چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
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| بهرام جمالی قراخانلو | اول |
| سولماز بابایی | دوم |
| اکرم آمقانی | سوم |
| عنوان | متن |
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| خلاصه مقاله | Introduction Type 2 diabetes mellitus (T2DM) is one of the major complications of obesity and overweight. Several factors such as inactivity, high blood pressure, and hyperlipidemia might lead to a higher risk of cardiovascular complications by increasing HbA1C, weight, and body fat in these patients. Lipocalin family proteins include retinol-binding protein 4 (RBP4), fatty acid-binding proteins (FABP), and lipocalin-2. Recent studies have suggested that these proteins, as novel inflammatory markers, may affect signaling pathways in patients with obesity and T2DM. Recently, lipocalin-2, an adipocyte-derived and acute-phase protein, has been correlated with potentially positive effects on obesity and inflammation. Its elevated level activates inflammatory signaling pathways in patients with diabetes, and it is also associated with cardiovascular diseases. RBP4, a fat-derived adipokine, mainly secreted by adipose tissue and liver, systematically increases insulin resistance in humans and mice. Recently, declining RBP4 activity has been suggested to reduce insulin resistance and improve cell function in patients with diabetes. It has been reported that resistance training for eight weeks is associated with a significant decrease in the concentrations of FABP4 and Lcn2 in obese adult males. Aerobic training simultaneously improve cardiovascular state, muscle strength, endurance, posture, and flexibility. In particular, the cardiovascular system benefits from swimming because it improves the body's oxygen usage without causing the heart to overwork. One of the reasons water aerobic exercise was chosen is the unique characteristics of the population studied. For patients with T2DM, even daily routine is physically hard. Water aerobic exercise has many benefits: exercising in water requires to support only 50% of body weight; the risk of injury is comparatively lower on account of its low-impact character; stress and compression on the joints are low, and the resistance offered by water leads to better muscular endurance and tone; the heart rate is maintained at a lower rate than in other activities such as cycling and running. It has previously been reported that there were no differences in the effects of aerobic activities in the water versus weight-bearing aerobic exercise on the land. Finally, given the lack of studies on the relationship between selected exercises in the water and lipocalins as a risk factor for cardiovascular disease in people with T2DM, the present study was designed to investigate the effects of the selected exercises in water on RBP4, lipocalin-2, lipid profile, and insulin resistance indices in T2DM patients. Methodology: Forty postmenopausal women with type 2 diabetes were randomly assigned to a water exercise group (n=20) and a walking group (n=20). Participants completed three exercise sessions per week at 60-75% of maximum heart rate for three months under the supervision of a coach. Blood samples were collected before and after the exercise procedure. Plasma Glycated hemoglobin, RBP4, and insulin were analyzed using commercially available solid-phase, sandwich-based, and enzyme-linked immunosorbent assay kits. Lipocalin-2 and lipid profile were measured by the enzymatic colorimetric method. The HOMA-IR method was used to calculate the insulin resistance index. Data were analyzed with the t-test at the significant level of p≤0.05. Results: Fasting glucose levels showed a significant decrease in both groups after exercise compared to the baseline (p<0.05). Exercise did not significantly affect insulin levels in both groups. As an indicator of insulin resistance, HOMA-IR was significantly decreased after training in both groups (p<0.05). HbA1c levels after the exercises were significantly lower than before the exercises in both exercise groups. Walking training had no significant effects on RBP4 levels, but water exercise lowered RBP4 levels compared to the baseline (p<0.05). Discussion and Conclusion: This study indicated that 12 weeks of hydrotherapy significantly reduced insulin resistance, HbA1C, and FBS in postmenopausal women with T2DM. Previous studies have demonstrated the beneficial effects of exercise on insulin resistance. Exercise activates AMPK, which enhances the sensitivity of muscle glucose transport to insulin and suppresses glycogen synthesis. The AMPK is stimulated by allosteric modification through increased AMP/ATP ratio and decreased phosphocreatine (PCr). Additionally, a decline in muscle ATP, PCr, and glycogen contents and an increase in AMPK phosphorylation occurred immediately after the exercises. Resistance training has been associated with a substantial gain in skeletal muscle mass, which causes improvement in whole-body glucose disposal capacity. Furthermore, resistance training may preferentially reduce sub-skin adiposity, particularly abdominal and visceral adipose tissue. This improves insulin resistance. Interestingly, the current study results showed that 12 weeks of hydrotherapy significantly reduced lipid profile in the experimental group. These beneficial effects of water exercises on lipid composition may be due to the enhancement of lipoprotein lipase activity in muscle capillaries. In the present study, blood levels of lipocalin were decreased after 12 weeks of water exercise in women with T2DM. The mechanism of lipocalin modifications following exercise might be through the adaptation and the anti-inflammatory effects of exercise. Therefore, some researchers have reported that exercise reduces the activity of the proinflammatory transcription factor NF-kB and regulates the expression of lipocalin-2. As a result, exercise may decrease the expression and concentration of lipocalin-2 by decreasing NF-kB. Changes in serum levels of RBP4 play an important role in regulating insulin sensitivity. RBP4 affects insulin sensitivity by reducing the activation of phosphoinositol-3 kinase and phosphorylation of insulin in muscles. These steps are essential in glucose metabolism. Long-term physical activity in water significantly decreased blood glucose concentration in the present study. Specific biochemical changes of the organism take place in water. The water environment limits sweating; thereby, human organisms release four times more heat in water, similar to the water and air temperatures. Due to the facts mentioned earlier, one of the mechanisms to decrease blood glucose concentration might be the above-described process in which blood glucose is utilized. Based on the current study, it can be concluded that water exercise programs, due to involvement in the changes of hormonal and humeral indices, have insulin-like effects in postmenopausal women with T2DM. Overall, the results showed favorable effects of water exercises on RBP4, lipid profile, and insulin resistance in patients with T2DM. Mechanisms involved in these changes have not been fully defined. Since aerobic and resistance exercises in water with adequate intensity are included in the combined exercise group, these exercises may be beneficial as a complementary treatment for patients with T2DM. |
| کلمات کلیدی | HbA1c, Exercise, Insulin Resistance, Lipocalin-2, Retinol-Binding Protein-4 |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| 3.pdf | 1401/01/15 | 496368 | دانلود |
| hamayesh t 3.pdf | 1401/01/15 | 90787 | دانلود |
