The Effect of Exercise on Some Metabolic Side Effects and Psychological Characteristics of Patients with Type 2 Diabetes

Diabetes is a chronic progressive disease that has physical, metabolic, social and psychological challenges and increases the risk of concomitant mental health problems (1). Accelerated macrovascular complications in type 2 diabetes are due in part to increased metabolic side effects such as elevated cholesterol and LDL (4). In this regard, research has shown that there is a close relationship between fat percentage, body mass index and insulin concentration (5).Because the challenges of diabetes affect many aspects of patients' daily lives and their families, psychosocial assessment and treatment is a vital part of comprehensive diabetes care. The diabetic must accept that he or she may have diabetes-related complications; The patient should consider themselves an important member of the diabetes care team, not the person being cared for by the treatment team. Emotional stress can cause behavior change so that the other person does not follow their own diet, exercise, and treatment (6).For this reason, researchers have long used various methods to reduce the negative effects of diabetes, so that the effect of physical activity in the treatment of type 2 diabetes has long been known (7). Although a lot of research has been done in this field, but there is a big difference between the results of research (8).Regarding the treatment of mental problems of diabetic patients, considering that the use of sedatives and other drugs is always associated with many side effects, and today in the global medical system, more efforts are made to prevent and treat diseases without the use of drugs. It seems that participating in a regular and codified exercise program can play a major role in reducing the effects of diabetes, improving mental health and reducing the negative psychological effects of diabetes.Due to the conflicting results of research, researchers are trying to use different training methods to get the best results, so it seems necessary to design new protocols and study their impact on various factors. Also, considering that there is little research that in addition to examining the effect of aerobic exercise on metabolic side effects has examined the effect of these exercises on psychological factors in diabetic patients, the researcher seeks to answer the question of whether pyramidal aerobic exercise on cholesterol, HbA1c, LDL, affect anxiety and stress in type 2 diabetic patients?

For the present quasi-experimental study, which was performed with a pre-test-post-test design, 30 patients with type 2 diabetes in Zabol city were selected by convenience sampling and randomly divided into two groups. The research method was that 24 hours before and 48 hours after the last training session from the beginning of the research, the research variables in the pre-test were measured using blood sampling and Beck Anxiety and Stress Questionnaires. The training protocol in the present study included 8 weeks, 3 sessions per week and each training session included 45-60 minutes of pyramidal aerobic training in 3 stages. The volume of each training interval based on the intensity of training and the ability of the subjects started from light intensity in the first interval and increased in each interval.Resistance was also calculated using the reserve heart rate of each individual using the caronene formula (20). In order to observe the principle of overload, the training time was started from 15 minutes and reached 35 minutes in the eighth week. To divide the time in each interval, the total training time was divided into 3 parts; In the first 1.2, light exercise was performed (50-35% of the reserve heart rate). In the second interval, the training, which included the remaining 2.3 of the training time, was performed with an intensity of 50-65% of the reserve heart rate. The rest time between each interval was 3 minutes. Finally, descriptive statistics (tables and graphs) and Shapiro-Wilk tests, paired t-test and independent t-test were used for statistical analysis of data.

The results showed that after 8 weeks of pyramidal aerobic training, cholesterol, LDL, HbA1c, depression, anxiety and stress in the experimental group were significantly reduced in the post-test compared to the pre-test. However, in the post-test control group, this value increased compared to the pre-test, but was not statistically significant.The results were compared with the control group to ensure that the decrease in research variables was due to the present research protocol. Control can be confidently reported that the changes were due to the training protocol.

Findings of this study showed that 8 weeks of aerobic exercise significantly reduced total cholesterol, HbA1C, LDL, anxiety, depression and stress in patients with type 2 diabetes. In the above explanation, it can be said that research has shown that muscle contraction has an insulin-like role and sends a large amount of glucose into the cell to be used for energy production. 33 Muscle contraction increases membrane permeability to glucose, possibly due to an increase in the number of glucose transporters in the membrane. Exercise (Glut4) increases plasma in trained muscles, which improves Glut4 levels of insulin on glucose metabolism (28).In the above explanation, it can be said that physical activity in women increases the level of progesterone and this increase reduces psychological symptoms such as anxiety. In general, physical activity seems to improve mood symptoms, including anxiety, by the mechanism of action on cerebral endorphins (34). Physical activity increases the efficiency of the mind, the feeling of freshness and health, and provides a good mental attitude to life, provides mental health. Women are more affected by the psychological factors of physical activity than men and their sense of well-being increases more than men (35). Research has shown that anxiety and stress are caused by a lack of self-confidence in people. As Farad's social interactions increase in team sports, their self-esteem improves and self-confidence increases. On the other hand, team sports reduce stress and anxiety. Although self-confidence was not examined in the present study, it may be one of the mechanisms related to the findings of the present study.