# Effects of Different Intensity Exercise on the Patients of Oxidative Stress Factors and Glycemic Control Type 2 Diabetes Mellitus

Authors: Hu Wang; Yongbo Wang
Journal: Mathematical Problems in Engineering
 (2022)

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## Abstract

This study’s major purpose was to examine the impact of two various exercise intensities on glucagon-like peptide-1 and endoplasmic reticulum stress in teenagers with type 2 diabetes. Twenty teenagers with T2DM were recruited in the trial and randomly assigned to one of two groups: HIT (n = 10) or LIT (n = 10). At a heart rate of less than 45 percent, the low-intensity intense exercise group participated in aerobic activity training. Interval training with a heart rate reserve of at least 80% was used by the high-intensity intermittent training group. Both groups had the same weekly energy expenditure (1,200 kcal/week). The nositol required enzyme 1 and X-box binding protein-1 improved in both groups, but the difference in improvement between the two groups was not statistically significant. High-intensity interval training led to a significant decrease in body fat percentage among participants. After 12 weeks, the C-peptide levels had risen and varied considerably between the two groups. According to the homeostasis model assessment, there were significant differences between the groups in fasting glucose and insulin resistance, and leptin levels reduced after 12 weeks. The 12-week rise in glucagon-like peptide-1 was different across the groups. In teenagers with type 2 diabetes mellitus, high-intensity intermittent exercise training may enhance glycemic management, physical body composition, glucagon-like peptide-1, and endoplasmic reticulum stress.


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## Body

## 1. Introduction

Physical exercise and regular activity are proven to prevent and cure type 2 diabetes effectively. The majority of research, however, have demonstrated that it includes low-to-moderate intensity exercise, such as walking, cycling, and running, for more than 30 minutes and has a beneficial impact on type 2 diabetes. Nevertheless, many fitness plans include intrinsic characteristics, such as the kind and amount of exercise, that vary. Two independent meta-analyses show that high strength activity will be more helpful than moderate activity in managing glycemic control in type 2 diabetes patients [1, 2]. Therefore, clinical experiments are required to examine the impacts of multiple exercise intensities on type 2 diabetes in order to determine the optimal training intensity [3]. High-intensity intensive exercise (HIT), a mix of numerous groups of high-intensity burst periods and low-intensity recovery periods, may be a better option for individuals with type 2 diabetes [4]. High-intensity exercise may successfully treat heart failure, COPD, and metabolic syndrome [5]. Low-intensity exercise boosts energy expenditure, but it is difficult to maintain due to weariness, boredom, and monotony.The relationship between metabolic disorders and ERF is strong. Moreover, er function has been implicated in the aetiology of metabolic and genetic disorders, including obesity, diabetes, and hyperlipidemia [6]. Through control of eukaryotic synthesis and protein transport, the ER stress response manifests its most typical features. Not only is it intimately associated to survival, cell differentiation, immunity, and physiological adaptations but also it is indirectly or directly linked to several disease and immunological pathologies [7]. However, there are few studies on the relationship between er stress and glucagon-like peptide-1 (GLP-1) and diabetes mellitus.Determining the efficacy of low-intensity exercise vs. high-intensity exercise in teenagers with type 2 diabetes was the purpose of this research. In addition, the impacts of energy-equivalent LIT and HIT on er occupational stress, glycemic management, and GLP-1 were examined. Provided exercise can be done effectively; HIT, owing to LIT, focuses on reducing er stress and increasing GLP-1, but the body composition modification objective remains the same. The goal of this study was to compare the effectiveness of low- and high-intensity exercise among adolescents with type 2 diabetes. In addition, the effects of energy-equivalent HIT and LIT on work stress, glycemic control, and GLP-1 were investigated. HIT due to LIT concentrates on lowering physiological stress and raising GLP-1, although the goal of altering body composition remains the same, provided that the activity can be performed properly. The rest of the study is organized as follows. The subjects and methods are the work of Section2. In Section 3, our work is placed on the studies of the western blotting. In Section 4, the statistical analysis is the main content of this section. In Section 5, we summarize the whole study.


## 2. Subjects and Methods

Twenty individuals were randomised to the LIT (n = 10) and HIT (n = 10) groups at random. The mean age was 17.2 ± 3.1 years, the mean height was 170.3 ± 9.2 cm, the mean body mass index (BMI) was 24.5 ± 5.5 kg·m−2, and the mean disease course was 51.4 years. The subjects conducted a 2-hour glucose tolerance test with glucose tolerance levels ≤140 mg/dL, blood glucose levels 200 mg/dL, and glucose tolerance levels ≥140 mg/dL.All individuals were subjected to medical screening, which included health condition assessment, medical examination, and blood analysis. Completely understand and agree. In addition, none of the individuals got insulin therapy, and their drugs were not altered during activity. Before the exercise programme started, anthropometric measures were taken on all individuals. Biological reactance was used to assess body composition. Using a customised Bruce protocol, all individuals were evaluated for maximal exercise. The maximum oxygen consumption (VO2max; Ml. kg 1 min−1) was measured using the Quark B2 analyser during treadmill exercise testing with the individuals. Using the Borg scale, self-perceived pressure per minute (RPE) was measured. Considering the individuals’ safety, the VO2max was evaluated using ACSM exercise guidelines [8].Using the maximal incremental exercise test’s maximum heart rate (HRmax) and VO2max, the ACSM metabolic equation was utilised to compute heart rate threshold, platform speed, and secondary objectives. To get the target heart rate (THR), increasing loads were applied to the participants’ heart rates as measured by a polar heart rate monitor and their ratings of perceived exertion. LIT monitored platform runs six times per week for twelve weeks at an effort of 40% heart rate reserve (HRR). When doing extended activity, LIT individuals expend 200 calories. HIT performed platform running and walking 3 times per week for 12 weeks at an intensity 80% HRR under HRR. 400 kcal were burned when HIT individuals did sustained high-intensity interval exercise (30 s recovery and 30 s sprint).


## 3. The Western Blotting

Preparation of western blot and tissue lysis fluid: on a 7.5% polyacrylamide gel, 40 g of protein was extracted and deposited to a nitrate fibre membrane. Imprinted regions have molecular weights of 250–100 kD, 100–65 kD, and 30–65 kD. Rabbit polyclonal antibody IRE1 detects the 250–100 kD fragment (1 : 1000 dilution). The 100–65 kD fragment was identified using rabbit anticlonal IRE1A antibodies (1 : 1000 dilution). The 20–65 kD fragment was identified by anti-XBP-1S mouse monoclonal antibody. Protein expression was measured by comparing protein standard mobility to protein expression. The membrane was examined and monitored using the ChemiDoc XRS system. Image Lab software was used to analyse the relative intensity of the western blotting bands in a semiquantitative manner. The Lichun red S stain was used as an internal control.The percentage of glycosylated haemoglobin in serum (HbAlc) was evaluated using affinity chromatography. High performance liquid chromatography was used to determine the HbA1c level. The steady-state model was used to evaluate fasting insulin resistance: fasting blood glucose (mg. DL−1) and fasting plasma insulin (μU. DL− 1)/405.


## 4. The Statistical Analysis

The data were analysed using SPSS19.0 software. All data are represented using the formula mean ± standard deviation. Bivariate ANVOA controls for group differences, test time, blood composition related to exercise type, differences in body composition, and independent and pairedT tests for post-HOT testing. The significance level was set at P<0.05.


### 4.1. Results

Table1 displays the characteristics of participants in the LIT and HIT groups at the beginning of the trial. There were significant variations between groups in terms of body fat percentage P<0.05 and body weight. HIT led to a larger decrease in body fat levels than LIT P<0.05.Table 1
The physical body changes after 12 weeks of exercise.
VariableGroupBefore the trialAfter the experimentWeight (kg)HIT67.6 ± 10.565.0 ± 11.2∗LIT67.0 ± 22.667.0 ± 22.1BMI (kg/m2)HIT25.6 ± 7.723.9 ± 7.1∗LIT23.4 ± 3.223.5 ± 3.6Body fat percentage (%)HIT27.5 ± 6.425.5 ± 5.5∗&LIT28.5 ± 0.227.1 ± 3.1∗VO2maxHIT29.8 ± 3.031.2 ± 2.2∗&(ml·kg−1·min−1)LIT30.5 ± 4.733.4 ± 3.2∗Note:∗represents significant differences within groups P<0.05; & represents an obviously different LIT P<0.05.The improvements in blood glucose management after exercising are shown in Table2. After 12 weeks of exercising, there were significant variations in C-peptide levels across groups P<0.05. Additionally, insulin levels reduced considerably in the HIT group following 12 weeks of exercising. After fasting glucose, HOMA-IR, and 12 weeks of exercising, leptin levels reduced, with significant dissimilarities P<0.05. After 12 weeks of exercise, there was no significant change in HbA1c.Table 2
Changes in blood glucose control after exercise.
VariableGroupBefore the trialAfter the experimentC-peptideHIT2.9 ± 1.34.7 ± 2.1&LIT3.9 ± 2.35.4 ± 2.2InsulinHIT42.1 ± 27.418.7 ± 8.81∗LIT58.3 ± 38.846.5 ± 41.1Glucose (ng/ml)HIT174.3 ± 25.5138.8 ± 35.7&LIT175.3 ± 18.5131.8 ± 26.4HOMA-I (μU/ml)HIT17.4 ± 10.56.5 ± 3.4&LIT24.9 ± 16.713.5 ± 11.4HbA1c (%)HIT8.8 ± 3.36.6 ± 1.0LIT7.4 ± 1.26.4 ± 0.4Leptin (ng/dl)HIT1923 ± 6701178 ± 406&LIT1423 ± 683979 ± 618Note:∗represents intragroup difference; & represents the difference from LIT P<0.05The results of GlP-1, XBP-1S, and IRE1A change after 12 weeks of exercise, as shown in Table3.Table 3
GlP-1, XBP-1S, and IRE1A changes after 12 weeks of exercise.
VariableGroupBefore the trialAfter the experimentGLP-1 (ng/dl)HIT0.21 ± 0.020.39 ± 0.04∗&LIT0.21 ± 0.020.36 ± 0.02∗XBP-1s (ng/dl)HIT3.88 ± 4.016.33 ± 6.65∗LIT2.54 ± 1.453.17 ± 1.98∗IRE1Α (ng/dl)HIT29.23 ± 20.2322.85 ± 21.43∗LIT34.16 ± 23.9829.20 ± 24.00∗Note:∗represents the difference between groups; & represents the difference from LIT P<0.05


### 4.2. Discussion

HIT may be utilised as an exercise treatment for individuals with type 2 diabetes and is preferable than energy-intensive LIT in terms of improving body fat percentage, glucose management, and GLP-1 levels. The design of the research includes the meticulous and effective matching of exercise energy consumption to the intensity level of the training team. There is a correlation between HIT and LIT.The findings showed statistically significant reductions in results between the two different groups. Nevertheless, there was no substantial difference in bmi rise and er oxidative stress factor (XBP-1S, IEX-α). GLP-1 and blood glucose control improved dramatically in the HIT groups at 3 months.ADA and ACSM promote moderate and vigorous exercise for diabetes patients and give evidence-based recommendations to support the design of exercise recommendations based on endurance training, duration, frequency, and advancement rate [9]. In the research, the severity variables varied across groups, although the exercise volume, duration, and advancement rate variables remained constant. People with type 2 diabetes who participate in moderate or strenuous exercise may see comparable improvements in muscle mass and glycemic management, according to the study’s key conclusion.HIT resulted with greater improvements in body weight, BMI, blood glucose management, and body fat percentage (fasting glucose, C-peptide, and homA-IR) than the frequently suggested LIT exercise plan for diabetes. HIT also shows favorable changes in IRE1, XBP-1S, and GLP-1, which are important ER stress-related variables, indicating a more enhancing effect in type 2 diabetes.The recommendations of the American College of Sports Medicine (ACSM) suggest that patients with diabetes engage in moderate-to-medium activity aerobic activity for more than 150 minutes per week. HIT may nonetheless function, prevent metabolic disorders such as diabetes and obesity, improve energy expenditure, and decrease stress [9, 10]. A variety of impediments to physical exercise were mentioned by sedentary diabetics, with “lack of time” being the most prevalent. There is, nevertheless, a growing amount of research comparing the benefits of typical endurance training with HIT on the reduction of metabolic disorders, as well as which exercise consumes less time.Because of this, HIT is seen as an excellent method for alleviating LIT boredom [11]. Moreover, HIT improves weight management and insulin sensitivity in type 2 diabetes [12]. The impacts of HIT on health indicators, physiological role, or capacity were comparable to those of LIT; however, the benefits of HIT on patient health were much greater than those of LIT. In the research, the HIT group had a much lower proportion of pre-exercise body fat compared to their pre-exercise counterparts. The HIT group saw a higher drop in body fat percentage (−7.69%) than the LIT group. In both groups, blood glucose management improved, although the HIT group was more successful. Exercise significantly affects glucose metabolism by altering body fat percentage and body weight, according to previous research.The glycemic management of type 2 diabetes is a medically significant independent predictor that may predict the likelihood of problems in diabetes [13]. Specifically, the majority of research have shown that HIT (80% of maximal output power) enhances glycemic control following weight reduction [14]. It reduces cholesterol, insulin secretion, and triglyceride levels, improves blood glucose levels, and inhibits glucose absorption in skeletal muscle by direct stimulation [15]. Based on changes in body composition, the HIT group had a higher decrease in blood glucose levels than the LIT group. In addition, leptin levels decreased in both groups, although the HIT group was more successful.High blood sugar owing to relative insulin shortage and insulin resistance characterizes type 2 diabetes, which is produced by the interplay of hereditary and acquired variables, such as lack of exercise and an excessive diet, and is defined by a genetic predisposition. There is strong evidence that physical activity enhances insulin sensitivity. Adolescents and children with insulin resistance benefit from regular exercise [16]. There are a large number of studies classifying the impact of exercise on reducing insulin resistance according to kind, frequency, and activity duration [17]. The HIT group had greater improvements in fasting glucose, HOMA-IRs, and C-peptide levels to a protein processing mismatch between load and energy. The reduction of ER stress in the hypothalamus improves leptin resistance, which is also a key contributor to leptin resistance induction. The study showed a rise in er stress in the HIT team due to exercise-induced physiological stress, but no change in the LIT group. However, obesity, weight change, and insulin resistance (favorable changes in body fat) recommend that exercise also positively influences leptin modifications in teenagers with type 2 diabetes.Xbp-1s performs a critical function in sustaining cell viability in variously stressful situations, aiding in the response to immunological assaults and medication resistance [18]. In type 2 diabetes, Xbp-1s rises, although the impact of exercise-induced XBP-1S rise on insulin resistance has not been explored. The research found elevated levels of XBP-1S expression in both categories, although the HIT group had the highest levels. During high-intensity interval training, blood sugar depletion, hypoxia, and increased physiological stress may lead to this condition. Recent research has shown the efficacy of GLP-1 in treating diabetes and obesity. Glp-1, an intestinal glucagon, controls blood glucose [19], enhances insulin sensitivity by boosting pancreatic insulin production, and stimulates triglyceride hydrolysis in fatty tissue. Diabetic individuals have decreased Glp-1 [20]. In the meanwhile, investigations relating to exercise have demonstrated that the amount of intestinal glucagon, such as GLP-1, rises in healthy individuals. The outcomes of obese individuals who lose weight by exercise are comparable to those of normal-weight individuals [21]. Considering that exercise is the major intervention for the prevention and treatment of type 2 diabetes, it is crucial that exercise enhances Glp-1. Glp-1, which is engaged in the physiological control of eating and induces weight loss, is quickly degraded in response to food stimulation by inositol demand kinase-1 (IENE) [22]. During the course of the trial, Glp-1 levels grew dramatically in both groups, but more so in the HIT group. IRE1 also regulates the quantity of GLP-1, a crucial component in predicting insulin resistance and multiple sclerosis. It has a direct relationship with insulin resistance.The research indicated that individuals with obesity or multiple sclerosis had greater IRE1 levels, which were strongly connected to the BMI of healthier young adults. iSUM fell in both groups; however, the HIT group declined by about 21% more than just the LIT group. This impact may be attributable to a drop in body fat percentage and BMI, which resulted in a decline in IRE1 activity. It is believed to result in lower insulin resistance and better blood glucose control in type 2 diabetes [23]. Consequently, high-intensity interval training may enhance body composition, glucose management, and GLP-1 levels in teenagers with type 2 diabetes.


## 4.1. Results

Table1 displays the characteristics of participants in the LIT and HIT groups at the beginning of the trial. There were significant variations between groups in terms of body fat percentage P<0.05 and body weight. HIT led to a larger decrease in body fat levels than LIT P<0.05.Table 1
The physical body changes after 12 weeks of exercise.
VariableGroupBefore the trialAfter the experimentWeight (kg)HIT67.6 ± 10.565.0 ± 11.2∗LIT67.0 ± 22.667.0 ± 22.1BMI (kg/m2)HIT25.6 ± 7.723.9 ± 7.1∗LIT23.4 ± 3.223.5 ± 3.6Body fat percentage (%)HIT27.5 ± 6.425.5 ± 5.5∗&LIT28.5 ± 0.227.1 ± 3.1∗VO2maxHIT29.8 ± 3.031.2 ± 2.2∗&(ml·kg−1·min−1)LIT30.5 ± 4.733.4 ± 3.2∗Note:∗represents significant differences within groups P<0.05; & represents an obviously different LIT P<0.05.The improvements in blood glucose management after exercising are shown in Table2. After 12 weeks of exercising, there were significant variations in C-peptide levels across groups P<0.05. Additionally, insulin levels reduced considerably in the HIT group following 12 weeks of exercising. After fasting glucose, HOMA-IR, and 12 weeks of exercising, leptin levels reduced, with significant dissimilarities P<0.05. After 12 weeks of exercise, there was no significant change in HbA1c.Table 2
Changes in blood glucose control after exercise.
VariableGroupBefore the trialAfter the experimentC-peptideHIT2.9 ± 1.34.7 ± 2.1&LIT3.9 ± 2.35.4 ± 2.2InsulinHIT42.1 ± 27.418.7 ± 8.81∗LIT58.3 ± 38.846.5 ± 41.1Glucose (ng/ml)HIT174.3 ± 25.5138.8 ± 35.7&LIT175.3 ± 18.5131.8 ± 26.4HOMA-I (μU/ml)HIT17.4 ± 10.56.5 ± 3.4&LIT24.9 ± 16.713.5 ± 11.4HbA1c (%)HIT8.8 ± 3.36.6 ± 1.0LIT7.4 ± 1.26.4 ± 0.4Leptin (ng/dl)HIT1923 ± 6701178 ± 406&LIT1423 ± 683979 ± 618Note:∗represents intragroup difference; & represents the difference from LIT P<0.05The results of GlP-1, XBP-1S, and IRE1A change after 12 weeks of exercise, as shown in Table3.Table 3
GlP-1, XBP-1S, and IRE1A changes after 12 weeks of exercise.
VariableGroupBefore the trialAfter the experimentGLP-1 (ng/dl)HIT0.21 ± 0.020.39 ± 0.04∗&LIT0.21 ± 0.020.36 ± 0.02∗XBP-1s (ng/dl)HIT3.88 ± 4.016.33 ± 6.65∗LIT2.54 ± 1.453.17 ± 1.98∗IRE1Α (ng/dl)HIT29.23 ± 20.2322.85 ± 21.43∗LIT34.16 ± 23.9829.20 ± 24.00∗Note:∗represents the difference between groups; & represents the difference from LIT P<0.05


## 4.2. Discussion

HIT may be utilised as an exercise treatment for individuals with type 2 diabetes and is preferable than energy-intensive LIT in terms of improving body fat percentage, glucose management, and GLP-1 levels. The design of the research includes the meticulous and effective matching of exercise energy consumption to the intensity level of the training team. There is a correlation between HIT and LIT.The findings showed statistically significant reductions in results between the two different groups. Nevertheless, there was no substantial difference in bmi rise and er oxidative stress factor (XBP-1S, IEX-α). GLP-1 and blood glucose control improved dramatically in the HIT groups at 3 months.ADA and ACSM promote moderate and vigorous exercise for diabetes patients and give evidence-based recommendations to support the design of exercise recommendations based on endurance training, duration, frequency, and advancement rate [9]. In the research, the severity variables varied across groups, although the exercise volume, duration, and advancement rate variables remained constant. People with type 2 diabetes who participate in moderate or strenuous exercise may see comparable improvements in muscle mass and glycemic management, according to the study’s key conclusion.HIT resulted with greater improvements in body weight, BMI, blood glucose management, and body fat percentage (fasting glucose, C-peptide, and homA-IR) than the frequently suggested LIT exercise plan for diabetes. HIT also shows favorable changes in IRE1, XBP-1S, and GLP-1, which are important ER stress-related variables, indicating a more enhancing effect in type 2 diabetes.The recommendations of the American College of Sports Medicine (ACSM) suggest that patients with diabetes engage in moderate-to-medium activity aerobic activity for more than 150 minutes per week. HIT may nonetheless function, prevent metabolic disorders such as diabetes and obesity, improve energy expenditure, and decrease stress [9, 10]. A variety of impediments to physical exercise were mentioned by sedentary diabetics, with “lack of time” being the most prevalent. There is, nevertheless, a growing amount of research comparing the benefits of typical endurance training with HIT on the reduction of metabolic disorders, as well as which exercise consumes less time.Because of this, HIT is seen as an excellent method for alleviating LIT boredom [11]. Moreover, HIT improves weight management and insulin sensitivity in type 2 diabetes [12]. The impacts of HIT on health indicators, physiological role, or capacity were comparable to those of LIT; however, the benefits of HIT on patient health were much greater than those of LIT. In the research, the HIT group had a much lower proportion of pre-exercise body fat compared to their pre-exercise counterparts. The HIT group saw a higher drop in body fat percentage (−7.69%) than the LIT group. In both groups, blood glucose management improved, although the HIT group was more successful. Exercise significantly affects glucose metabolism by altering body fat percentage and body weight, according to previous research.The glycemic management of type 2 diabetes is a medically significant independent predictor that may predict the likelihood of problems in diabetes [13]. Specifically, the majority of research have shown that HIT (80% of maximal output power) enhances glycemic control following weight reduction [14]. It reduces cholesterol, insulin secretion, and triglyceride levels, improves blood glucose levels, and inhibits glucose absorption in skeletal muscle by direct stimulation [15]. Based on changes in body composition, the HIT group had a higher decrease in blood glucose levels than the LIT group. In addition, leptin levels decreased in both groups, although the HIT group was more successful.High blood sugar owing to relative insulin shortage and insulin resistance characterizes type 2 diabetes, which is produced by the interplay of hereditary and acquired variables, such as lack of exercise and an excessive diet, and is defined by a genetic predisposition. There is strong evidence that physical activity enhances insulin sensitivity. Adolescents and children with insulin resistance benefit from regular exercise [16]. There are a large number of studies classifying the impact of exercise on reducing insulin resistance according to kind, frequency, and activity duration [17]. The HIT group had greater improvements in fasting glucose, HOMA-IRs, and C-peptide levels to a protein processing mismatch between load and energy. The reduction of ER stress in the hypothalamus improves leptin resistance, which is also a key contributor to leptin resistance induction. The study showed a rise in er stress in the HIT team due to exercise-induced physiological stress, but no change in the LIT group. However, obesity, weight change, and insulin resistance (favorable changes in body fat) recommend that exercise also positively influences leptin modifications in teenagers with type 2 diabetes.Xbp-1s performs a critical function in sustaining cell viability in variously stressful situations, aiding in the response to immunological assaults and medication resistance [18]. In type 2 diabetes, Xbp-1s rises, although the impact of exercise-induced XBP-1S rise on insulin resistance has not been explored. The research found elevated levels of XBP-1S expression in both categories, although the HIT group had the highest levels. During high-intensity interval training, blood sugar depletion, hypoxia, and increased physiological stress may lead to this condition. Recent research has shown the efficacy of GLP-1 in treating diabetes and obesity. Glp-1, an intestinal glucagon, controls blood glucose [19], enhances insulin sensitivity by boosting pancreatic insulin production, and stimulates triglyceride hydrolysis in fatty tissue. Diabetic individuals have decreased Glp-1 [20]. In the meanwhile, investigations relating to exercise have demonstrated that the amount of intestinal glucagon, such as GLP-1, rises in healthy individuals. The outcomes of obese individuals who lose weight by exercise are comparable to those of normal-weight individuals [21]. Considering that exercise is the major intervention for the prevention and treatment of type 2 diabetes, it is crucial that exercise enhances Glp-1. Glp-1, which is engaged in the physiological control of eating and induces weight loss, is quickly degraded in response to food stimulation by inositol demand kinase-1 (IENE) [22]. During the course of the trial, Glp-1 levels grew dramatically in both groups, but more so in the HIT group. IRE1 also regulates the quantity of GLP-1, a crucial component in predicting insulin resistance and multiple sclerosis. It has a direct relationship with insulin resistance.The research indicated that individuals with obesity or multiple sclerosis had greater IRE1 levels, which were strongly connected to the BMI of healthier young adults. iSUM fell in both groups; however, the HIT group declined by about 21% more than just the LIT group. This impact may be attributable to a drop in body fat percentage and BMI, which resulted in a decline in IRE1 activity. It is believed to result in lower insulin resistance and better blood glucose control in type 2 diabetes [23]. Consequently, high-intensity interval training may enhance body composition, glucose management, and GLP-1 levels in teenagers with type 2 diabetes.


## 5. Conclusion

In conclusion, the research examined the effects of LIT and HIT with equivalent energy expenditure on changes in physical body mass, glycemic management, GLP-1, and ERS levels. The findings imply that HIT may be used in type 2 diabetic patients. In particular, HIT mitigates the deterioration of glycemic control and is better than LIT in order to improve glycemic control, body composition, and GLP-1 levels. Therefore, HIT should be a more effective kind of exercise intervention for people with type 2 diabetes.



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