Mohammad Babaei 
, Ameneh Pourrahim , Davar Khodadadi , Samaneh Hadi , REZA Farzizadeh , Samira Davarpanah
, Ameneh Pourrahim , Davar Khodadadi , Samaneh Hadi , REZA Farzizadeh , Samira Davarpanah
Mohaghegh Ardabili University , m.babaei9674@gmail.com
Abstract: (332 Views)
Background & Aims: Diabetes Mellitus (DM) is an incurable disorder with various complications that causes damage to various organs. According to reports, 463 million adults worldwide suffer from DM, which is expected to increase to 578 million by 2030 (1).
Hyperglycemia is the most common symptom of diabetes, which is caused by an autoimmune disease of pancreatic cells, ultimately leading to a decrease in insulin secretion in type 1 diabetes (T1DM) or insulin resistance in type 2 diabetes (T2DM). The creation of oxidative stress in diabetic patients and subsequent disruption of vascular endothelial function directly and indirectly affects the function of the human reproductive system (1,2). It has been shown that half of the men with diabetes have poor semen quality and dysfunctional reproductive system. These factors are influenced by various mechanisms such as neuropathy, endocrine disorders and oxidative stress. According to various reports, erectile dysfunction (ED) occurs in 59% of men with diabetes. ED is caused by hyperglycemia because it increases the amount of ROS (reactive oxygen species) and advanced glycation end products (AGEs) and by disrupting the metabolism of eNOS (endothelial nitric oxide synthase), it decreases the synthesis of nitric oxide (NO)(3,4). Nitric oxide is an unstable messenger molecule that plays a role in the regulation of gonadotropin hormones, sperm capacitation, erection and ejaculation (5). Oxytocin, which induces mating behavior in both sexes, induces the release of gonadotropin-releasing hormone (GnRH) through the production of NO. Also, NO controls the mating behavior in men through neural mediators related to ejaculation, so that the inhibition of nitric oxide synthesis reduces the frequency of ejaculation and the duration of ejaculation by reducing the activity of the sympathetic nervous system. Many researches show that testosterone levels decrease in diabetic men (5). A decrease in vascular endothelial growth factor (VEGF) may disrupt the function of vascular endothelial cells, which leads to blockage of small arteries (microcirculation) in the testis, which in turn causes morphological and structural changes (6,7). It is believed that in immature rats, DM can cause gonadal growth retardation, decreased sexual behavior and testosterone synthesis while promoting gonadal atrophy (6,7). In both type 1 and type 2 diabetes animal models, studies have shown a significant decrease in antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) and a significant increase in malondialdehyde (MDA) levels (15,16). Also, studies in type 2 diabetic mice have reported upregulation of pro-apoptotic protein BAX and downregulation of anti-apoptotic protein Bcl-2. Apoptosis is a physiological process that occurs in order to remove damaged cells in testicular tissue and other tissues and plays an important role in tissue compatibility. The process of apoptosis occurs in two internal (mitochondria-dependent) and external (ligand-dependent) pathways. In the internal pathway of apoptosis, the Bcl-2 family includes BAX and Bcl-2 proteins as the upstream regulators of apoptosis. Bcl-2 is one of the apoptosis-inhibiting proteins that prevents the oxidative destruction of the cell and by maintaining the integrity of the mitochondrial membrane by removing H+ ions, it binds to the apoptotic protease activation factor and activates caspase 9 (17,18).This decrease in antioxidant capacity and the predominance of oxidant conditions in diabetes cause structural changes in the testicles, decrease in sperm production, decrease in sperm motility and decrease in the number of Leydig cells (testosterone secreting cells) and Sertoli cells (13,19).
Sedentary lifestyle is one of the causes of type 2 diabetes. Physical activity is the most powerful factor in preventing diseases such as obesity and diabetes. Exercise reduces oxidative stress, increases antioxidant capacity and reduces insulin resistance (27). Physical activity increases the uptake of glucose by muscle tissues and reduces blood glucose (28). It has also been reported that physical exercises protect cells from apoptosis and improve spermatogenesis and increase sex hormones (29). However, according to our knowledge, these new evidences that investigate the effect of physical activity on blood sugar levels, sex hormones, antioxidant enzymes, oxidative stress and apoptosis indicators of testicular tissue of diabetic patients, have not been critically evaluated. Therefore, in this article, we review the published evidence to determine whether physical activity can be used as a therapeutic tool for the sexual health of patients with type 2 diabetes. It is hoped that the information presented will be valuable to physicians, exercise physiologists, and those interested in personal or public health..
Methods: This study was conducted in April and May 2024, focusing on investigating the effects of physical activity on some health and fertility indicators of the reproductive system of diabetic patients. Pub Med, Science Direct, Med Line, SID and Google Scholar databases were used in this study. Also, the keywords "diabetes", "diabetes and sexual diseases", "physical activity and diabetes", "physical activity and sexual health" were used to search for articles. The criteria for selecting articles for this study included the following: 1- Original and scientific-research articles. 2- The studied samples should not have any other disease apart from diabetes. 3- The exercise protocols used in the articles should not be short-term or acute. 4- The articles have only examined the response to sports activity (without the use of various medical drugs). The exclusion criteria for articles from this study included the following: 1- Review articles. 2- In the articles, drugs and blood sugar lowering supplements have been used. The articles used in this study were in the time range between 2015 and 2024. 25 articles were collected from scientific databases, and after reading the articles, 11 articles were included in the present study. Results: The results of the present study showed that regular physical activity reduces blood sugar levels, increases sex hormone levels, antioxidant enzymes and oxidative stress, and apoptotic indices of testicular tissue of diabetic patients. The proposed mechanism for reducing blood sugar, improving antioxidant defense and increasing the levels of sex hormones and reducing apoptotic proteins due to regular exercise can be pointed to the fact that physical activity increases the muscle response to insulin through the expression and increases the activity of proteins involved in carbohydrate metabolism. So that physical activity increases the activity of glycogen synthetase and the expression of glucose transporter 4 (GLUT4) proteins. Also, research results have shown that exercise increases insulin sensitivity in diabetic patients and facilitates the entry of blood sugar into muscle cells, which ultimately leads to a decrease in blood sugar levels.
Conclusion: The results of this study show that regular physical activity can reduce blood sugar, increase the levels of sex hormones, increase the activity of antioxidant enzymes, reduce oxidative stress, increase anti-apoptotic factors and decrease pro-apoptotic factors.
Hyperglycemia is the most common symptom of diabetes, which is caused by an autoimmune disease of pancreatic cells, ultimately leading to a decrease in insulin secretion in type 1 diabetes (T1DM) or insulin resistance in type 2 diabetes (T2DM). The creation of oxidative stress in diabetic patients and subsequent disruption of vascular endothelial function directly and indirectly affects the function of the human reproductive system (1,2). It has been shown that half of the men with diabetes have poor semen quality and dysfunctional reproductive system. These factors are influenced by various mechanisms such as neuropathy, endocrine disorders and oxidative stress. According to various reports, erectile dysfunction (ED) occurs in 59% of men with diabetes. ED is caused by hyperglycemia because it increases the amount of ROS (reactive oxygen species) and advanced glycation end products (AGEs) and by disrupting the metabolism of eNOS (endothelial nitric oxide synthase), it decreases the synthesis of nitric oxide (NO)(3,4). Nitric oxide is an unstable messenger molecule that plays a role in the regulation of gonadotropin hormones, sperm capacitation, erection and ejaculation (5). Oxytocin, which induces mating behavior in both sexes, induces the release of gonadotropin-releasing hormone (GnRH) through the production of NO. Also, NO controls the mating behavior in men through neural mediators related to ejaculation, so that the inhibition of nitric oxide synthesis reduces the frequency of ejaculation and the duration of ejaculation by reducing the activity of the sympathetic nervous system. Many researches show that testosterone levels decrease in diabetic men (5). A decrease in vascular endothelial growth factor (VEGF) may disrupt the function of vascular endothelial cells, which leads to blockage of small arteries (microcirculation) in the testis, which in turn causes morphological and structural changes (6,7). It is believed that in immature rats, DM can cause gonadal growth retardation, decreased sexual behavior and testosterone synthesis while promoting gonadal atrophy (6,7). In both type 1 and type 2 diabetes animal models, studies have shown a significant decrease in antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) and a significant increase in malondialdehyde (MDA) levels (15,16). Also, studies in type 2 diabetic mice have reported upregulation of pro-apoptotic protein BAX and downregulation of anti-apoptotic protein Bcl-2. Apoptosis is a physiological process that occurs in order to remove damaged cells in testicular tissue and other tissues and plays an important role in tissue compatibility. The process of apoptosis occurs in two internal (mitochondria-dependent) and external (ligand-dependent) pathways. In the internal pathway of apoptosis, the Bcl-2 family includes BAX and Bcl-2 proteins as the upstream regulators of apoptosis. Bcl-2 is one of the apoptosis-inhibiting proteins that prevents the oxidative destruction of the cell and by maintaining the integrity of the mitochondrial membrane by removing H+ ions, it binds to the apoptotic protease activation factor and activates caspase 9 (17,18).This decrease in antioxidant capacity and the predominance of oxidant conditions in diabetes cause structural changes in the testicles, decrease in sperm production, decrease in sperm motility and decrease in the number of Leydig cells (testosterone secreting cells) and Sertoli cells (13,19).
Sedentary lifestyle is one of the causes of type 2 diabetes. Physical activity is the most powerful factor in preventing diseases such as obesity and diabetes. Exercise reduces oxidative stress, increases antioxidant capacity and reduces insulin resistance (27). Physical activity increases the uptake of glucose by muscle tissues and reduces blood glucose (28). It has also been reported that physical exercises protect cells from apoptosis and improve spermatogenesis and increase sex hormones (29). However, according to our knowledge, these new evidences that investigate the effect of physical activity on blood sugar levels, sex hormones, antioxidant enzymes, oxidative stress and apoptosis indicators of testicular tissue of diabetic patients, have not been critically evaluated. Therefore, in this article, we review the published evidence to determine whether physical activity can be used as a therapeutic tool for the sexual health of patients with type 2 diabetes. It is hoped that the information presented will be valuable to physicians, exercise physiologists, and those interested in personal or public health..
Methods: This study was conducted in April and May 2024, focusing on investigating the effects of physical activity on some health and fertility indicators of the reproductive system of diabetic patients. Pub Med, Science Direct, Med Line, SID and Google Scholar databases were used in this study. Also, the keywords "diabetes", "diabetes and sexual diseases", "physical activity and diabetes", "physical activity and sexual health" were used to search for articles. The criteria for selecting articles for this study included the following: 1- Original and scientific-research articles. 2- The studied samples should not have any other disease apart from diabetes. 3- The exercise protocols used in the articles should not be short-term or acute. 4- The articles have only examined the response to sports activity (without the use of various medical drugs). The exclusion criteria for articles from this study included the following: 1- Review articles. 2- In the articles, drugs and blood sugar lowering supplements have been used. The articles used in this study were in the time range between 2015 and 2024. 25 articles were collected from scientific databases, and after reading the articles, 11 articles were included in the present study. Results: The results of the present study showed that regular physical activity reduces blood sugar levels, increases sex hormone levels, antioxidant enzymes and oxidative stress, and apoptotic indices of testicular tissue of diabetic patients. The proposed mechanism for reducing blood sugar, improving antioxidant defense and increasing the levels of sex hormones and reducing apoptotic proteins due to regular exercise can be pointed to the fact that physical activity increases the muscle response to insulin through the expression and increases the activity of proteins involved in carbohydrate metabolism. So that physical activity increases the activity of glycogen synthetase and the expression of glucose transporter 4 (GLUT4) proteins. Also, research results have shown that exercise increases insulin sensitivity in diabetic patients and facilitates the entry of blood sugar into muscle cells, which ultimately leads to a decrease in blood sugar levels.
Conclusion: The results of this study show that regular physical activity can reduce blood sugar, increase the levels of sex hormones, increase the activity of antioxidant enzymes, reduce oxidative stress, increase anti-apoptotic factors and decrease pro-apoptotic factors.
Keywords: sex hormones, oxidative stress, antioxidant enzymes, apoptosis indicators, testicular tissue
Type of Study: review article |
Subject:
Exercise Physiology
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