پژوهش در علوم توانبخشی

تأثیر ورزش‌های ترکیبی هوازی و مقاومتی بر شاخص‌های بیوشیمیایی بیماران مبتلا به دیابت نوع دو

نوع مقاله : مقاله پژوهشی اصیل

نویسندگان

1 استادیار، گروه فیزیوتراپی، دانشکده علوم توان‌بخشی، دانشگاه علوم پزشکی همدان، همدان، ایران

2 دانشیار، مرکز تحقیقات فیزیوتراپی و گروه فیزیوتراپی، دانشکده توان‌بخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

10.22122/jrrs.v14i4.3356

چکیده

مقدمه: بیماری دیابت یکی از مهم‌ترین مشکلات سلامت در نواحی آسیایی است. فعالیت فیزیکی نقش مهمی در کنترل متغیرهای متأثر از دیابت ایفا می‌کند. هدف از انجام پژوهش حاضر، بررسی اثرات ورزش در متغیرهای بیوشیمیایی بیماران مبتلا به دیابت نوع دو بود.مواد و روش‌ها: در این مطالعه کارآزمایی بالینی، 40 بیمار از میان 702 فرد داوطلب مبتلا به دیابت انتخاب و به صورت تصادفی به دو گروه ورزش‌های ترکیبی (هوازی و مقاومتی) و شاهد تقسیم شدند. برنامه مداخله گروه ترکیبی شامل 24 جلسه ورزش هوازی روی تردمیل با شیب صفر درجه، به صورت 3 روز در هفته و هر جلسه به مدت 30 دقیقه با شدت 70-50 درصد حداکثر ضربان قلب بود و افراد از جلیقه حاوی وزنه حین انجام برنامه ورزشی استفاده نمودند. گروه شاهد به مدت دو ماه در هیچ نوع فعالیت ورزشی شرکت نداشت. متغیرها قبل و بعد از 24 جلسه مداخله درمانی اندازه‌گیری گردید.یافته‌ها: در ابتدای مداخله، تفاوت معنی‌داری بین دو گروه از نظر قد، وزن، شاخص توده بدنی (Body mass index یا BMI) و سابقه ابتلا به دیابت وجود نداشت. پس از هشت هفته، میزان قند خون ناشتا (Fasting blood sugar یا FBS) و مقدار Glycosylated hemoglobin (HbA1c) در گروه ترکیبی کاهش معنی‌داری را نشان داد (به ترتیب 001/0 = P و 002/0 = P)، اما در متغیرهای Very low-density lipoprotein (VLDL)، Low-density lipoprotein (LDL)، تری‌گلیسرید، کلسترول و High-sensitivity C-reactive protein (HS-CRP) گروه ترکیبی تغییری مشاهده نشد (050/0 < P). میزان High-density lipoprotein (HDL) در گروه ترکیبی بدون تغییر و در گروه شاهد با افزایش گزارش گردید (001/0 = P).نتیجه‎گیری: 24 جلسه ورزش باعث کاهش FBS و HbA1c شرکت‌کنندگان گروه ترکیبی هوازی و مقاومتی در بیماران مبتلا به دیابت گردید. کاهش شاخص HDL در گروه شاهد و عدم تغییر آن در گروه ترکیبی، زنگ خطری برای افراد بی‌تحرک می‌باشد. به منظور مشاهده اثرات بیشتر در متغیرهای دیگر، انجام مداخله با شدت‌های بالاتر و تعداد جلسات بیشتر ضروری به نظر می‌رسد.

کلیدواژه‌ها

  1. Rahbar S, Naimi SS, Soltani AR, Rahimi A, Akbarzadeh Baghban A, et al. Improvement in biochemical parameters in patients with type 2 diabetes after twenty-four sessions of aerobic exercise: A randomized controlled trial. Iran Red Crescent Med J 2017; 19(7): e13931.
  2. Rahbar S, Naimi SS, Reza SA, Rahimi A, Akbarzadeh BA, Khorami N. Are twenty-four sessions of aerobic exercise sufficient for improving cardiac parameters in diabetes mellitus? A randomized controlled trial. J Tehran Heart Cent 2018; 13(2): 43-51.
  3. Barrett EJ, Liu Z. The endothelial cell: An "early responder" in the development of insulin resistance. Rev Endocr Metab Disord 2013; 14(1): 21-7.
  4. Wildman RP, Schott LL, Brockwell S, Kuller LH, Sutton-Tyrrell K. A dietary and exercise intervention slows menopause-associated progression of subclinical atherosclerosis as measured by intima-media thickness of the carotid arteries. J Am Coll Cardiol 2004; 44(3): 579-85.
  5. Lewis MT, Lujan HL, Tonson A, Wiseman RW, DiCarlo SE. Obesity and inactivity, not hyperglycemia, cause exercise intolerance in individuals with type 2 diabetes: Solving the obesity and inactivity versus hyperglycemia causality dilemma. Med Hypotheses 2019; 123: 110-4.
  6. Aggarwala J, Sharma S, Saroochi, Jain A, Sarkar A. Effects of aerobic exercise on blood glucose levels and lipid profile in diabetes mellitus type 2 subjects. Al Ameen J Me d Sci 2016; 9(1): 65-9.
  7. Alves AJ, Viana JL, Cavalcante SL, Oliveira NL, Duarte JA, Mota J, et al. Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated. World J Cardiol 2016; 8(10): 575-83.
  8. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016; 39(11): 2065-79.
  9. Bellavere F, Cacciatori V, Bacchi E, Gemma ML, Raimondo D, Negri C, et al. Effects of aerobic or resistance exercise training on cardiovascular autonomic function of subjects with type 2 diabetes: A pilot study. Nutr Metab Cardiovasc Dis 2018; 28(3): 226-33.
  10. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003; 26(11): 2977-82.
  11. Walsh JH, Bilsborough W, Maiorana A, Best M, O'Driscoll GJ, Taylor RR, et al. Exercise training improves conduit vessel function in patients with coronary artery disease. J Appl Physiol (1985) 2003; 95(1): 20-5.
  12. Gordon L, Morrison E, Mcgrowder DA, Young R. Changes in clinical and metabolic parameters after exercise therapy in patients with type 2 diabetes. Arch Med Sci 2008: 4(4):427-37.
  13. Azarbayjani MA, Behboudi L, Aghaalinejad H, Salavati M. Comparative effects of aerobic training and whole body vibration on plasma adiponectin and insulin resistance in type 2 diabetic men. Ann Biol Res 2011, 2(5): 671-80.
  14. Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 2002; 56(2): 115-23.
  15. Tessier D, Menard J, Fulop T, Ardilouze J, Roy M, Dubuc N, et al. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Arch Gerontol Geriatr 2000; 31(2): 121-32.
  16. El-Kader SMA. Aerobic versus resistance exercise training in modulation of insulin resistance, adipocytokines and inflammatory cytokine levels in obese type 2 diabetic patients. J Adv Res 2011; 2(2): 179-83.
  17. Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE. Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract 2008; 79(3): 405-11.
  18. Maiorana A, O'Driscoll G, Cheetham C, Dembo L, Stanton K, Goodman C, et al. The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol 2001; 38(3): 860-6.
  19. Okada S, Hiuge A, Makino H, Nagumo A, Takaki H, Konishi H, et al. Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb 2010; 17(8): 828-33.
  20. Bacchi E, Negri C, Zanolin ME, Milanese C, Faccioli N, Trombetta M, et al. Metabolic effects of aerobic training and resistance training in type 2 diabetic subjects: a randomized controlled trial (the RAED2 study). Diabetes Care 2012; 35(4): 676-82.
  21. Azimi M, Marefati H, Yousefzadeh G, Mohajeri M. The effect of aerobic exercise on plasma visfatin and glycemic control in type 2 diabetic men treated with metformin. Journal of Health and Physical Activity 2012; 3(2): 19-23.
  22. Fathi R, Esmaeili B, Talebi-Garakani E, Saghebjoo M. The effect of 8-weeks of aerobic exercise training on plasma visfatinand lipid profile of overweight women. Journal of Health and Physical Activity 2013; 4(2): 63-8.
  23. Melton CE, Tucker PS, Fisher-Wellman KH, Schilling BK, Bloomer RJ. Acute exercise does not attenuate postprandial oxidative stress in prediabetic women. Phys Sportsmed 2009; 37(1): 27-36.
  24. Pahkala K, Heinonen OJ, Simell O, Viikari JS, Ronnemaa T, Niinikoski H, et al. Association of physical activity with vascular endothelial function and intima-media thickness. Circulation 2011; 124(18): 1956-63.
  25. Fakhry F, Spronk S, de RM, den Hoed PT, Hunink MG. Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication. Arch Phys Med Rehabil 2011; 92(7): 1066-73.
  26. Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010; 304(20): 2253-62.
  27. Rahbar S, Naimi SS, Reza Soltani A, Rahimi A, Akbarzadeh Baghban A, Noori A, et al. Changes in vascular structure in diabetic patients after 8 weeks aerobic physical exercise: A randomized controlled trial. Int J Diabetes Dev Ctries 2018; 38(2): 202-8.
  28. Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48(9): 1865-70.
  29. Spence AL, Carter HH, Naylor LH, Green DJ. A prospective randomized longitudinal study involving 6 months of endurance or resistance exercise. Conduit artery adaptation in humans. J Physiol 2013; 591(5): 1265-75.
  30. Hajihasani A, Bahrpeyma F, Bakhtiari A H, Taghikhani M. Effects of eccentric and concentric exercises on some blood biochemical parameters in patients with type 2 diabetes. Koomesh 2012; 13(3): 338-44. [In Persian].
  31. American Diabetes Association. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clin Diabetes 2016; 34(1): 3-21.
  32. Maiorana AJ, Naylor LH, Exterkate A, Swart A, Thijssen DH, Lam K, et al. The impact of exercise training on conduit artery wall thickness and remodeling in chronic heart failure patients. Hypertension 2011; 57(1): 56-62.
  33. Roghani T, Torkaman G, Movasseghe S, Hedayati M, Goosheh B, Bayat N. Effects of short-term aerobic exercise with and without external loading on bone metabolism and balance in postmenopausal women with osteoporosis. Rheumatol Int 2013; 33(2): 291-8.
  34. Marcus RL, Smith S, Morrell G, Addison O, Dibble LE, Wahoff-Stice D, et al. Comparison of combined aerobic and high-force eccentric resistance exercise with aerobic exercise only for people with type 2 diabetes mellitus. Phys Ther 2008; 88(11): 1345-54.
  35. McConell GK, Lee-Young RS, Chen ZP, Stepto NK, Huynh NN, Stephens TJ, et al. Short-term exercise training in humans reduces AMPK signalling during prolonged exercise independent of muscle glycogen. J Physiol 2005; 568(Pt 2): 665-76.
  36. Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Koyama H, et al. Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Res Clin Pract 2004; 65(2): 85-93.
  37. Horii N, Sato K, Mesaki N, Iemitsu M. Increased muscular 5alpha-dihydrotestosterone in response to resistance training relates to skeletal muscle mass and glucose metabolism in type 2 diabetic rats. PLoS One 2016; 11(11): e0165689.
  38. Ribeiro AS, Schoenfeld BJ, Souza MF, Tomeleri CM, Venturini D, Barbosa DS, et al. Traditional and pyramidal resistance
  39. training systems improve muscle quality and metabolic biomarkers in older women: A randomized crossover study. Exp Gerontol 2016; 79: 8-15.
  40. Tibana RA, Navalta J, Bottaro M, Vieira D, Tajra V, Silva AO, et al. Effects of eight weeks of resistance training on the risk factors of metabolic syndrome in overweight /obese women - "a pilot study". Diabetol Metab Syndr 2013; 5(1): 11.
  41. Pattyn N, Cornelissen VA, Eshghi SR, Vanhees L. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: A meta-analysis of controlled trials. Sports Med 2013; 43(2): 121-33.
  42. Khan HA, Sobki SH, Khan SA. Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia. Clin Exp Med 2007; 7(1): 24-9.
  43. Ahmed SE, Ahmed SE, Abdul-Raheem EM. Assessment of plasma levels of fasting blood glucose, triglycerides, total cholesterol, and HbA1c in patients with type 2 diabetes mellitus. Int J Health Sci Res 2013; 3(9):1 -6.
  44. Barter P. The role of HDL-cholesterol in preventingatherosclerotic disease. Eur Heart J Suppl 2005; 7(Suppl F): F4-F8.
  45. Barter PJ. High density lipoprotein: A therapeutic target in type 2 diabetes. Endocrinol Metab (Seoul) 2013; 28(3): 169-77.
  46. Iborra RT, Ribeiro IC, Neves MQ, Charf AM, Lottenberg SA, Negrao CE, et al. Aerobic exercise training improves the role of high-density lipoprotein antioxidant and reduces plasma lipid peroxidation in type 2 diabetes mellitus. Scand J Med Sci Sports 2008; 18(6): 742-50.
  47. Zaer Ghodsi N, Zolfaghari MR, Fattah A. The impact of high intensity interval training on lipid profile, inflammatory markers and anthropometric parameters in inactive women. Med Lab J 2016; 10(1): 56-60.
  48. Roghani T, Torkaman G, Movasseghe Sh, Hedayati M, Goosheh B. The effect of short-term program of resisted treadmill walking on correlation between body composition parameters and estradiol, progesterone and cortisol hormone levels in osteoporotic postmenopausal women. J Res Rehabil Sci 2012; 8(6): 1148-58. [In Persian].
  49. Barter PJ. The causes and consequences of low levels of high density lipoproteins in patients with diabetes. Diabetes Metab J 2011; 35(2): 101-6.
  50. Tayebi S M, Mottaghi S, Mahmoudi S A, Ghanbari-Niaki A. The effect of a short-term circuit resistance training on blood glucose, plasma lipoprotein and lipid profiles in young female students. Jentashapir J Health Res 2016; 7(5): e33899.
  51. Honka MJ, Bucci M, Andersson J, Huovinen V, Guzzardi MA, Sandboge S, et al. Resistance training enhances insulin suppression of endogenous glucose production in elderly women. J Appl Physiol (1985) 2016; 120(6): 633-9.
  52. Ruby M, Repka CP, Arciero PJ. Comparison of protein-pacing alone or with yoga/stretching and resistance training on glycemia, total and regional body composition, and aerobic fitness in overweight women. J Phys Act Health 2016; 13(7): 754-64.
  53. Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347(19): 1483-92.
  54. Shiraishi FG, Stringuetta BF, Oliveira E Silva VR, Martin LC, Hueb JC, Goncalves RS, et al. Inflammation, diabetes, and chronic kidney disease: Role of aerobic capacity. Exp Diabetes Res 2012; 2012: 750286.
  55. Pepys MB, Hirschfield GM. C-reactive protein: A critical update. J Clin Invest 2003; 111(12): 1805-12.
  56. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001; 286(3): 327-34.
  57. Hammonds TL, Gathright EC, Goldstein CM, Penn MS, Hughes JW. Effects of exercise on C-reactive protein in healthy patients and in patients with heart disease: A meta-analysis. Heart Lung 2016; 45(3): 273-82.
  58. Alberga AS, Prud'homme D, Kenny GP, Goldfield GS, Hadjiyannakis S, Gougeon R, et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond) 2015; 39(10): 1494-500.
پژوهش در علوم توانبخشی
دوره 14، شماره 4 - شماره پیاپی 4
مهر 1398
صفحه 230-238