Volume 16, Issue 64 (12-2026)
NCMBJ 2026, 16(64): 1-28 |
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Feiz Mahdavi K, Azarbayjani M A, Riyahi Malayeri S, Matin Homaei H. The Effect of Aerobic Exercise and Medicinal Plants on Insulin Resistance. , NCMBJ. 2026; 16 (64) :1-28
URL: http://ncmbjpiau.ir/article-1-1892-en.html
URL: http://ncmbjpiau.ir/article-1-1892-en.html
Department of Exercise Physiology, CT. C., Islamic Azad University, Tehran, Iran.
Abstract: (42 Views)
Extended Abstract
Background and Aim: Insulin resistance (IR) is a central metabolic abnormality associated with obesity, physical inactivity, and sedentary behavior, characterized by impaired insulin responsiveness in skeletal muscle, liver, and adipose tissue. This dysfunction reduces peripheral glucose uptake and hepatic glucose regulation and, when persistent, increases the risk of type 2 diabetes mellitus, non-alcoholic fatty liver disease, cardiovascular complications, and chronic low-grade inflammation. Regular aerobic exercise is recognized as an effective non-pharmacological strategy for improving insulin sensitivity, glycemic regulation, mitochondrial function, and metabolic health. Concurrently, medicinal plants and their bioactive phytochemicals have received increasing attention because of their antioxidant, anti-inflammatory, and glucose-regulatory properties. Polyphenols, flavonoids, terpenoids, organosulfur compounds, and other phytochemicals may influence molecular pathways that overlap with exercise-induced metabolic adaptations. Despite the growing number of studies conducted by Iranian exercise physiologists, evidence regarding the combined application of aerobic exercise and medicinal plants remains fragmented. Therefore, this narrative review aimed to synthesize research conducted by Iranian investigators on the combined effects of aerobic exercise and medicinal plants on IR-related outcomes and to examine the molecular mechanisms potentially underlying these effects.
Materials and Methods: A structured narrative review was conducted using the Magiran academic database. The search included all eligible publications indexed from the beginning of database coverage through Spring 2025. Search terms in Persian and English included “insulin resistance,” “aerobic exercise,” “medicinal plant,” “phytochemicals,” and “IR.” Eligible studies were original empirical investigations, including human clinical or quasi-experimental studies and controlled experimental animal studies. Studies were included when they investigated the concurrent use of an aerobic exercise protocol and a medicinal plant, plant extract, or phytochemical intervention and assessed IR-related metabolic outcomes. Review articles, opinion papers, editorials, case reports, and studies examining exercise or plant-based interventions alone were excluded. Retrieved records were initially screened and subsequently evaluated manually to confirm eligibility and extract relevant information regarding intervention characteristics and metabolic outcomes.
Results: A total of 40 original studies met the inclusion criteria and investigated combined aerobic exercise and plant-based interventions in humans and experimental animal models. Cinnamon was the most frequently investigated intervention, with nine studies, followed by green tea with six studies and ginger with four studies. Other interventions included green coffee, pomegranate, garlic, stevia, chlorella, licorice, wild pistachio, crocin, Caucasian whortleberry, saffron, sumac, curcumin, resveratrol, artichoke, walnut, and ginseng. The majority of the reviewed studies reported reductions in fasting glucose, fasting insulin, and/or HOMA-IR following combined aerobic exercise and plant-based interventions. These findings suggest that concurrent interventions may influence complementary metabolic pathways involved in the development and persistence of IR. Aerobic exercise promotes skeletal muscle glucose uptake through AMPK activation, enhancement of IRS-1/PI3K/Akt signaling, and increased GLUT4 translocation to the sarcolemmal membrane. Exercise also improves mitochondrial oxidative capacity and fatty acid oxidation, thereby reducing intracellular lipid accumulation and lipid-derived metabolites that can interfere with insulin signaling. In addition, regular aerobic exercise may attenuate oxidative stress and chronic low-grade inflammation by modulating pro-inflammatory cytokines and adipokines. Medicinal plants may complement these adaptations through multiple bioactive constituents capable of modulating insulin signaling, glucose transport, lipid metabolism, and cellular redox balance. Several phytochemicals have been reported to influence the PI3K/Akt pathway, AMPK activity, GLUT4-mediated glucose transport, and PPAR-related metabolic regulation. Their antioxidant effects may further reduce reactive oxygen species and protect cellular signaling components from oxidative impairment. Anti-inflammatory actions involving attenuation of NF-κB signaling and reductions in mediators such as TNF-α, IL-6, and IL-1β may also contribute to improved insulin responsiveness. Cinnamon was associated with potential improvements in insulin signaling, GLUT4 activity, and PPAR-related pathways, whereas green tea catechins may influence AMPK activation and glucose metabolism. Ginger and its major bioactive constituents, particularly gingerols, may exert metabolic effects through AMPK-related signaling and attenuation of oxidative and inflammatory stress. Similarly, garlic, pomegranate, stevia, curcumin, resveratrol, saffron, chlorella, licorice, and other investigated interventions may affect glucose and lipid metabolism through overlapping antioxidant, anti-inflammatory, and insulin-sensitizing mechanisms. Nevertheless, the magnitude and consistency of these effects varied across studies, indicating that the interaction between exercise and plant-derived compounds cannot be considered uniform. Notably, some studies involving aerobic exercise combined with green tea or pomegranate-based interventions reported no significant changes in HOMA-IR or related indices. Such inconsistencies may reflect differences in phytochemical composition, extract standardization, bioavailability, dosage, intervention duration, exercise intensity, and baseline metabolic status. Overall, the available evidence indicates a biologically plausible convergence between exercise-induced metabolic adaptations and phytochemical-mediated regulation of insulin signaling, oxidative stress, inflammation, and lipid metabolism.
Conclusion: The findings of this narrative review suggest that combining aerobic exercise with medicinal plants may represent a promising complementary strategy for improving insulin sensitivity and glucose metabolism. The potential benefits may arise from interactions among AMPK activation, IRS-1/PI3K/Akt signaling, GLUT4 translocation, enhanced mitochondrial function, improved lipid oxidation, and attenuation of oxidative stress and chronic inflammation. However, substantial heterogeneity in plant species, phytochemical composition, extract formulation, dosage, exercise modality, intensity, duration, participant characteristics, and methods used to assess IR limits direct comparison across studies. Further well-designed, adequately powered randomized controlled trials using standardized plant preparations and clearly defined aerobic exercise protocols are warranted to establish dose-response relationships, optimal intervention duration, long-term safety, and the tissue-specific molecular mechanisms underlying these combined interventions.
Background and Aim: Insulin resistance (IR) is a central metabolic abnormality associated with obesity, physical inactivity, and sedentary behavior, characterized by impaired insulin responsiveness in skeletal muscle, liver, and adipose tissue. This dysfunction reduces peripheral glucose uptake and hepatic glucose regulation and, when persistent, increases the risk of type 2 diabetes mellitus, non-alcoholic fatty liver disease, cardiovascular complications, and chronic low-grade inflammation. Regular aerobic exercise is recognized as an effective non-pharmacological strategy for improving insulin sensitivity, glycemic regulation, mitochondrial function, and metabolic health. Concurrently, medicinal plants and their bioactive phytochemicals have received increasing attention because of their antioxidant, anti-inflammatory, and glucose-regulatory properties. Polyphenols, flavonoids, terpenoids, organosulfur compounds, and other phytochemicals may influence molecular pathways that overlap with exercise-induced metabolic adaptations. Despite the growing number of studies conducted by Iranian exercise physiologists, evidence regarding the combined application of aerobic exercise and medicinal plants remains fragmented. Therefore, this narrative review aimed to synthesize research conducted by Iranian investigators on the combined effects of aerobic exercise and medicinal plants on IR-related outcomes and to examine the molecular mechanisms potentially underlying these effects.
Materials and Methods: A structured narrative review was conducted using the Magiran academic database. The search included all eligible publications indexed from the beginning of database coverage through Spring 2025. Search terms in Persian and English included “insulin resistance,” “aerobic exercise,” “medicinal plant,” “phytochemicals,” and “IR.” Eligible studies were original empirical investigations, including human clinical or quasi-experimental studies and controlled experimental animal studies. Studies were included when they investigated the concurrent use of an aerobic exercise protocol and a medicinal plant, plant extract, or phytochemical intervention and assessed IR-related metabolic outcomes. Review articles, opinion papers, editorials, case reports, and studies examining exercise or plant-based interventions alone were excluded. Retrieved records were initially screened and subsequently evaluated manually to confirm eligibility and extract relevant information regarding intervention characteristics and metabolic outcomes.
Results: A total of 40 original studies met the inclusion criteria and investigated combined aerobic exercise and plant-based interventions in humans and experimental animal models. Cinnamon was the most frequently investigated intervention, with nine studies, followed by green tea with six studies and ginger with four studies. Other interventions included green coffee, pomegranate, garlic, stevia, chlorella, licorice, wild pistachio, crocin, Caucasian whortleberry, saffron, sumac, curcumin, resveratrol, artichoke, walnut, and ginseng. The majority of the reviewed studies reported reductions in fasting glucose, fasting insulin, and/or HOMA-IR following combined aerobic exercise and plant-based interventions. These findings suggest that concurrent interventions may influence complementary metabolic pathways involved in the development and persistence of IR. Aerobic exercise promotes skeletal muscle glucose uptake through AMPK activation, enhancement of IRS-1/PI3K/Akt signaling, and increased GLUT4 translocation to the sarcolemmal membrane. Exercise also improves mitochondrial oxidative capacity and fatty acid oxidation, thereby reducing intracellular lipid accumulation and lipid-derived metabolites that can interfere with insulin signaling. In addition, regular aerobic exercise may attenuate oxidative stress and chronic low-grade inflammation by modulating pro-inflammatory cytokines and adipokines. Medicinal plants may complement these adaptations through multiple bioactive constituents capable of modulating insulin signaling, glucose transport, lipid metabolism, and cellular redox balance. Several phytochemicals have been reported to influence the PI3K/Akt pathway, AMPK activity, GLUT4-mediated glucose transport, and PPAR-related metabolic regulation. Their antioxidant effects may further reduce reactive oxygen species and protect cellular signaling components from oxidative impairment. Anti-inflammatory actions involving attenuation of NF-κB signaling and reductions in mediators such as TNF-α, IL-6, and IL-1β may also contribute to improved insulin responsiveness. Cinnamon was associated with potential improvements in insulin signaling, GLUT4 activity, and PPAR-related pathways, whereas green tea catechins may influence AMPK activation and glucose metabolism. Ginger and its major bioactive constituents, particularly gingerols, may exert metabolic effects through AMPK-related signaling and attenuation of oxidative and inflammatory stress. Similarly, garlic, pomegranate, stevia, curcumin, resveratrol, saffron, chlorella, licorice, and other investigated interventions may affect glucose and lipid metabolism through overlapping antioxidant, anti-inflammatory, and insulin-sensitizing mechanisms. Nevertheless, the magnitude and consistency of these effects varied across studies, indicating that the interaction between exercise and plant-derived compounds cannot be considered uniform. Notably, some studies involving aerobic exercise combined with green tea or pomegranate-based interventions reported no significant changes in HOMA-IR or related indices. Such inconsistencies may reflect differences in phytochemical composition, extract standardization, bioavailability, dosage, intervention duration, exercise intensity, and baseline metabolic status. Overall, the available evidence indicates a biologically plausible convergence between exercise-induced metabolic adaptations and phytochemical-mediated regulation of insulin signaling, oxidative stress, inflammation, and lipid metabolism.
Conclusion: The findings of this narrative review suggest that combining aerobic exercise with medicinal plants may represent a promising complementary strategy for improving insulin sensitivity and glucose metabolism. The potential benefits may arise from interactions among AMPK activation, IRS-1/PI3K/Akt signaling, GLUT4 translocation, enhanced mitochondrial function, improved lipid oxidation, and attenuation of oxidative stress and chronic inflammation. However, substantial heterogeneity in plant species, phytochemical composition, extract formulation, dosage, exercise modality, intensity, duration, participant characteristics, and methods used to assess IR limits direct comparison across studies. Further well-designed, adequately powered randomized controlled trials using standardized plant preparations and clearly defined aerobic exercise protocols are warranted to establish dose-response relationships, optimal intervention duration, long-term safety, and the tissue-specific molecular mechanisms underlying these combined interventions.
Type of Study: Review Article |
Subject:
Biochemistry
Received: 2026/11/3 | Accepted: 2026/12/1 | Published: 2026/12/1
Received: 2026/11/3 | Accepted: 2026/12/1 | Published: 2026/12/1
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