***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS We examined the effects of physical activity with or without dietary restriction for 3 months on regional fat and insulin sensitivity and compared the effect of total energy expenditure from all levels of physical activity with that of physical activity energy expenditure from moderate-to-vigorous exercise in obese women with Type 2 diabetes . METHODS In this r and omized , controlled trial , we assessed change of body weight , abdominal visceral fat area , subcutaneous fat area and insulin sensitivity , expressed as K(ITT ) , and monitored total energy expenditure and physical activity energy expenditure using an accelerometer during a 12-week intervention in four groups : control , diet , exercise and diet plus exercise . RESULTS The mean body mass index was 28.0 + /- 2.7 kg/m(2 ) and the mean duration of diabetes was 8 + /- 6 years . Both the diet and diet plus exercise groups showed significant body weight loss compared with the control group ( P < 0.05 ) . However , the visceral fat area was reduced only in the diet and exercise group ( P = 0.017 ) and the subcutaneous fat area was reduced only in the diet group ( P = 0.009 ) . Mean energy intake was an independent determinant of the change in subcutaneous fat area ( P = 0.020 ) and mean total anergy expenditure was an independent determinant of visceral fat area ( P = 0.002 ) . Insulin sensitivity K(ITT ) was associated with physical activity energy expenditure ( P = 0.006 ) , energy intake ( P = 0.047 ) and the change in fructosamine level ( P = 0.016 ) but not with changes in body weight , subcutaneous fat area , visceral fat area or adipokine level . CONCLUSIONS Exercise had an additive effect to dietary restriction on visceral fat reduction . Visceral fat area was associated with total energy expenditure , but insulin sensitivity was associated with physical activity energy expenditure BACKGROUND Increased blood pressure ( BP ) in type 2 diabetes ( T2DM ) markedly increases cardiovascular disease morbidity and mortality risk compared to having increased BP alone . OBJECTIVE To investigate whether exercise reduces suboptimal levels of untreated suboptimal BP or treated hypertension . DESIGN Prospect i ve , r and omized controlled trial for 6 months . SETTING Single center in Baltimore , MD , USA . PATIENTS 140 participants with T2DM not requiring insulin and untreated SBP of 120–159 or DBP of 85–99 mmHg , or , if being treated for hypertension , any SBP < 159 mmHg or DBP < 99 mmHg ; 114 completed the study . INTERVENTIONS upervised exercise , 3 times per week for 6 months compared with general advice about physical activity .  MEASUREMENTS Resting SBP and DBP ( primary outcome ) ; diabetes status , arterial stiffness assessed as carotid-femoral pulse-wave velocity ( PWV ) , body composition and fitness ( secondary outcomes ) . RESULTS Overall baseline BP was 126.8 ± 13.5 / 71.7 ± 9.0 mmHg , with no group differences . At 6 months , BP was unchanged from baseline in either group , BP 125.8 ± 13.2 / 70.7 ± 8.8 mmHg in controls ; and 126.0 ± 14.2 / 70.3 ± 9.0 mmHg in exercisers , despite attaining a training effects as evidence d by increased aerobic and strength fitness and lean mass and reduced fat mass ( all p < 0.05 ) , Overall baseline PWV was 959.9 ± 333.1 cm/s , with no group difference . At 6-months , PWV did not change and was not different between group ; exercisers , 923.7 ± 319.8 cm/s , 905.5 ± 344.7 , controls . LIMITATIONS A completion rate of 81 % . CONCLUSIONS Though exercisers improve fitness and body composition , there were no reductions in BP . The lack of change in arterial stiffness suggests a resistance to exercise-induced BP reduction in persons with T2DM OBJECTIVE To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness , body composition , and glycemic control . RESEARCH DESIGN AND METHODS Subjects with type 2 diabetes were r and omized to a control ( n = 8) , continuous-walking ( n = 12 ) , or interval-walking group ( n = 12 ) . Training groups were prescribed five sessions per week ( 60 min/session ) and were controlled with an accelerometer and a heart-rate monitor . Continuous walkers performed all training at moderate intensity , whereas interval walkers alternated 3-min repetitions at low and high intensity . Before and after the 4-month intervention , the following variables were measured : VO2max , body composition , and glycemic control ( fasting glucose , HbA1c , oral glucose tolerance test , and continuous glucose monitoring [ CGM ] ) . RESULTS Training adherence was high ( 89 ± 4 % ) , and training energy expenditure and mean intensity were comparable . VO2max increased 16.1 ± 3.7 % in the interval-walking group ( P < 0.05 ) , whereas no changes were observed in the continuous-walking or control group . Body mass and adiposity ( fat mass and visceral fat ) decreased in the interval-walking group only ( P < 0.05 ) . Glycemic control ( elevated mean CGM glucose levels and increased fasting insulin ) worsened in the control group ( P < 0.05 ) , whereas mean ( P = 0.05 ) and maximum ( P < 0.05 ) CGM glucose levels decreased in the interval-walking group . The continuous walkers showed no changes in glycemic control . CONCLUSIONS Free-living walking training is feasible in type 2 diabetic patients . Continuous walking offsets the deterioration in glycemia seen in the control group , and interval walking is superior to energy expenditure – matched continuous walking for improving physical fitness , body composition , and glycemic control This study examined the effects of aerobic exercise without weight loss , a hypocaloric high monounsaturated fat diet , and diet plus exercise ( D+E ) on total abdominal and visceral fat loss in obese postmenopausal women with type 2 diabetes . Thirty-three postmenopausal women ( body mass index , 34.6 + /- 1.9 kg/m(2 ) ) were assigned to one of three interventions : a hypocaloric high monounsaturated fat diet alone , exercise alone ( EX ) , and D+E for 14 wk . Aerobic capacity , body composition , abdominal fat distribution ( magnetic resonance imaging ) , glucose tolerance , and insulin sensitivity were measured pre- and postintervention . Body weight ( approximately 4.5 kg ) and percent body fat ( approximately 5 % ) were decreased ( P < 0.05 ) with the D and D+E intervention , whereas only percent body fat ( approximately 2.3 % ) decreased with EX . Total abdominal fat and sc adipose tissue ( SAT ) were reduced with the D and D+E interventions ( P < 0.05 ) , whereas visceral adipose tissue ( VAT ) decreased with the D+E and EX intervention , but not with the D intervention . EX result ed in a reduction in total abdominal fat , VAT , and SAT ( P < 0.05 ) despite the lack of weight loss . The reductions in total abdominal fat and SAT explained 32.7 % and 9.7 % , respectively , of the variability in the changes in fasting glucose levels , whereas the reductions in VAT explained 15.9 % of the changes in fasting insulin levels ( P < 0.05 ) . In conclusion , modest weight loss , through either D or D+E , result ed in similar improvements in total abdominal fat , SAT , and glycemic status in postmenopausal women with type 2 diabetes ; however , the addition of exercise to diet is necessary for VAT loss . These data demonstrate the importance of exercise in the treatment of women with type 2 diabetes OBJECTIVE To investigate the effect of an exercise intervention on flow-mediated dilation ( FMD ) and circulating endothelial biomarkers in adults with type 2 diabetes ( T2DM ) . METHODS Sedentary adults ( n = 140 ) , aged 40 - 65 , with T2DM and untreated pre or Stage I hypertension or treated hypertension were r and omized to a 6-month , supervised , exercise program ( 3 × week ) or a sedentary control . Assessment s included BMI , body and visceral fat , blood pressure , lipids , HbA1c , insulin sensitivity ( QUICKI ) , fitness , FMD , E-selectin , P-selectin , intracellular and vascular cellular adhesion molecules ( ICAM , VCAM ) , and tissue plasminogen activator ( tPA ) . Intervention effects were compared by t-tests . Pearson 's correlations were calculated between changes in cardiovascular risk factors and endothelial outcomes . RESULTS Exercisers significantly improved BMI ( -0.6 kg/m(2 ) ) , body fat % ( -1.4 % ) , HbA1c ( -0.5 % ) , and fitness ( 2.9 mL/kg min ) vs. controls ( p < 0.05 ) . However , there were no differences between groups in changes in FMD , E-selectin , P-selectin , ICAM , VCAM , or tPA . Among exercisers , changes in cardiovascular risk factors correlated with several biomarkers . Decreased P-selectin correlated with decreased BMI ( r = 0.29 , p = 0.04 ) and increased HDL cholesterol ( r = -0.36 , p = 0.01 ) . Decreased ICAM correlated with decreased triglycerides and HbA1c ( r = 0.30 , p = 0.04 ; r = 0.31 , p = 0.03 ) and increased QUICKI ( r = - 0.28 , p = 0.05 ) . Decreased tPA correlated with decreased total body and visceral fat ( r = 0.28 , p = 0.05 ; r = 0.38 , p = 0.008 ) and increased QUICKI ( r = -0.38 , p = 0.007 ) . CONCLUSIONS While exercise result ed in improved fitness , body composition , and glycemic control , there were no changes in FMD or circulating endothelial biomarkers . The associations of changes in cardiovascular risk factors and endothelial biomarkers suggest that improvement in risk factors could mediate the exercise-induced improvements in endothelial function seen in prior studies Background Our goal was to investigate the effects of low intensity resistance training on body fat , muscle mass and strength , cardiovascular fitness , and insulin sensitivity in type 2 diabetes . Methods Twenty-eight overweight women with type 2 diabetes were r and omly assigned to a resistance training group ( RG , n = 13 ) or a control group ( CG , n = 15 ) . RG performed resistance training using elastic b and s , of which strength was equal to 40 to 50 % of one repetition maximum ( 1RM ) , for three days per week . Each exercise consisted of three sets for 60 minutes . We assessed abdominal fat using computed tomography , muscle mass using dual-energy X-ray absorptiometry , and muscle strength using Keiser 's chest and leg press . Insulin sensitivity was measured using the insulin tolerance test , and aerobic capacity was expressed as oxygen uptake at the anaerobic threshold ( AT-VO2 ) before and after the 12-week exercise program . Results The age of participants was 56.4 ± 7.1 years , duration of diabetes was 5.9 ± 5.5 years , and BMI was 27.4 ± 2.5 kg/m2 , without significant differences between two groups . During intervention , a greater increase in muscle mass and greater decreases in both total fat mass and abdominal fat were observed in RG compared to those of CG ( P = 0.015 , P = 0.011 , P = 0.010 , respectively ) . Increase in 1RM of upper and lower extremities was observed in the RG ( P = 0.004 , P = 0.040 , respectively ) , without changes in AT-VO2 and insulin resistance in either group . Conclusion In conclusion , the low intensity resistance training was effective in increasing muscle mass and strength and reducing total fat mass without change of insulin sensitivity in type 2 diabetic patients Aims /hypothesisType 2 diabetes is regarded as inevitably progressive , with irreversible beta cell failure . The hypothesis was tested that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake . Methods Eleven people with type 2 diabetes ( 49.5 ± 2.5 years , BMI 33.6 ± 1.2 kg/m2 , nine male and two female ) were studied before and after 1 , 4 and 8 weeks of a 2.5 MJ ( 600 kcal)/day diet . Basal hepatic glucose output , hepatic and peripheral insulin sensitivity and beta cell function were measured 
    Output:
    
Aerobic exercise ( ES=-0.23 , 95 % CI : -0.44 to -0.03 ; P=0.025 ) but not resistance training exercise ( ES=-0.13 , 95 % CI : -0.37 to 0.12 ; P=0.307 ) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes  .
These data suggest that exercise  effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aim ed at reducing visceral fat in obesity-related type 2 diabetes .