***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 
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    Input: Summary Background Accumulating data support the atheroprotective role of the novel adipokines , apelin and ghrelin . The aim of the present r and omized study was to investigate the effects of aerobic exercise training on these adipokines in patients with type 2 diabetes mellitus ( T2DM ) . Material / Methods Fifty-four overweight ( BMI > 25 kg/m2 ) patients with T2DM , but without vascular complications , were r and omized to either the aerobic exercise training group ( EG , N=27 ) , 4 times/week , 45–60 min/session ; or to the control group ( CG , N=27 ) , orally instructed to increase physical activity .  Clinical glycemic and lipid parameters , exercise capacity ( VO2peak ) , insulin , HOMA-IR , and serum levels of apelin and ghrelin were assessed at baseline and after 12 weeks . Results Aerobic exercise significantly improved lipid and glycemic profile and insulin sensitivity compared to CG ( p<0.05 ) . Furthermore , between-groups comparison showed a considerable exercise-induced upregulation in apelin ( p=0.007 ) and VO2peak ( p<0.001 ) levels . Negligible changes in body-weight , waist-hip ratio and ghrelin concentrations were detected within and between groups after the completion of the study ( p>0.05 ) . However , subgroup analysis revealed a considerable increment in ghrelin levels only in the exercise-treated women compared to their control counterparts ( p=0.038 ) . LDL and HOMA-IR reduction were found to be independent predictors of apelin increment in multiple regression analysis ( R2=0.391 , p=0.011 ) . Conclusions In patients with T2DM , systemic , long-term , aerobic exercise exerts positive effects on apelin and ghrelin ( only in women ) , even in the absence of significant weight loss , suggesting its pleiotropic effects 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 The objective of this study was to determine the impact of an aerobic physical exercise program in the treatment of a group of elderly patients with type 2 diabetes mellitus ( DM ) in relation to metabolic control , physical capacity , quality of life ( QOL ) and attitudes toward diabetes . Patients were r and omly assigned to either an experimental ( n=19 ) or a control ( n=20 ) group . The following measurements were conducted at baseline and after week 16 : glycosylated hemoglobin ( hbA1c ) , fructosamine , 3 h oral glucose tolerance test , treadmill test ( Balke-Naughton ) , and a question naire on QOL and attitudes toward DM . After the intervention , the experimental group showed a significant decrease of glucose excursion during the oral glucose tolerance test ( OGTT ) ( area under the curve ) ( 16.6+/-3.8 vs. 15.3+/-3.1 , P<0.05 ) and an increase in total time on the treadmill ( s ) ( 423+/-207 vs. 471+/-230 , P<0.05 ) . An improvement in the attitudes toward DM was observed in the experimental group ( P=0.01 ) but not in the control group . Female gender , higher body mass index and hbA1c were factors associated with a response to the intervention . This study suggests that physical exercise has significant effects on glucose excursion during an OGTT and exercise tolerance in elderly patients with type 2 DM This study examined the independent and combined effects of diet and exercise on adipocytokine and inflammatory cytokines in postmenopausal women with type 2 diabetes . Using a r and omized , controlled design , 33 women ( age , 50 - 70 years ) were assigned to diet alone ( D ) , exercise alone ( EX ) , or diet + exercise ( D + E ) for 14 weeks . Before and after the interventions , blood sample s for adipocytokines and inflammatory markers were drawn , a meal test was performed , and abdominal fat distribution was measured by magnetic resonance imaging ( MRI ) . Body weight decreased approximately 4.5 + /- 0.6 kg ( P < .05 ) after the D and D + E interventions , whereas only small changes in body weight were found with the exercise-alone intervention . Plasma C-reactive protein levels were decreased by approximately 15 % with all 3 interventions , whereas leptin levels were reduced with the D and D + E intervention ( D : pre = 48.7 + /- 6.0 , post = 38.9 + /- 5.0 ng/mL ; D + E : pre = 38.5 + /- 6.0 , post = 22.9 + /- 5.0 ng/mL ; P < .05 ) with no differences between groups . There was a trend for leptin levels to decrease in the EX group ( P = .06 ) . Plasma resistin levels were not altered by the 3 interventions from pre- to posttreatment ( D : pre = 6.9 + /- 0.6 , post = 6.2 + /- 0.4 ng/mL ; D + E : pre = 5.6 + /- 0.6 , post = 5.7 + /- 0.4 ng/mL ; E : pre = 6.2 + /- 0.6 , post = 5.9 + /- 0.6 ng/mL , P > .05 ) , and no differences in adiponectin and tumor necrosis factor alpha ( TNF- alpha ) levels were found . Visceral adipose tissue and tumor necrosis factor alpha were the only predictors of calculated insulin resistance ( P < .05 ) , explaining 43 % of the variability . A typically prescribed weight loss program with lifestyle changes result ed in few changes in adipocytokines and inflammatory cytokines in older women with type 2 diabetes , suggesting that dramatic weight loss or clinical interventions are needed This study assessed the effects of inactivity on GLUT-4 content of human skeletal muscle and evaluated resistance training as a countermeasure to inactivity-related changes in GLUT-4 content in skeletal muscle . Nine young men participated in the study . For 19 days , four control subjects remained in a -6 degrees head-down tilt at all times throughout bed rest , except for showering every other day . Five training group subjects also remained at bed rest , except during resistance training once in the morning . The resistance training consisted of 30 isometric maximal voluntary contractions for 3 s each ; leg-press exercise was used to recruit the extensor muscles of the ankle , knee , and hip . Pauses ( 3 s ) were allowed between bouts of maximal contraction . Muscle biopsy sample s were obtained from the lateral aspect of vastus lateralis ( VL ) muscle before and after the bed rest . GLUT-4 content in VL muscle of the control group was significantly decreased after bed rest ( 473 + /- 48 vs. 398 + /- 66 counts . min-1 . microgram membrane protein-1 , before and after bed rest , respectively ) , whereas GLUT-4 significantly increased in the training group with bed rest ( 510 + /- 158 vs. 663 + /- 189 counts . min-1 . microgram membrane protein-1 , before and after bed rest , respectively ) . The present study demonstrated that GLUT-4 in VL muscle decreased by approximately 16 % after 19 days of bed rest , and isometric resistance training during bed rest induced a 30 % increase above the value of GLUT-4 before bed rest Aims /hypothesisAdults with type 2 diabetes mellitus have impaired microvascular function . It has been hypothesised that microvascular function may be restored through regular exercise . The aim of this study was to investigate whether 6 months of regular aerobic exercise would improve microvascular function in adults with type 2 diabetes . Material s and methods Fifty-nine patients with type 2 diabetes ( 32 males , age 62.9±7.6 years , HbA1c 6.8±0.9 % ) were r and omised to either a 6-month aerobic exercise programme ( 30 min , three times a week , 70–80 % of maximal heart rate ) or a ‘ st and ard care ’ control group . Before and after the intervention period , microvascular function was assessed as the maximum skin hyperaemia to local heating and endothelial and non-endothelial responsiveness following the iontophoretic application of acetylcholine and sodium nitroprusside . Maximal oxygen uptake , as an index of aerobic fitness , was assessed using a maximal exercise test . Results No significant improvement was seen in the exercise group compared with the control group for any of the variables measured : maximal oxygen uptake ( control pre : 1.73±0.53 [ means±SD ] vs post : 1.67±0.40 ; exercise pre : 1.75±0.56 vs post : 1.87±0.62 l/min , p=0.10 ) ; insulin sensitivity ( insulin tolerance test ) ( control pre : −0.17±0.06 vs post : −0.17±0.06 ; exercise pre : −0.16±0.1 vs post : −0.17±0.07 mmol l−1 min−1 , p=0.97 ) ; maximal hyperaemia ( control pre : 1.49±0.43 vs post : 1.52±0.57 ; exercise pre : 1.42±0.36 vs post : 1.47±0.33 V , p=0.85 ) ; peak response to acetylcholine ( control pre : 1.37±0.47 vs post : 1.28±0.37 ; exercise pre : 1.27±0.44 vs post : 1.44±0.23 V , p=0.19 ) or to sodium nitroprusside ( control pre : 1.09±0.50 vs post : 1.10±0.39 ; exercise pre : 1.12±0.28 vs post : 1.13±0.40 V , p=0.98 ) . Conclusions /interpretationIn this group of type 2 diabetic patients with good glycaemic control a 6-month aerobic exercise programme did not improve microvascular function or aerobic fitness Physical activity enhances insulin action in obese/overweight individuals . However , the exercise prescription required for the optimal enhancement is not known . The purpose of this study was to test the hypothesis that exercise training consisting of vigorous-intensity activity would enhance insulin sensitivity more substantially than moderate-intensity activity . Sedentary , overweight/obese subjects ( n = 154 ) were r and omly assigned to either control or an exercise group for 6 mo : 1 ) low-volume/moderate-intensity group [ approximately 12 miles walking/wk at 40 - 55 % peak O2 consumption ( Vo2 peak ) ] , 2 ) low-volume/high-intensity group ( approximately 12 miles jogging/wk at 65 - 80 % Vo2 peak ) , and 3 ) high-volume/high-intensity group ( approximately 20 miles jogging/wk at 65 - 80 % Vo2 peak ) . Training volume ( miles/wk ) was achieved by exercising approximately 115 min/wk ( low-volume/high-intensity group ) or approximately 170 min/wk ( low-volume/moderate-intensity and high-volume/high 
    Output:
    
Baseline HbA1c was inversely correlated with HbA1c reductions after the three types of exercise training .
In aerobic training , exercise volume ( represented by frequency of sessions ) was associated with changes in HbA1c ( weighted r = −0.64 ) , while no variables were correlated with glycaemic control induced by resistance training .
Conclusions /interpretationReduction in HbA1c is associated with exercise frequency in supervised aerobic training , and with weekly volume of resistance exercise in supervised combined training .
Therefore , exercise volume is a major determinant of glycaemic control in patients with type 2 diabetes