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1.
Glycemic and cardiometabolic effects of exercise in South Asian Sri Lankans with type 2 diabetes mellitus: A randomized controlled trial Sri Lanka diabetes aerobic and resistance training study (SL-DARTS).
Ranasinghe, C, Devage, S, Constantine, GR, Katulanda, P, Hills, AP, King, NA
Diabetes & metabolic syndrome. 2021;(1):77-85
Abstract
BACKGROUND AND AIMS To examine the effects of aerobic training (AT) and resistance training (RT) compared to standard care on glycemic control in South Asian Sri Lankan adults with Type 2 Diabetes Mellitus (T2DM). METHODS Randomized controlled trial (RCT) with parallel-group design recruited 86 sedentary Sri Lankans (aged 35-65 years) with T2DM into aerobic training (AT, n = 28), resistance training (RT, n = 28) and control (CN, n = 30) groups. Supervised progressive exercise training consisting of 75 min per session, 2 days per week for 12 weeks was conducted. The primary outcome was pre- and post-intervention absolute change in hemoglobin A1c (HBA1c). Secondary outcomes were serum lipids, liver enzymes, chronic inflammatory status, anthropometry, body composition and blood pressure. RESULTS The absolute change in HbA1c of RT vs. CN was -0.08% (95% CI, 0.8% to -0.7%, p = 0.8) and AT vs. CN was -0.22% (95% CI, 0.95% to -0.5%). Subgroup analysis (n = 49) with a high baseline HbA1c (>7.5%), absolute reduction in HbA1c in exercise groups were statistically significant (RT vs. CN was -0.37%; 95% CI 1.3% to -0.6%, p = 0.04 and AT vs. CN was -0.57%; 95% CI 1.7% to -0.6%, p = 0.03). The effect sizes (total and subgroup HbA1c >7.5%) ranged from 0.7 to 1.0 in AT, 0.4 to 1.1 in RT compared to 0.35 to 0.6 for the CN. Secondary outcomes did not significantly differ among groups. CONCLUSIONS Exercise training 2 days/week improved glycemic control in Sri Lankan adults with T2DM and the effects were significant in high baseline HbA1c (>7.5%) groups (RT > AT).
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2.
Impact of a Three-Week in-Hospital Multidisciplinary Body Weight Reduction Program on Body Composition, Muscle Performance and Fatigue in a Pediatric Obese Population with or without Metabolic Syndrome.
Rigamonti, AE, Tringali, G, Micheli, R, Col, A, Tamini, S, Saezza, A, Cella, SG, Sartorio, A
Nutrients. 2020;(1)
Abstract
Metabolic syndrome is a combination of cardiometabolic risk factors, frequently detected in obese children and adolescents. To date, few clinical studies have evaluated the effectiveness of multidisciplinary body weight reduction programs on body mass index, body composition, muscle performance and fatigue in pediatric obese subjects suffering from metabolic syndrome, which might represent a sub-population that is more difficult to be treated and worthy of more intensive interventions than a population less metabolically complicated. The aim of the present study was to compare the impact of a three-week in-hospital multidisciplinary integrated body weight reduction program (BWRP) on body mass index (BMI), body composition (particularly, fat mass (FM) and fat-free mass (FFM)), motor control (evaluated by one-leg standing balance (OLSB) test), muscle performance (evaluated by the stair climbing test (SCT)) and fatigue (evaluated by fatigue severity scale (FSS)) in a pediatric obese population with or without metabolic syndrome. A pediatric population of 548 obese subjects without metabolic syndrome (F/M = 312/236; age range: 8-18 years; BMI: 36.3 ± 6.7 kg/m2) and 96 obese subjects with metabolic syndrome (F/M = 53/43; age range: 9-18 years; BMI: 38.3 ± 6.9 kg/m2) was recruited. The BWRP significantly reduced BMI, FM (expressed as %), SCT time and FSS score, and increased OLSB time in all subgroups of obese subjects, independent of sex and metabolic syndrome, with preservation of FFM. No significant differences in |ΔBMI|, |ΔFM|, |ΔOLSB| or |ΔSCT| times and |ΔFSS| score were found when comparing subjects (males and females) with or without metabolic syndrome, apart from obese females without metabolic syndrome, who exhibited a lower weight loss and FM (expressed as %) reduction when compared to the corresponding male counterpart. In conclusion, the beneficial effects of a three-week BWRP on BMI, body composition, muscle performance and fatigue in a pediatric obese population were not found to be different in patients with or without metabolic syndrome, thus indicating that the more metabolically compromised patient is as responsive to a short-term BWRP as the patient without metabolic syndrome. More prolonged follow-up studies are, however, necessary in order to verify whether the adherence to the multidisciplinary recommendations at home and the long-term maintenance of the positive effects in the two subgroups of patients will remain similar or not.
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3.
The benefits of yoga practice compared to physical exercise in the management of type 2 Diabetes Mellitus: A systematic review and meta-analysis.
Jayawardena, R, Ranasinghe, P, Chathuranga, T, Atapattu, PM, Misra, A
Diabetes & metabolic syndrome. 2018;(5):795-805
Abstract
Yoga is increasingly used as an adjunctive therapy in the management of Type-2 Diabetes Mellitus (T2DM). The present study aims to systematically evaluate the literature and perform a meta-analysis on the effects of yoga practice compared to physical exercise in the management of T2DM. Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed, Web of Science and Scopus. All controlled clinical trials involving patients with T2DM, comparing yoga as an intervention with physical exercise and evaluating glycaemic control and other outcomes between the intervention and control groups were included in the analysis. Eight studies were eligible to be included in the systematic review. In total, 842 participants were assigned to a Yoga intervention or a control group with an Exercise intervention and the age range of participants was 30-78 years. A significant reduction in FBG (15.16 mg/dl), PPBG (28.66 mg/dl), HbA1c (0.39%) and BMI (0.71 kg/m2) was noted in the intervention group ('Yoga') compared to the control group ('Physical Exercise') in the pooled analysis. We did not observe any significant difference between the two groups for lipid parameters, other body composition measures (WC and WHR) and Blood Pressure. In conclusion, our results show that Yoga has beneficial effects on glycaemic control in comparison to physical exercise in T2DM However, individual studies showed considerable heterogeneity. Hence, further well-controlled randomized trials are required prior to drawing conclusions about the benefits of yoga in comparison to physical exercise.
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4.
Homeostasis Model Assessment-Adiponectin: the role of different types of physical exercise in obese adolescents.
da Silveira Campos, RM, Landi Masquio, DC, Campos Corgosinho, F, de Lima Sanches, P, de Piano, A, Carnier, J, Leão da Silva, P, Grotti Clemente, AP, de Castro Ferreira Vicente, SE, Oyama, LM, et al
The Journal of sports medicine and physical fitness. 2017;(6):831-838
Abstract
BACKGROUND Homeostasis Model Assessment-Adiponectin (HOMA-AD) is suggesting a new biomarker of insulin resistance in obese population. In this way, the purpose of this study was to investigate the effects of different kinds of exercise in the sensitive index predictor of insulin resistance. METHODS A total of 148 obese adolescents were enrolled in the program. They aged 15-19 y, with Body Mass Index (BMI) ≥P95th and were submitted to 1 year of interdisciplinary weight loss therapy, randomized in two groups, aerobic training (AT) (N.=51) and aerobic plus resistance training (N.=97). Blood samples were collected to analyze adiponectin, glucose and insulin concentrations. The insulin resistance was measured by HOMA-AD and Homeostasis Model Assessment Insulin Resistance Index (HOMA-IR). RESULTS Both kinds of exercise training promoted a decrease in body mass, body mass index, fat mass, visceral and subcutaneous fat. However, only aerobic plus resistance training was effective to reduce HOMA-AD, insulin and glucose concentration; and increase insulin sensibility and adiponectin concentration. CONCLUSIONS The aerobic plus resistance training was more effective than AT alone to improve the HOMA-AD, suggesting clinical application on obesity, diabetes, atherosclerosis and metabolic syndrome control in the pediatric population.
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5.
[Effect of two hypocaloric diets and their combination with physical exercise on basal metabolic rate and body composition].
Bonfanti, N, Fernández, JM, Gomez-Delgado, F, Pérez-Jiménez, F
Nutricion hospitalaria. 2014;(3):635-43
Abstract
BACKGROUND Metabolic syndrome (MetS) is diagnosed by the detection of at least three criteria (hypertriglyceridemia, low HDL-C, hypertension, obesity and altered fasting glucose). Visceral fat excess would be the starting point for its development. Scientific evidence supports hypocaloric diets -mediterranean or low fat diet and rich in complex carbohydrates diet included- as the best treatment to reduce fat mass (FM), maximizing its impact by combining them with physical exercise (PE). However, the effects of these treatments on basal metabolic rate (BMR) of patients with MetS, are unknown. OBJECTIVE To study the effect of the hypocaloric diet - mediterranean or low fat diet- with or without PE on the BMR and body composition (BC) of adults with MetS. METHODS 36 volunteers, MetS, both sexes, > 50 years, meeting the inclusion criteria. They were randomly assigned to a group of intervention (3 months) of hypocaloric diet: mediterranean diet (MED), low fat and rich in complex carbohydrates diet (CHO) and both combined with PE (MEDE and CHOE respectively). Anthropometric data was taken (weight, muscle mass (MM) and FM) and BMR was determined by indirect calorimetry, before and after intervention. RESULTS The addition of PE to both hypocaloric treatments produced greater FM loss and weight loss than dieting alone, being this loss in CHOE > MEDE (p < 0.05). These groups decreased the BMR after treatment being MEDE > CHOE (p < 0.05). Mediterranean diet with or without PE lost MM (p < 0.05) being MEDE > MED CONCLUSIONS CHOE induces less reduction of BMR while supporting a better profile of BC than MEDE.
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6.
Simvastatin impairs exercise training adaptations.
Mikus, CR, Boyle, LJ, Borengasser, SJ, Oberlin, DJ, Naples, SP, Fletcher, J, Meers, GM, Ruebel, M, Laughlin, MH, Dellsperger, KC, et al
Journal of the American College of Cardiology. 2013;(8):709-14
Abstract
OBJECTIVES This study sought to determine if simvastatin impairs exercise training adaptations. BACKGROUND Statins are commonly prescribed in combination with therapeutic lifestyle changes, including exercise, to reduce cardiovascular disease risk in patients with metabolic syndrome. Statin use has been linked to skeletal muscle myopathy and impaired mitochondrial function, but it is unclear whether statin use alters adaptations to exercise training. METHODS This study examined the effects of simvastatin on changes in cardiorespiratory fitness and skeletal muscle mitochondrial content in response to aerobic exercise training. Sedentary overweight or obese adults with at least 2 metabolic syndrome risk factors (defined according to National Cholesterol Education Panel Adult Treatment Panel III criteria) were randomized to 12 weeks of aerobic exercise training or to exercise in combination with simvastatin (40 mg/day). The primary outcomes were cardiorespiratory fitness and skeletal muscle (vastus lateralis) mitochondrial content (citrate synthase enzyme activity). RESULTS Thirty-seven participants (exercise plus statins: n = 18; exercise only: n = 19) completed the study. Cardiorespiratory fitness increased by 10% (p < 0.05) in response to exercise training alone, but was blunted by the addition of simvastatin resulting in only a 1.5% increase (p < 0.005 for group by time interaction). Similarly, skeletal muscle citrate synthase activity increased by 13% in the exercise-only group (p < 0.05), but decreased by 4.5% in the simvastatin-plus-exercise group (p < 0.05 for group-by-time interaction). CONCLUSIONS Simvastatin attenuates increases in cardiorespiratory fitness and skeletal muscle mitochondrial content when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome. (Exercise, Statins, and the Metabolic Syndrome; NCT01700530).
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7.
Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome.
Nybacka, Å, Carlström, K, Ståhle, A, Nyrén, S, Hellström, PM, Hirschberg, AL
Fertility and sterility. 2011;(6):1508-13
Abstract
OBJECTIVE To compare the influence of dietary management and/or physical exercise on ovarian function and metabolic variables in women with polycystic ovary syndrome (PCOS). DESIGN Randomized 4-month trial with three interventions and a long-term follow-up. SETTING Women's health clinical research unit at a university hospital. PATIENT(S): Fifty-seven overweight/obese women with PCOS. INTERVENTION(S): Dietary management, physical exercise, or both, using programs individually adapted and supervised by a dietician and/or a physical therapist. MAIN OUTCOME MEASURE(S): Ovarian function, endocrinologic, and metabolic status and body composition. RESULT(S): On average, body mass index was reduced 6% by the dietary management, 3% by the exercise, and 5% by the combined interventions. Lower body fat and lean body mass were significantly decreased in the dietary groups, whereas upper body fat was lowered and lean body mass maintained by exercise alone. The menstrual pattern was significantly improved in 69% and ovulation confirmed in 34% of the patients, with no differences among the groups. The strongest predictor of resumed ovulation was a high serum level of insulin-like growth factor-binding protein 1 after the intervention. Follow-up of one-half of the patients for a median of 2.8 years revealed sustained weight reduction and improvement in menstrual pattern. CONCLUSION(S): Dietary management and exercise, alone or in combination, are equally effective in improving reproductive function in overweight/obese women with PCOS. The underlying mechanisms appear to involve enhanced insulin sensitivity. Supportive individualized programs for lifestyle change could exert long-term beneficial effects.
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8.
Diet or exercise: what is more effective in preventing or reducing metabolic alterations?
Bo, S, Ciccone, G, Guidi, S, Gambino, R, Durazzo, M, Gentile, L, Cassader, M, Cavallo-Perin, P, Pagano, G
European journal of endocrinology. 2008;(6):685-91
Abstract
OBJECTIVE/DESIGN The influence of diet and exercise on metabolic syndrome is controversial since fit individuals might also eat healthier foods. We evaluated the association of diet/exercise variation with reductions in metabolic variables and C-reactive protein (CRP) values in the experimental and control arms of a 1-year randomized lifestyle intervention trial performed in patients with multiple metabolic abnormalities. METHODS A prospective study of 169 cases and 166 controls after a lifestyle intervention was performed. RESULTS In the intervention group, 15/169 (8.9%), 63/169 (37.3%), and 70/169 (41.4%) reached only dietary, only exercise, and dietary/exercise targets respectively. Reductions in weight, body mass index (BMI), and waist were significant only in patients who increased exercise. Most controls did not reach any target (131/166, 78.9%), while only few patients reached only dietary (13/166, 7.8%), only exercise (5/166, 3.0%), and dietary/exercise targets (17/166, 10.2%). Weight, BMI, and waist reduction was more pronounced in those reaching the exercise target. In the whole cohort, increased exercise was inversely associated with weight, BMI, waist, and CRP, increased saturated fat was directly associated with weight, BMI, waist, and diastolic pressure variations, while increased fiber intake was inversely associated with glucose values in a multiple regression model. After adjusting for waist changes, the associations between exercise and CRP (beta=-0.023; 95% CI -0.028 -0.017; P<0.001) and the associations between fiber and glucose (beta=-0.022; -0.031 -0.013; P<0.001) remained significant. CONCLUSIONS Independent of weight reduction, exercise level and fiber intake are inversely associated with CRP and fasting glucose values respectively. Change in lifestyle may lower inflammation and prevent metabolic deterioration.
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9.
The metabolic syndrome and the immediate antihypertensive effects of aerobic exercise: a randomized control design.
Pescatello, LS, Blanchard, BE, Van Heest, JL, Maresh, CM, Gordish-Dressman, H, Thompson, PD
BMC cardiovascular disorders. 2008;:12
Abstract
BACKGROUND The metabolic syndrome (Msyn) affects about 40% of those with hypertension. The Msyn and hypertension have a common pathophysiology. Exercise is recommended for their treatment, prevention and control. The influence of the Msyn on the antihypertensive effects of aerobic exercise is not known. We examined the influence of the Msyn on the blood pressure (BP) response following low (LIGHT, 40% peak oxygen consumption, VO2peak) and moderate (MODERATE, 60% VO2peak) intensity, aerobic exercise. METHODS Subjects were 46 men (44.3 +/- 1.3 yr) with pre- to Stage 1 hypertension (145.5 +/- 1.6/86.3 +/- 1.2 mmHg) and borderline dyslipidemia. Men with Msyn (n = 18) had higher fasting insulin, triglycerides and homeostasis model assessment (HOMA) and lower high density lipoprotein than men without Msyn (n = 28) (p < 0.01). Subjects consumed a standard meal and 2 hr later completed one of three randomized experiments separated by 48 hr. The experiments were a non-exercise control session of seated rest and two cycle bouts (LIGHT and MODERATE). BP, insulin and glucose were measured before, during and after the 40 min experiments. Subjects left the laboratory wearing an ambulatory BP monitor for the remainder of the day. Repeated measure ANCOVA tested if BP, insulin and glucose differed over time among experiments in men without and with the Msyn with HOMA as a covariate. Multivariable regression analyses examined associations among BP, insulin, glucose and the Msyn. RESULTS Systolic BP (SBP) was reduced 8 mmHg (p < 0.05) and diastolic BP (DBP) 5 mmHg (p = 0.052) after LIGHT compared to non-exercise control over 9 hr among men without versus with Msyn. BP was not different after MODERATE versus non-exercise control between Msyn groups (p > or = 0.05). The factors accounting for 17% of the SBP response after LIGHT were baseline SBP (beta = -0.351, r2 = 0.123, p = 0.020), Msyn (beta = 0.277, r2 = 0.077, p = 0.069), and HOMA (beta = -0.124, r2 = 0.015, p = 0.424). Msyn (r2 = 0.096, p = 0.036) was the only significant correlate of the DBP response after LIGHT. CONCLUSION Men without the Msyn respond more favorably to the antihypertensive effects of lower intensity, aerobic exercise than men with the Msyn. If future work confirms our findings, important new knowledge will be gained for the personalization of exercise prescriptions among those with hypertension and the Msyn.
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10.
[New criteria and care for metabolic syndrome].
Laakso, M
Duodecim; laaketieteellinen aikakauskirja. 2005;(14):1521-30