Discussion
muscle mass increase, T1DM, diabetes
DISEASE, COMPLICATIONS, DIABETES
The present study assessed the effect of concurrent resistance-aerobic training on selected inflammatory factors and hormones related to blood glucose homeostasis in children with T1DM. Based on the results, the experimental group had a significant decline in blood glucose index and Hb A1c after 16 weeks of concurrent training. The growth hormone index was enhanced significantly only in the experimental group. On the other hand, although the training protocol increased IGF-1, the increase was not statistically significant. The results, however, implied that despite the decreased blood sugar indices and enhanced growth hormone in the intervention group, it did not affect inflammatory markers in these patients. To the best of our knowledge, this is the first study reporting the effect of concurrent resistance and aerobic training on inflammatory indices in children with T1DM. Since it is crucial to control T1DM in children and hinder its complications, the findings should be considered in pediatric diabetes control programs. This concurrent training is recommended for children as it is both low-cost and highly useful in preventing the consequences of the disease in the future.We found that Hb A1c was statistically significant, but it changed very slightly. This may occur because our participants already have had a good apparent control on their blood glucose so that they had relatively low HbA1c at the beginning. Regarding fast blood glucose, a significant decline was observed after the training. This can be related to moderate intensity and long duration of the exercise training. On the other hand, neither blood glucose index nor Hb A1c changed in the control group. It can be concluded that exercise training provokes various responses in blood glucose concentration depending on its intensity and duration, so it was shown that low-intensity sprint exercises and training with weight increased blood glucose. Similar to the results of the current study in terms of blood sugar and Hb A1c, Fountaine et al. reported that moderate-intensity continuous training and high-intensity intermittent sprint training contributed to maintaining target blood sugar levels in adults with T1DM [However, Landt et al. did not show any significant changes in the blood glucose level of children with T1DM aged 11 after 5 months of aerobic training [On the other hand, the present study revealed that the growth hormone levels were significantly increased in both groups. Nevertheless, this training protocol failed to increase IGF-1 significantly. In contrast, Færch et al. reported a negative relationship between IGF-1 and glycemic control in patients with T1DM [Physical activities and appropriate exercise training can affect final height growth, muscle mass increase, and body fat decrease via inducing the secretion of growth hormone and, subsequently, IGF-1. On the other hand, the growth of various body systems in children and juveniles closely depends on the level of these hormones. Concerning the increase in these hormones in the present study, it can be noted that adaptability to training boosts growth hormone and IGF-1 transporters in the body, so their increase after 16 weeks of moderate-intensity training can be attributed to this adaptability.Proteins bound to growth hormone and IGF-1 are influential in their performance [On the other hand, the study revealed that inflammatory indices were increased in both groups. This finding supported the results of a study on the effect of high-intensity aerobic and resistance training in adults with T1DM [A recent study by Boff et al. on the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training on adults with T1DM indicated that hs-CRP was increased in both protocols. The training protocols were performed in stationary cycle ergometers at 50–85% high intensity and 50% moderate intensity for 40 min for 8 weeks at a frequency of three times a week [This study had some strengths and limitations. We indicated the tanner staging and participants in the groups were evenly distributed by tanner stages. We also assessed the effect of Pilates training, which is low-cost, healthy, and safe, especially for children. They also need no specific instrument and are readily available everywhere. However, there were some limitations. Future research needs to use random sampling with larger sample sizes. Nonetheless, the participants of both groups were selected homogenously. The participants enrolled in the study already had very good glucose control. It seems that longer exercise training should be performed to improve effectiveness.