TG, and in T2 and T3 of LDL-c Figure 2 and Supplementary Table S2.

Moreover, the link between PA and insulin was also stronger in males Table 4 and Supplementary Table S2. Table 4. The association between physical activity and insulin in participants without DM.

Figure 2. Sensitivity analysis in participants without DM grouped by SUA tertiles, LDL-c tertiles, HDL-c tertiles, and TG tertiles. A—C The association between physical activity and insulin grouped by SUA tertiles in participants without DM.

D—F The association between physical activity and insulin grouped by LDL-c tertiles in participants without DM. G—I The association between physical activity and insulin grouped by HDL-c tertiles in participants without DM.

J—L The association between physical activity and insulin grouped by TG tertiles in participants without DM. In subgroup analysis stratified by SUA, HDL-c, LDL-c, and TG tertiles, the model is not adjusted for SUA, HDL-c, LDL-c, and TG, respectively.

It is well known that PA improves IR Sampath Kumar et al. Herein, our logistic regression analyses showed that increased intensities of PA could significantly reduce insulin levels, and this tendency persisted in different stratified analysis.

The link between PA and insulin persisted even after adjusting for confounding factors, independent of gender. High-intensity PA significantly lowered insulin levels in the lower and higher SUA tertiles, and in three tertiles of lipid indices LDL-c, HDL-c, and TG in the general population.

In addition, the association between PA and insulin was stronger in male individuals than in females, and sensitivity analysis observed similar link between PA and insulin in participants without DM. Collectively, these results revealed that different intensities of PA had different effects on insulin under different lipid indices LDL-c, HDL-c, and TG and SUA levels.

To the best of our knowledge, this is the first study to show the association between PA and insulin under different levels of SUA and lipid indices LDL-c, HDL-c, and TG. Insulin is the only hormone in the body that reduces blood glucose while also promoting the production of glycogen, fat, and protein.

Insulin resistance occurs when the pancreas secretes a substantial amount of insulin to maintain glucose levels in the normal range. Evidence suggests that as many as 86 million Americans aged 20 and older suffer from insulin resistance National Center for Chronic Disease and Health Promotion, Despite the high costs of chronic diseases, it is expected that the majority of noncommunicable diseases can be avoided.

Physical inactivity is a big risk factor, and hence, PA is an obvious remedy, in addition to a poor diet, cigarette use, and problematic alcohol consumption. This study found that increased intensities of PA can considerably reduce insulin levels, with high-intensity PA exhibiting the best results.

Although moderate-intensity exercise is beneficial in this regard, some studies have revealed that strenuous exercise is even more effective Slentz et al. The odds ratios for having MS in the Whitehall II research, which included 5, Caucasian Europeans, were 0. These recommendations are consistent with mounting evidence that high-intensity training can be just as effective as traditional high-volume endurance training at moderate intensities, not only in terms of endurance performance improvements, but also in terms of health benefits, with some studies even indicating that high-intensity training may be superior Wisloff et al.

The above recommendations, undoubtedly, better support our results. This study confirmed that SUA and insulin were positively correlated. The strong intercorrelation between hyperuricemia and IR has been well demonstrated in previous studies.

Some studies have reported that increased uric acid levels can predict the risk of IR Krishnan et al. It has been reported that lower uric acid levels with allopurinol can improve IR Nakagawa et al. In this study, results obtained in the lower and higher SUA tertiles also showed that high-intensity PA could significantly reduce insulin levels.

The underlying mechanism of this association may be clarified from the aspect of redox in the body. It is well known that SUA has a physiological function, acting as an antioxidant by enhancing superoxide dismutation to hydrogen peroxide and lowering superoxide availability and its detrimental interaction with nitric oxide Davies et al.

When the level of uric acid gradually rises, it will produce pro-oxidant properties. Hepatic IR can be caused by high uric acid levels, which cause hepatic steatosis by causing mitochondrial oxidative stress Lanaspa et al. Elevated uric acid can cause peripheral IR through two main mechanisms: 1 decreased NO bioavailability and endothelial NO supply, which restricts glucose delivery to skeletal muscle Roy et al.

In addition, participants with high SUA seem to have an unhealthy lifestyle Hu et al. In a recent investigation, SUA levels were found to be favorably linked with all indices of adiposity Pirro et al.

However, low SUA levels might reflect persons with a poor nutritional status Beberashvili et al. Therefore, low SUA levels represent reduced total antioxidant capacity. Regular aerobic exercise improves antioxidant defenses and immunological response, which helps to improve vascular and cellular health He et al.

Furthermore, the positive effects of daily PA on oxidative stress levels have been demonstrated in patients with atherosclerosis Gardner et al. To reduce oxidative damage, cells increase de novo synthesis of antioxidant enzymes during persistent exercise training.

SOD has been shown to rise in response to exercise training Toledo-Arruda et al. Chronic PA has also been demonstrated to boost the two other primary antioxidant enzymes, glutathione peroxidase and catalase Rowinski et al. These results obtained in this study suggested that high-intensity PA still reduced insulin levels under conditions of oxidative stress of the body, possibly because PA can not only reduce weight, but also stabilize oxidative stress levels in the body, thereby increasing insulin sensitivity and reducing insulin levels.

It is well known that both insulin resistance and insulin secretion defects are two core mechanisms during the development of DM.

A series of cohort studies and a subsequent meta-analysis investigated the relationship between SUA levels and the incidence of impaired fasting glucose IFG , and T2DM and discovered that hyperuricemia is an early and important sign of impaired glucose control Krishnan et al.

Therefore, sensitivity analysis was performed in participants without DM. Interestingly, we observed that high-intensity PA reduced insulin levels at all levels of SUA.

This may be related to the antioxidant of SUA itself and the complicated relationship between SUA and IR and DM, but the specific mechanism needs further epidemiological research and basic experimental studies to confirm.

In this study, we found a positive correlation between TG and insulin, and a negative correlation between LDL-c, HDL-c, and insulin. It is widely recognized that insulin resistance IR plays a critical role in the pathogenesis of dyslipidemia.

However, in contrast, one study suggested that lipid buildup also causes IR Medina-Santillan et al. Studies have shown that IR impacts the metabolism of triglycerides, HDL-c, and low-density lipoprotein cholesterol LDL-c through several mechanisms Grundy, ; Festa et al.

Increased levels of hepatic triglyceride lipase HTGL have also been associated with IR, which may result in faster HDL-c clearance and lower HDL-c levels Baynes et al.

It should be noted that IR and dyslipidemia are risk factors for CVDs and DM. Recent research on the relationship between physical inactivity and CVD has yielded sobering results, showing that physical inactivity is a potential risk factor that considerably increases susceptibility to CVD Erlichman et al.

In an RCT study, which the overall effects of PA were analyzed by quartiles of daily steps of all subjects, there were significant reductions in total and LDL cholesterol and visceral fat area between the highest daily steps over 6, and the lowest quartile —2, daily steps and they confirmed that habitual and structured PA with the acceleration levels of 0.

Furthermore, PA has been used as a therapeutic strategy for the prevention of CVD and DM Pearson et al. Previous studies have focused on that PA not only improves IR, but also improves lipid homeostasis Herzig et al. In our study, however, the high-intensity PA effects on insulin were statistically significant regardless of changes in lipid indices TG, HDL-c, and LDL-c levels and other confounding factors.

The improvement in the insulin levels of our participants appeared to be mostly an independent outcome and is not affected by lipid levels. Our new results in sensitivity analysis also confirmed that the change in PA had an independent effect on insulin levels regardless of the levels of lipid indices TG, HDL-c, and LDL-c in participants without DM, and these results may reflect the effects of PA on insulin signaling in the skeletal muscle Despres et al.

Interestingly, we found that the relationship between PA and insulin was more pronounced in men. According to numerous research conducted predominantly in male populations Lehtonen and Viikari, ; Huttunen et al.

Recent studies have revealed that sex hormones may play a role in the control of insulin receptors Bertoli et al. In addition, there are gender differences in substrate utilization during exercise Ruby and Robergs, However, the role of sex hormones in this pathway is unclear, and thus further methodological studies should be conducted.

However, the study had some limitations. To begin with, the cross-sectional study design did not rule out the possibility of a causal link between SUA, lipid, and insulin levels.

Second, we were unable to rule out the impact of underlying disorders and medications, particularly hypoglycemic medicines, on the outcomes. Further basic mechanism research and a large population-based sample should be conducted in a prospective manner to solve these constraints.

In conclusion, this study shows that PA can significantly lower insulin levels, and high-intensity PA still has additional potential benefits for insulin levels, even in the condition of dyslipidemia and hyperuricemia.

When properly programmed, regular PA can not only reduce risk factors for a range of noncommunicable diseases, such as CVD, sarcopenia, metabolic syndrome, osteoporosis, and depression, but also increase physical performance strength, power, and endurance , physical, and mental health.

Unlike medication, PA typically has no adverse effects, is inexpensive, cures multiple health concerns at once, and may have extra potential advantages. The datasets presented in this study can be found in online repositories.

YL and RF: conceptualization. YL, RF, ZH, and JL: methodology. YX: validation, resources, and project administration. YL, RF, and JL: formal analysis.

YX and XY: investigation. YL, RF, and ZH: writing — original draft preparation. YX, YZ, and XY: writing — review and editing. YX and YZ: funding acquisition. All authors contributed to the article and approved the submitted version. For people engaging in long duration exercise, a combination of these two regimen changes may be necessary to prevent hypoglycemia during and after exercise.

Breadcrumb Home You Can Manage and Thrive with Diabetes Fitness Blood Glucose and Exercise. There are a few ways that exercise lowers blood glucose also known as blood sugar : Insulin sensitivity is increased, so your muscle cells are better able to use any available insulin to take up glucose during and after activity.

When your muscles contract during activity, your cells are able to take up glucose and use it for energy whether insulin is available or not.

Understanding Your Blood Glucose and Exercise The effect physical activity has on your blood glucose will vary depending on how long you are active and many other factors. Hypoglycemia and Physical Activity People taking insulin or insulin secretagogues oral diabetes pills that cause your pancreas to make more insulin are at risk for hypoglycemia if insulin dose or carbohydrate intake is not adjusted with exercise.

If you experience hypoglycemia during or after exercise, treat it immediately: Follow the rule: 1. Check your blood glucose. It is more likely to occur if you: Take insulin or an insulin secretagogue Skip meals Exercise for a long time Exercise strenuously If hypoglycemia interferes with your exercise routine, talk to your health care provider about the best treatment plan for you.

By combining these dietary choices with a regular exercise regimen, individuals can create a powerful synergy, leading to more effective management of metabolic health. This approach is about creating a harmonious balance between what you eat and how you move, ensuring that each aspect supports the other.

Adopting this integrated approach to diet and exercise doesn't just help with managing blood sugar levels; it also promotes overall metabolic health. Regular physical activity boosts metabolism and enhances the body's ability to use insulin effectively.

When this is paired with a diet that supports these same goals, the benefits are compounded. For example, a low-glycemic diet not only aids in glucose management but also helps in maintaining a healthy weight and reducing inflammation, both of which are key to enhancing insulin sensitivity.

Thus, combining diet with exercise for metabolic health is not just about adding two health strategies together; it's about creating a comprehensive lifestyle approach where each element supports and enhances the other, leading to a healthier, more balanced metabolic state 3 , 5 , 14 , Research has found that various exercise programs can significantly improve insulin sensitivity in different populations, including those with prediabetes, polycystic ovary syndrome PCOS , or obesity.

For instance, a study highlighted that regular physical activity reduces the risk of insulin resistance and metabolic syndrome. It was found that exercise, especially high-intensity interval training HIIT , produces greater benefits on whole-body insulin sensitivity. Both aerobic and resistance exercises can improve glycemic regulation, with suggestions that a combination of these exercises might be more effective.

In another study focusing on prediabetes, aerobic exercises like dance, treadmill running, and walking were shown to significantly reduce body mass index and fasting blood glucose levels.

This demonstrates the potential of aerobic exercises to positively impact glycemic levels in individuals with prediabetes. Similarly, a study on women with PCOS found that vigorous-intensity exercise led to significant improvements in cardiorespiratory fitness, body composition, and insulin resistance.

These findings suggest that high-intensity workouts can be particularly effective for metabolic health in women with PCOS. For obese and overweight individuals, research shows that a combination of aerobic and resistance training can be highly beneficial.

This study revealed that such a combined exercise regimen could improve insulin sensitivity and glycemic control in prediabetic patients more effectively than either type of exercise alone.

Another study demonstrated that a week exercise training program could effectively reduce body fat and improve insulin sensitivity and secretion in overweight and obese adolescents, including those with impaired glucose tolerance.

Overcoming common obstacles to regular exercise can be challenging, but with some practical strategies, it's entirely achievable. A frequent barrier is the lack of time.

One effective way to tackle this is by reviewing your weekly schedule and identifying three minute time slots that could be dedicated to physical activity. Integrating exercise into daily routines is another smart approach.

This could include walking around your neighborhood, opting for stairs instead of elevators, or fitting in a quick workout while watching TV. Turning everyday activities into opportunities for exercise makes it more feasible to stay active, even with a busy schedule. Motivation and consistency are crucial for maintaining an exercise habit.

Start by defining a personal reason for exercising, which can provide a deeper motivation and a stronger commitment to your goals.

Setting small, achievable targets can also help maintain motivation over time. Begin with activities that feel manageable, like walking or biking, and gradually increase the intensity and duration as you build confidence and endurance.

To improve adherence to a regular exercise routine, make it a priority in your daily plan, and consider exercising with friends for added encouragement and accountability. Choosing activities you enjoy will also make it easier to stick to your plan.

Keeping a record of your workouts in a journal can be an additional source of motivation. Enhancing insulin sensitivity and overall metabolic health is significantly influenced by regular exercise, which is particularly beneficial for individuals with conditions such as prediabetes, PCOS, or obesity.

A combination of physical activities, including aerobic exercises, resistance training, and HIIT, offers varied benefits in improving insulin response. Overcoming barriers like lack of time or motivation is essential, and adopting practical strategies for daily physical activity can be highly effective.

Additionally, integrating exercise with dietary adjustments, such as a low-glycemic diet, forms a comprehensive approach to better manage insulin sensitivity and achieve optimal metabolic wellness.

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