Effect of High Intensity Interval Training on Adiponectin Hormone in Women with Diabesity

Med. J. Cairo Univ., Vol. 84, No. 2, December: 225-230, 2016 www.medicaljournalofcairouniversity.net Effect of High Intensity Interval Training on Adiponectin Hormone in Women with Diabesity ESLAM A. ABD EL-GHAFFAR, M.Sc.; AZZA A. ABD EL-HADY, Ph.D.; MOHAMED A. SHENDY, Ph.D. and WALEED TAHA, Ph.D. The Department of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University Abstract Objectives: To investigate the effect of high intensity interval training on adiponectin hormone, Impaired Fasting Glucose (IFG) and body mass index in women with diabesity. Methodology: Forty obese women participated in the study were selected from Helwan General Hospital, their age ranged from 40-50 years and their BMI ranged from 30-34.9 kg/m 2. They were received high intensity interval training at intensity level of (85-90% of MHR), three times per week for 12 weeks. The BMI, Adiponectin hormone and fasting blood glucose were measured before and after the program. Results: There was a significant increase of serum adiponectin level and a significant reduction of fasting blood glucose and BMI. Conclusions: The high intensity interval training is an effective tool to decrease insulin resistance and BMI and this effect is mediated, in part, by the increase in adiponectin in women with diabesity wich consequently helps in the treatment of diabesity. Key Words: Diabesity HIIT Adiponectin. Introduction OBESITY is an excess of body fat that frequently results in a significant impairment of health. It results when the size or number of fat cells in a person's body increases. A normal-weight person has between 30 and 35 billion fat cells. When a person gains weight, these fat cells first increase in size and later in number. One pound of body fat represents about 3500 calories. When a person starts losing weight, the cells decrease in size, but the number of fat cells generally stays the same. This is part of the reason that once you gain a significant amount of weight it is more difficult to Correspondence to: Dr. Eslam A. Abd El-Ghaffar, The Department of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University lose it. However, some recent studies seem to imply that fat cells can be destroyed as a result of certain medications and that a decrease in fat cell number may occur if a lower body weight is maintained for a prolonged period of time [1]. Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both. The chronic hyperglycemia of diabetes is associated with significant long-term sequel, particularly damage, dysfunction and failure of various organs especially the kidneys, eyes, nerves, heart and blood vessels [2]. Obesity and type II diabetes are diseases that can substantially decrease life expectancy, diminish quality of life and increase healthcare costs. The incidence of obesity and diabetes continues to rise by epidemic proportions. So the term Diabesity has been coined to describe obesity-dependent diabetes [3]. High Intensity Intermittent Exercise (HIIE) protocols have varied considerably but typically involve repeated brief sprinting at an all-out intensity immediately followed by low intensity exercise or rest. The length of both the sprint and recovery periods has varied from 6s to 4min. Most commonly the sprints are performed on a stationary cycle ergometer at intensity in excess of 90% of maximal oxygen uptake (VO 2 max) [4]. Adiponectin is synthesized primarily in white adipose tissue and at lower concentrations, in brown adipose tissue. Much lower concentrations of expression have been reported in skeletal muscle, liver, colon, cardiac tissue, salivary glands, and placenta. Adiponectin is even detected in cerebrospinal fluid and breast milk at much lower 225

226 Effect of High Intensity Interval Training on Adiponectin Hormone in Women concentrations. Normal plasma adiponectin concentrations range between 5 and 30 µg/ml (depending on the assay used) [5]. Considering that adiponectin appears to be a modulator of lipid metabolism and systemic inflammation, it has been proposed as a novel predictor of individuals at risk for the metabolic syndrome and possibly type-2 diabetes [6]. Patients and Methods Forty diabetic women with class (l) obsity were selected from Helwan General Hospital to participate in the study, their ages ranged from 40-50 years old. They were divided into two groups equal in number. Group A (study group): This group composed of 20 women received low-calorie diet (1 000Kcal/day) and high intensity interval training sessions for 3 sessions per week for twelve weeks, Group B (control group): This group composed of 20 women received low-calorie diet (1000Kcal/ day) only for twelve weeks. The study was performed from (Jan. 2016 to April 2016). Inclusive criteria: - Women have class (1) obesity their BMI ranged from 30 to 34.9kg/m 2. - Obese women diagnosed as diabetic (type II) with fasting blood glucose ranged from (126-160) mg/dl. - Level of hormone not more than 8 µg/ml. - Time of affection of diabetes not more than 5 years. - Not taking medication that might affect their performance or their appetite. - They must be under medical supervision. - A written informed consent from the patients is a must to participate in our study. Exclusive criteria: Those women with wither of the following diseases were excluded from the study, sever orthopedic or any muscloskletal disease, sever chronic chest disease, rneal failure, unstable cardio vascular diseases, sever systemic disease and otuonomic neuropathy. Investigations: - Before selecting the patients, their body mass index was calculated which calculated as weight (kg)/height 2 (m) [7]. - Their Adiponectin level in the blood was measured and redorded. - Their fasting blood glucose level after 8 hours fasting was measured and recorded. - All the parameters were considerd as abase line and repeated for follow-up comparison after the programe. Diet: Low-calorie diet (1000Kcal/day) contained 30% of calories from fat, 50% from carbohydrate, 20% from proteins. Exercise parameters: Mode: Walking on treadmill. Duration: 20-42min. (total session). Frequency: Three times/week (day after day). Intensity: High intensity (85-90% MHR) and recovery at (60-70% MHR), calculated as (220 minus age). Guide lines and precautions for the programe: - Before starting any HIIT program, all subjects were able to exercise for at least 20-30 minutes at 70-85% of her previously measured maximum heart rate, without exhaustion. - The subjetcs warm up and cool down for at least five minutes before and after each HIIT session. - The subjects work as hard as they can during the high intensity intervals, until they feel pain in their muscles indicating that they have entered his anaerobic zone. - If they experience any chest pain or breathing difficulties during the HIIT workout, cool down immediately done. - If the heart rate does not drop back down to about 70% of the max during recovery intervals, we may need to shorten the work intervals and/or lengthen the recovery intervals. Statistical analysis: - The measured variables were described as mean (age, weight, height and BMI) and standard deviation. - Un paired test was conducted for comparison of BMI, fasting blood glucose and adiponectin hormone between both groups before and after the study. - Paired test was conducted for comparison between pre and post treatment mean s of BMI, fasting blood glucose and adiponectin hormone in each group. - The level of significance for all statistical tests was set at p<0.05.

Eslam A. Abd El-Ghaffar, et al. 227 - All statistical measures were performed through the Statistical Package for Social Studies (SPSS) Version 19 for windows. Results I- Descriptive analysis of the anthropometric measures (age, height, weight and BMI) of all the subjects: The mean age, weight and height of all the subjects participating in this study (20 one in the study group and 20 one in the control group) are listed in (Table 1). There was no significance difference between both groups in the mean age, weight, height, and BMI (p>0.05). II- Comparison between the mean s of all variables of the study (BMI, fasting blood glucose level and adiponectin level) before and after treatment in the two groups (study and control): From the data listed in (Table 2) we can see that there was a significant decrease in BMI and fasting blood glucose level of both study and control groups post treatment compared with pretreatment, while there was a significant increase in adiponectin level in both study and control groups post treatment compared with pre treatment. III- Comparison between control group and study group in both pretreatment and post treatment s of (BMI, fasting blood glucose level and adiponectin level): From the data listed in (Table 3) we can see that there was no significant difference in the mean s of BMI, fasting blood glucose level and adiponectin level between both groups (study and control) pre-treatment, while comparison between the study and control groups postreatment showed a significant decrease in the mean s of BMI and fasting blood glucose level of the study group compared with the control group, and a significant increase in adiponectin level of the study group compared with the control group. Table (1): Descriptive statistics and test of the mean age, weight, height, and BMI of study and control groups. Study group X ± SD Control group MD Sig. Age (years) 45±3.35 Weight (kg) 86.63 ±6.82 Height (cm) 160.3 ±6.39 BMI (kg/m 2 ) 33.64 ± 1.28 44.7±3.46 85.58±7 160±6.65 33.63± 1.2 0.3 1.05 0.3 0.01 0.27 0.47 0.14 0.01 0.78 0.63 0.88 0.99 X : Mean. SD : Standard Deviation. MD : Mean Difference. : Unpaired. : Probability. : Non Significant. Table (2): test of comparison between pre and post treatment mean s of (BMI, fasting blood glucose level and adiponectin level) of both groups (study and control). Study Gp Control Gp Pre-ttt X ± SD Posttt p - Pre-ttt X ± SD Posttt BMI (kg/m 2 ) Fasting blood glucose (mg/dl) Adiponectin (µg/ml) 33.64± 1.28 141.1 ±6.26 4.28±0.29 29.87± 1.99 112.95±8.02 6.59±0.3 8 10.59 11.52 21.37 0.0001* 0.0001* 0.0001* 33.63± 1.2 13 8.75±8.57 4.34±0.3 31.51± 1.21 121.2±9.94 5.22±0.75 20.23 7.74 5.19 X : Mean. SD: Standard Deviation. : Paired. : Probability. *: Significant. Table (3): test of comparison between study and control groups in both pre and post treatment mean s of (BMI, fasting blood glucose level and adiponectin level). Pre-ttt Posttt Study Gp Control Gp X ± SD Study Gp Control Gp X ± SD BMI (kg/m 2 ) Fasting blood glucose (mg/dl) Adiponectin (µg/ml) X : Mean. SD : Standard Deviation. 33.64± 1.28 141.1 ±6.26 4.28±0.29 33.63± 1.2 138.75±8.57 4.34±0.3 0.01 0.98 0.63 : Paired. : Probability. 0.99 0.32 0.53 29.87± 1.99 112.95±8.02 6.59±0.3 8 *: Significant. 31.51 ± 1.21 121.2±9.94 5.22±0.75 3.14 2.88 7.2 0.003* 0.006*

228 Effect of High Intensity Interval Training on Adiponectin Hormone in Women Discussion Adiponectin is a very important hormone; it plays a major role in increasing fatty acid combustion and energy consumption, which leads to decreased triglyceride content in the liver and skeletal muscle, and thus increased insulin sensitivity [8]. Several cross-sectional studies have shown an association between low serum adiponectin levels and insulin resistance, type-2 diabetes, and cardiovascular disease in humans. A similar inverse relationship between adiponectin levels and incidence of insulin resistance, type-2 diabetes, and atherosclerosis has been demonstrated in followup study [9], however few studies had been found investigating the effect of high intensity interval training on Adiponectin hormone. Similar to our results Moghadasi et al., and Kordi et al., found that there was a significant increase in adiponectin level after 12 weeks and six weeks respectively [10,11]. As Moghadasi et al., [10], used a sample size of 16 middle aged men who performed a program of four days a week at an intensity corresponding to 75-85% of maximum oxygen consumption for 45 minutes. While kordi et al., [11], used a sample size of 22 students who performed three HIIE sessions per week for six weeks. Each session consisted of either four to six repeats of maximal sprint running within a 20m area with 20-30sec recovery. Furthermore Parsian et al., [12] found that aerobic exercise for three months increased adiponectin level in patients with type II diabetes. Their study was made using a sample size of 30 adult men with type II diabetes, performing a three times aerobic exercises per week for a three monthes with an intensity of 50 to 70 heart rate reserve. Obese subjects showed decreased plasma level of adiponectin while exercise seems to restore it [13]. However in contrast to our results, Trapp et al., [14] found that there was no significant change in Adiponectin level after performing high intensity interval training in a study made to assess the effect of HITT on fat loss and fasting insulin levels of young women. Similarly Jorge et al., [15] contradicted our results by their conclusion that, Adiponectin levels were not affected by exercise training despite enhanced insulin action. As they found that the levels of Adiponectin and cytokine produced by adipose tissue was correlating with insulin resistance, and their levels in the patients did not change after training. Once more Nassis et al., [16], reported that there were no changes either in Adi- ponectin or in inflammatory markers after 12 weeks of training. It was found that 12 weeks of supervised exercise did not induce significant changes in total serum adiponectin levels despite decreases in body fat and increases in insulin sensitivity [17]. However on shifting the search to the studies discussing the effect of high intensity interval training on the fasting blood glucose level in diabetec patients we found that there were some studies that agreed with our results. As Kordi et al., [12] stated that after six weeks of (HIIT) there was a significant increase of adiponectin level in sedentary young women, there was also an increase in insulin sensitivity level and decrease in fasting blood glucose level. Similarly, Parsian et al., [13], found that exercise is an effective non-pharmacological treatment to decrease hyperglycemia in patients with type II diabetes in addition to its effect in increasing adiponectin level. They stated that adiponectin levels and insulin sensitivity with hyperglycemia are less in diabetic patients than healthy subjects which is similar to our results. Again our results were in agreement with those of Trapp et al., and Jorge et al., as the first study used a sample size of fourty five women with a mean BMI of 23.2±2.0kgm/m 2 and mean age of 20.2±2.0 years, they proved that there was a significant decrease in fasting blood glucose level and insulin resistance after 15 weeks of (HIIT) [14]. While the second study used a sample size of 48 diabetic type II patients with exercise training of three times a week for three months and they found that there was a significant decrease of fasting plasma glucose, post prandial plasma glucose and blood lipids in blood [15]. However, although that Kordi et al., [12] had also found that there were an increase in insulin sensitivity levels, and decrease in insulin resistance levels and weight after six weeks of high intensity interval training in all subjects but these changes were not statistically significant. The third variable that was investigated in our study was the BMI, regarding the effect of (HIIT) on the body mass index, Kordi et al., [12], approved that six-weeks of high intensity interval training led to a significant decrease in the body fat percentage, BMI and Waist Hip Ratio, and these are nearly similar to our results regarding the BMI.

Eslam A. Abd El-Ghaffar, et al. 229 However contradicting our results, O'Leary et al., [17], stressed on that, improvement in patients with diabesity can occur without substantial decrease in weight, fat percentage and body mass index, they also highlighted the benefit of elevated physical activity even without caloric restriction. Similarly Nassis et al., [16], said that aerobic exercise training improves insulin sensitivity without changes in body weight, body fat, body mass index and inflammatory markers in over weight and obese girls. Based on all the previously mentioned results regarding the three variables under investigation in our study, we found that there is an inverse relation between adiponectin level in the blood and both fasting blood glucose level and BMI as a result of (HIIT). The link we found between the three variables was also reached by other studies which proved that adiponectin levels were significantly elevated with exercise training in type II diabetes while insulin resistance was reduced [18]. Similarly In a review by Yokoyama et al., [19], it was noted that, training greater than two months that employs enough exercise (volume frequency, intensity, and duration) to reduce body weight and increase insulin sensitivity will increase adiponectin leve. Conclusions: From the result of this study we concluded that high intensity interval training has a positive effect on decreasing insulin resistance and increasing body mass index in women with diabesity, and these are mediated by the increase in adiponectin hormone level and consequently helps in the treatment of diabesity. References 1- McMILLEN I.C., RATTANATRAY L., DUFFIELD J.A., MORRISON J.L., MAcLAUGHLIN S.M., GENTILI S. and MUHLHAUSLER B.S.: The early origins of later obesity: Pathways and mechanisms. Adv. Exp. Med. Biol., 646: 71-81, 2009. 2- American Diabetes Association: Introduction. Diabetes Care; 39: S1-S2, 2016. 3- TOPLAK H., HOPPICHLER F., WASCHER T.C., SCHIN- DLER K. and LUDVIK B.: [Obesity and type 2 diabetes]. Wien Klin Wochenschr, 128: 196-200, 2016. 4- BOUTCHER S.H.: High-Intensity Intermittent Exercise and Fat Loss. Journal of Obesity, 2011: 868305, 2011. 5- ZIEMKE F. and MANTZOROS C.: Adiponectin in insulin resistance: Lessons from translational research. Am. J. Clin. Nutr., 91: 258S-61S, 2010. 6- REGETEINER J.G., REUSCH J.E., STEWART K.J. and VEVES A.: Diabetes and Exercise. Humana Press, a part of Springer Science Business Media, LLC, New York, 5: 15-22, 2009. 7- World Health Organization. Waist circumference and waiship ratio: Report of a WHO expert consultation, Geneva, 8-11 December 2008. 8- KADOWAKI T., YAMAUCHI T., KUBOTA N., HARA K., UEKI K. and TOBE K.: Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. Journal of Clinical Investigation, 116: 1784-92, 2006. 9- MENZAGHI C., TRISCHITTA V. and DORIA A.: Genetic Influences of Adiponectin on Insulin Resistance, Type 2 Diabetes, and Cardiovascular Disease. Diabetes, 56: 1198-09, 2007. 10- SUN J., COUPER D. and PANKOW J.: Senstivity and specificity of anthropometrics for the prediction of diabetes in a biricial cohort. Obes. Res., 9: 696-705, 2009. 11- MOGHADASI M., MOHEBBI H., RAHMANI-NIA F., HAS SAN-NIA S., NOROOZI H. and Pirooznia N.: Highintensity endurance training improves adiponectin mrna and plasma concentrations. Eur. J. Appl. Physiol., 112: 1207-14, 2012. 12- KORDI M., CHOOPANI S., HEMMATINAFAR M. and CHOOPANI Z.: The effects of six weeks high intensity interval training (HIIT) on resting plasma levels of adiponectin and fat loss in sedentary young women Journal of Jahrom University of Medical Sciences, 11: 23-31, 2013. 13- PARSIAN H., EIZADI M., KHORSHIDI D. and KHA- NALI F.: The effect of long-term aerobic exercise on serum adiponectin and insulin sensitivity in type II diabetec patients. Journal of Jahrom University of Medical Sciences, 11: 36-43, 2013. 14- TRAPP E., CHISHOLM D., FREUND J. and BOUTCHER S.: The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. International Journal of Obesity, 32: 684-91, 2008. 15- JORGE M., De OLIVEIRA V., RESENDE N., PARAISO L., CALIXTO A., DINIZ A., RESENDE E., ROPELLE E., CARVALHEIRA J., ESPINDOLA F., JORGE P. and GELONEZE B.: The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metabolism Clinical and Experimental, 60: 1244-52, 2011. 16- NASSIS G., PAPANTAKOU K., SKENDERI K., TRI- ANDAFILLOPOULOU M., KAVOURAS S.A., YANNA- KOULIA M., CHROUSOS G.P. and SIDOSSIS L.S.: Aerobic exercise training improves insulin sensitivity without changes in body weight, body fat, adiponectin, and inflammatory markers in overweight and obese girls. Metabolism Clinical and Experimental, 54: 1472-9, 2005. 17- O'LEARY, SCHJERLING P. and PEDERSEN B.K.: Physical activity and plasma interleukin-6 in humans, effect of intensity of exercise. Eur. J. Appl. Physiol., 83: 512-5, 2007.

230 Effect of High Intensity Interval Training on Adiponectin Hormone in Women 18- OBERBACH G., KEARNEY E.M., NEVILL A.M., WOOLFMAY K. and BIRD S.R.: The effects of 24 weeks of moderate-or high-intensity exercise on insulin resistance. Eur. J. Appl. Physiol., 95: 522-8, 2006. 19- YOKOYAMA M., DOUCET E. and PIERRELS K.: Impact of high intensity exercise on energy expenditure, lipid oxidation and body fatness. Inter. J. of Obes., 25: 332-9, 2009.