Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 30:716-718, 2007
DOI: 10.2337/dc06-1507
© 2007 by the American Diabetes Association
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yeh, S.-H.
Right arrow Articles by Yang, K. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yeh, S.-H.
Right arrow Articles by Yang, K. D.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Clinical Care/Education/Nutrition
Brief Report

Tai Chi Chuan Exercise Decreases A1C Levels Along With Increase of Regulatory T-Cells and Decrease of Cytotoxic T-Cell Population in Type 2 Diabetic Patients

Shu-Hui Yeh, PHD1,2, Hau Chuang, MS3,4, Li-Wei Lin, MS5, Chiu-Yueh Hsiao, MS6, Pei-Wen Wang, MD4,7 and Kuender D. Yang, MD, PHD3,4

1 Department of Nursing, Chang Gung Institute of Technology, Kwei-Shan, Taoyuan, Taiwan
2 Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
3 Department of Medical Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kwei-Shan, Taoyuan, Taiwan
4 Chang Gung University, Kwei-Shan, Taoyuan, Taiwan
5 Department of Nursing, Fooyin University, Kaohsiung, Taiwan
6 Department of Nursing, Tzu-Hui Institute of Technology, Ping-Tung, Taiwan
7 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan

Address correspondence and reprint requests to Kuender D. Yang, MD, PhD, Medical Research, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 833, Taiwan. E-mail: yangkd{at}adm.cgmh.org.tw

Abbreviations: FBG, fasting blood glucose • TCC, Tai Chi Chuan


   INTRODUCTION
TOP
 INTRODUCTION
RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
 References
 
Type 2 diabetes is a metabolic syndrome associated with chronic inflammation (1–3). Although exercise training has been proven beneficial in treatment of type 2 diabetes (4,5), this preventive and therapeutic modality remains underused (5). Recently, evidence (6) indicates that physical inactivity can increase proinflammatory burden independently of obesity, and exercise may induce anti-inflammatory mediators (7). Strenuous exercise has been shown to augment proinflammatory reaction (8,9) and compromise adaptive immunity with a higher risk of upper respiratory tract infections (9,10). Moreover, strenuous exercise might also potentiate hypoglycemia in elderly diabetic patients (11). In contrast, certain studies show that moderate exercise enhances T-cell function (12) and decreases respiratory infections (13), which suggests that the volume of exercise is a critical element of inducing a positive or negative immune response in diabetic patients. Tai Chi Chuan (TCC) exercise, a traditional Chinese martial art that is classified as a moderate exercise because it does not demand >55% of maximal oxygen intake (14), can benefit balance and cardiovascular and respiratory function (14–16). We have previously shown (17) that a regular TCC exercise for 12 weeks significantly enhances functional mobility and regulatory T-cell function of normal adult volunteers; however, we could not assess the effect of TCC exercise on glycemic improvement. In this study, we recruited type 2 diabetic patients to participate in the TCC program to investigate the effect of TCC exercise on the metabolism of blood glucose and lymphocyte subpopulations.


   RESEARCH DESIGN AND METHODS—
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
RESULTS--
 CONCLUSIONS--
 References
 
This study was conducted in one group with pre- and post-TCC exercise immune tests. The study protocol was approved by the Institutional Review Board of Chang Gung Memorial Hospital, and written informed consent was obtained from all type 2 diabetic participants who had no autoimmune or immunodeficiency disorder and agreed to keep their regular diabetes medications and follow their diets over the exercise program. The estimated sample size was initially set at 30, based on the pre- and postexercise test design, with an effect size of 0.35, significant {alpha} level of 0.05, and power of 0.8. Thirty-nine diabetic patients participated in the 12-week TCC exercise program, and 32 (17 male and 15 female subjects) completed it. The mean ± SD age of the participants was 57.88 ± 14.14 years, and average length of type 2 diabetes was 5.46 ± 5.91 years. Participants performed the standardized Cheng’s Tai Chi 37 Forms under the guidance of an expert TCC master, as previously described (17,18). Each TCC session included a 10-min warm-up, 40-min practice, and 10-min cooldown. Sessions were given 3 days a week from 8:00 to 9:00 A.M.

Fasting blood glucose (FBG) in serum and A1C levels, complete blood counts, and T-lymphocyte subsets in blood were measured before and 3 days after the TCC program (17). Data from this study were analyzed using descriptive analysis and Student’s paired t test. Pearson’s product moment correlation was used to analyze correlations of FBG and A1C levels to lymphocyte subpopulations. Since the data of A1C changes before and after the TCC program did not have a normal distribution, the A1C changes were transformed into standard T-scores before the Pearson correlation analysis. A P value ≤0.05 was considered statistically significant.


   RESULTS—
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
CONCLUSIONS--
 References
 
All the participating type 2 diabetic patients had normal hemoglobin levels but higher FBG and A1C levels before the TCC exercise (Table 1). After the 12-week TCC exercise, the A1C levels revealed a significant decrease (P = 0.026) but were not clinically normalized. The fasting glucose levels had no significant decrease (P = 0.080) (Table 1). White blood cells, erythrocytes, and platelets were not significantly changed after the TCC exercise. Analysis of lymphocyte subpopulations showed that percentages of both CD4 and CD8 lymphocyte subpopulations significantly decreased after the TCC exercise, but absolute CD4 and CD8 lymphocytes had not significantly decreased after the exercise (Table 1).


View this table:
[in this window]
[in a new window]

  		Table 1— Changes in A1C, complete blood counts, and lymphocyte subsets before and after the TCC exercise program

 
Both proportional and absolute count of CD4CD25 regulatory T-lymphocytes significantly increased after the TCC exercise (P = 0.001 and P = 0.029, respectively). The proportional but not absolute count of CD8CD28 cytotoxic lymphocytes significantly decreased after TCC exercise (P = 0.048). Changes of CD4, CD8, and CD8CD28 cells before and after the TCC exercise were not correlated to changes of fasting glucose or A1C levels (P > 0.05), assessed by Pearson’s product moment correlation. In contrast, decreases of A1C levels in the participating type 2 diabetic patients were significantly correlated to increases of CD4CD25 regulatory T-cells after the TCC exercise (r = 0.313, P = 0.004).


   CONCLUSIONS—
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
References
 
Certain exercise programs have been tried (19–22) to improve metabolic dysfunction of type 2 diabetic patients. Although these studies have been meta-analyzed for their effects on physical fitness or A1C improvement (4,22), there is no study to date demonstrating regular exercise correlated to change of lymphocyte subpopulations. Our study is the first to demonstrate that a regular TCC exercise can increase CD4CD25 regulatory T-lymphocytes correlated with decreases of A1C levels in type 2 diabetic patients. The effect of TCC exercise on the increase in regulatory T-cells may indirectly be due to better cardiopulmonary fitness after exercise. Another possibility is that a regular TCC exercise can improve glucose metabolism, resulting in less glycosylated proteins, which benefit immune regulatory function in type 2 diabetic patients. It is known that glycosylated modulation of leukocyte surface receptors (23,24) and soluble cytokines (25) can significantly change immune functions. Further studies are needed to explore the glycosylated proteins other than A1C in type 2 diabetic patients that are involved in the improvement of immune functions after the TCC exercise. Moreover, an appropriate combination of the TCC exercise program with diabetic medications may improve both glucose metabolism and immunity of type 2 diabetic patients.


   Acknowledgments
 
This study was supported by grant NSC93-2314-B-255-002 from National Science Council and grant CMRPF850041 from Chang Gung Memorial Hospital, Taiwan.

The authors gratefully acknowledge the staff members and patients who participated in the study.


   Footnotes
 
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

Received for publication July 19, 2006. Accepted for publication December 1, 2006.


   References
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
 References
 

  1. Bloomgarden ZT: Inflammation, atherosclerosis, and aspects of insulin action. Diabetes Care 28:2312–2319, 2005[Free Full Text]
  2. Toutouzas K, Markou V, Drakopoulou M, Mitropoulos I, Tsiamis E, Vavuranakis M, Vaina S, Stefanadis C: Increased heat generation from atherosclerotic plaques in patients with type 2 diabetes: an increased local inflammatory activation. Diabetes Care 28:1656–1661, 2005[Abstract/Free Full Text]
  3. Tan KC, Chow WS, Tam S, Bacala R, Betteridge J: Association between acute-phase reactants and advanced glycation end products in type 2 diabetes. Diabetes Care 27:223–228, 2004[Abstract/Free Full Text]
  4. Nielsen PJ, Hafdahl AR, Conn VS, Lemaster JW, Brown SA: Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes. Diabetes Res Clin Pract 74:111–120, 2006[Medline]
  5. Steward KJ: Role of exercise training on cardiovascular disease in persons who have type 2 diabetes and hypertension. Cardiol Clin 22:569–586, 2004[Medline]
  6. Bruunsgaard H: Physical activity and modulation of systemic low-level inflammation. J Leukoc Biol 78:819–835, 2005[Abstract/Free Full Text]
  7. Peterson AM, Pederson BK: The anti-inflammatory effect of exercise. J Appl Physiol 98:1154–1162, 2005[Abstract/Free Full Text]
  8. Suzuki K, Nakaji S, Yamada M, Liu Q, Kurakake S, Okamura N, Kumae T, Umeda T, Sugawara K: Impact of a competitive marathon race on systemic cytokine and neutrophil responses. Med Sci Sports Exerc 35:348–355, 2003
  9. Suzuki K, Nakaji S, Yamada M, Totsuka M, Sato K, Sugawara K: Systemic inflammatory response to exhaustive exercise: cytokine kinetics. Exerc Immunol Rev 8:6–48, 2002[Medline]
  10. Nieman DC: Current perspective on exercise immunology. Curr Sports Med Rep 2:239–242, 2003[Medline]
  11. Meneilly GS, Tessier D: Diabetes in the elderly. Diabet Med 12:949–960, 1995[Medline]
  12. Shore S, Shinkai S, Rhind S, Shephard RJ: Immune responses to training: how critical is training volume? J Sports Med Phys Fitness 39:1–11, 1999[Medline]
  13. Davis JM, Murphy EA, Brown AS, Carmichael MD, Ghaffar A, Mayer EP: Effects of moderate exercise and oat beta-glucan on innate immune function and susceptibility to respiratory infection. Am J Physiol Regul Integr Comp Physiol 286:R366–R372, 2004[Abstract/Free Full Text]
  14. Wang C, Collet JP, Lau J: The effect of TCC exercise on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med 164:493–501, 2004[Abstract/Free Full Text]
  15. Lu WA, Kuo CD: The effect of Tai Chi Chuan on the autonomic nervous modulation in older persons. Med Sci Sports Exerc 35:1972–1976, 2003
  16. Tsang WW, Hui-Chan CW: Effect of 4- and 8-wk intensive Tai Chi training on balance control in the elderly. Med Sci Sports Exerc 36:648–657, 2004
  17. Yeh SH, Chuang H, Lin LW, Hsiao CY, Eng HL: Regular Tai Chi Chuan exercise enhances functional mobility and CD4CD25 regulatory T cells. Br J Sports Med 40:239–243, 2006[Abstract/Free Full Text]
  18. Cheng MC: Tai Chi Chuan: A Simplified Method of Calisthenics for Health and Self Defense. Berkeley, CA, North Atlantic Books, 1981, p. 32–111
  19. Woods JA, Lowder TW, Keylock KT: Can exercise training improve immune function in the aged? Ann N Y Acad Sci 959:117–127, 2002[Abstract/Free Full Text]
  20. Fritz T, Kramer DK, Karlsson HK, Galuska D, Engfeldt P, Zierath JR, Krook A: Low-intensity exercise increases skeletal muscle protein expression of PPARdelta and UCP3 in type 2 diabetic patients. Diabete Metab Res Rev 22:492–498, 2006
  21. Ratner RE, the Diabetes Prevention Program Research: An update on the diabetes prevention program. Endocr Pract 12(Suppl. 1):20–24, 2006
  22. Boule NG, Kenny GP, Haddad E, Wells GA, Sigal RJ: Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia 46:1071–1081, 2003[Medline]
  23. Muller I, Jenner J, Handgretinger R, Riberdy J, Kerst G: Glycosylation and lectins: examples of immunesurveillance and immune evasion. Histol Histopathol 19:527–533, 2004[Medline]
  24. Sun J, Duffy KE, Ranjith-Kumar CT, Xiong J, Lamb RJ, Santos J, Masarapu H, Cunningham M, Holzenburg A, Sarisky RT, Mbow ML, Kao C: Structural and functional analyses of the human Toll-like receptor 3: role of glycosylation. J Biol Chem 281:11144–11151, 2006[Abstract/Free Full Text]
  25. Van den Steen P, Rudd PM, Dwek RA, Van Damme J, Opdenakker G: Cytokine and protease glycosylation as a regulatory mechanism in inflammation and autoimmunity. Adv Exp Med Biol 435:133–143, 1998[Medline]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Age AgeingHome page
T. Tsang, R. Orr, P. Lam, E. Comino, and M. F. Singh
Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised double-blind sham-exercise-controlled trial
Age Ageing, January 1, 2008; 37(1): 64 - 71.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yeh, S.-H.
Right arrow Articles by Yang, K. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yeh, S.-H.
Right arrow Articles by Yang, K. D.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum