ABC | Volume 113, Nº6, December 2019

Review Article Ferrari et al. Exercise-mediated glucose uptake Arq Bras Cardiol. 2019; 113(6):1139-1148 Figure 2 – Schematic representation of activation of TLR 2, TLR4 or cytokine receptor by extracellular ligands and induction of inflammation and insulin resistance in an adipocyte. TLR2: toll-like receptor 2; TLR4: toll-like receptor 4; NF-κB: nuclear factor-kappa β; JNK: c-Jun N-terminal kinase; IKK: IkB kinase; GLUT4: glucose transporter type 4; IR: insulin resistance. Expression Expression Activation Activation Activation Translocation Expression NF-ĸB Pro-inflammatory cytokines JNK IKK RI GLUT4 TLR2, TLR4 or cytokine receptor Receptor ligands with diet 116 significantly increase adiponectin levels in adipose tissue inobese subjects, regardless of changes inbody composition. Inaddition, PE, particularly aerobic exercise, was able to change the body fat distribution, by reduction of pro-inflammatory cytokines and improvement of insulin sensitivity. 112 Finally, plasma levels of resistin (protein related to IR and glucose intolerance), decreased after PE programs. 117,118 Resistin is commonly found in obese individuals, and seems to be involved in IR. 119 It was recently demonstrated that accumulation of this protein is associated with lower survival of DM2 patients, and concentrations above 11 ng/mL indicate increased risk in these patients. 120 Reduction in resistin concentrations by interventions, such as PE, may be related to reduction in inflammation via release of anti-inflammatory cytokines rather than changes in glucose metabolism and reductions of body mass. 121 Therefore, obesity, in consonance with inflammatory process, can contribute to the increase in important inflammatory markers, such as pro-inflammatory cytokines. Available evidence has indicated that PE reduces these markers, regardless of a reduction in body weight. Final considerations PE stimulates many complex molecular and biochemical mechanisms, which promote a substantial improvement in insulin signaling and glucose uptake in IR states. It is important to highlight that evidences for the role of PE in reduction of the inflammatory process in IR associated with obesity were also presented. Author contributions Conception and design of the research, Acquisition of data and Writing of the manuscript: Ferrari F, Bock PM, Motta MT, Helal L; Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: Ferrari F, Bock PM, Helal L. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1144