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Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: a randomized controlled trial.
Obaya, HE, Abdeen, HA, Salem, AA, Shehata, MA, Aldhahi, MI, Muka, T, Marques-Sule, E, Taha, MM, Gaber, M, Atef, H
Frontiers in physiology. 2023;14:1186546
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Plain language summary
Stress is considered to be an important factor in type 2 diabetes mellitus (T2DM) and aerobic exercise can help modulate the stress response as well as being important in the management of diabetes. Mindfulness meditation and deep breathing have also been shown to have positive effects on both stress and T2DM. This 6-week single-blind, randomised, controlled trial evaluated the effect of 10 min slow deep breathing and 10 min mindfulness meditation following a 40 min aerobic exercise programme, compared to the 40 min aerobic exercise alone, on fasting blood glucose (FBG) and cortisol levels in 58 stressed women with T2DM. FBG and cortisol levels improved in both groups but more so in the group who received the deep breathing and mindfulness meditation in addition to the exercise intervention: 20% vs 30% reduction in cortisol and 10% vs 15% reduction in FBG. The authors conclude that adding slow deep breathing and mindfulness meditation to an exercise programme may be useful in the management of stressed women with T2DM and reduce their cardiometabolic risk.
Expert Review
Conflicts of interest:
None
Take Home Message:
Practitioners could consider slow deep breathing and mindfulness meditation, added to aerobic exercise, as potentially useful components of the T2DM management program for stressed women.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
Stress, a key factor for Type 2 diabetes mellitus (T2DM), stimulates the hypothalamus-pituitary-adrenal gland (HPA) and triggers parasympathetic nerve withdrawal, leading to increased circulating cortisol levels and higher levels of blood glucose. Exercise is a key intervention that can modulate the HPA axis and help manage stress.
Methods
Fifty-eight women (aged between 40-50), diagnosed with T2DM for at least 5 years but medically stable with moderate to high stress scores were randomised to either aerobic training (AT) or aerobic exercise combined with slow deep breathing and mindfulness meditation (DMM) training three times weekly over 6-weeks.
AT group performed aerobic exercise on a treadmill at an intensity of 60%– 75% of the maximum heart rate for a total of 40 min, including a 5 minute warm up and 5 min cool down.
AT + DMM group performed a combination of aerobic exercise as per the AT group followed by a total of 10 minutes of diaphragmatic slow, deep breathing; and mindfulness meditation.
Results
Both groups showed a change from baseline in serum cortisol to p<0.0001
At 6 weeks in the AT + DMM group, the primary outcome of serum cortisol (nmol/L) levels was 12.59 nmol/L [95% CI 4.45-6.52] a decrease of 30.29% and the fasting blood glucose levels (secondary outcome) was 136.37mg/dl (95% CI: 9.19–2.6) a decrease of 14.54%
In the AT group performing only aerobic exercise decreased serum cortisol levels by 20.16% and FBG levels decreased by 9.97%.
Conclusion
This study showed that combining slow deep breathing and mindfulness meditation with aerobic exercise reduced the serum cortisol (p = 0.01) and FBG levels (p = 0.001) in women with T2DM compared to when only aerobic training was performed.
Clinical practice applications:
Consider a combined therapy approach with diaphragmatic breathing exercises and aerobic exercises that targets both the endocrine and autonomic nervous systems, as this may have a synergistic effect to assist with maintaining normal blood sugar levels and cortisol levels in individuals with T2DM.
Considerations for future research:
Future research is needed to determine the most effective combination of therapies for managing both FBG and serum cortisol levels in individuals with T2DM.
Abstract
Background: Aerobic exercise combined with breathing exercise can be an integral part of diabetes mellitus treatment. This single-center, randomized, parallel-group study investigated the effect of the combination of aerobic exercise with slow deep breathing and mindfulness meditation on the glucose and cortisol levels of women with type 2 diabetes mellitus (T2DM). Materials and Methods: Fifty-eight middle-aged women with T2DM (mean age: 45.67 ± 2.92 years) were randomly assigned to either the aerobic training group (AT: n = 29; mean age [46.1 ± 2.7 years]) or the aerobic exercise combined with slow deep breathing and mindfulness meditation (AT + DMM: n = 29; mean age [45.24 ± 3.14 years]). Aerobic exercise was performed at 60%-75% of the maximum heart rate. The women in each group were asked to perform the training three times weekly over a 6-week period. The duration of each session was 40 min for the AT group and 60 min for the AT + DMM group. The two groups were asked to perform aerobic exercise at 60%-75% of the maximum heart rate. Their fasting blood glucose (FBG) and serum cortisol levels were measured at the baseline and after the 6 weeks. Results: Compared with the AT group, the group undertaking 6 weeks of aerobic training combined with slow, deep breathing exercises and mindfulness meditation showed significantly lower levels of FBG (p = 0.001) and cortisol levels (p = 0.01) than the AT group. Conclusion: The addition of slow deep breathing and mindfulness meditation to aerobic exercise can better control the glucose and cortisol levels of women with T2DM and thereby improve their outcomes and decrease their cardiometabolic risk.
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Genetic risk-factors for anxiety in healthy individuals: polymorphisms in genes important for the HPA axis.
Lindholm, H, Morrison, I, Krettek, A, Malm, D, Novembre, G, Handlin, L
BMC medical genetics. 2020;21(1):184
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Anxiety is a complex disorder that involves alterations in hormones secreted from glands in the brain. Genetic variations in these hormones can mean that some individuals are more susceptible to anxiety disorders. The aim of this observational study was to investigate possible relationships between genetic changes in brain hormones and anxiety in 72 individuals. The results showed that women were more likely than men to report feelings of anxiety and there were several relationships between genetic variations in brain hormones and self-reported measures of anxiety. It was concluded that genetic variations in brain hormones are associated with anxiety disorders in healthy individuals. This study could be used by healthcare professionals to understand how genetics could play a role in anxiety and that certain genes could be used to identify individuals at risk of anxiety disorders.
Abstract
BACKGROUND Two important aspects for the development of anxiety disorders are genetic predisposition and alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In order to identify genetic risk-factors for anxiety, the aim of this exploratory study was to investigate possible relationships between genetic polymorphisms in genes important for the regulation and activity of the HPA axis and self-assessed anxiety in healthy individuals. METHODS DNA from 72 healthy participants, 37 women and 35 men, were included in the analyses. Their DNA was extracted and analysed for the following Single Nucleotide Polymorphisms (SNP)s: rs41423247 in the NR3C1 gene, rs1360780 in the FKBP5 gene, rs53576 in the OXTR gene, 5-HTTLPR in SLC6A4 gene and rs6295 in the HTR1A gene. Self-assessed anxiety was measured by the State and Trait Anxiety Inventory (STAI) questionnaire. RESULTS Self-assessed measure of both STAI-S and STAI-T were significantly higher in female than in male participants (p = 0.030 and p = 0.036, respectively). For SNP rs41423247 in the NR3C1 gene, there was a significant difference in females in the score for STAI-S, where carriers of the G allele had higher scores compared to the females that were homozygous for the C allele (p < 0.01). For the SNP rs53576 in the OXTR gene, there was a significant difference in males, where carriers of the A allele had higher scores in STAI-T compared to the males that were homozygous for the G allele (p < 0.01). CONCLUSION This study shows that SNP rs41423247 in the NR3C1 gene and SNP rs53576 in the OXTR gene are associated with self-assessed anxiety in healthy individuals in a gender-specific manner. This suggests that these SNP candidates are possible genetic risk-factors for anxiety.