Effects of Traditional and Modified Arm Swing Exercise on Abdominal Obesity, Hemodynamics

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JEPonline

Effects of Traditional and Modified Arm Swing Exercise on Abdominal Obesity, Hemodynamics and Quality of Life in Patients with Metabolic Syndrome

Benja Songsaengrit1,4, Paitoon Benjapornlert2, Veeradej Pisprasert3, Ploypailin Aneknan4,Yupaporn Kanpettha1,4,Arisa Sespheng1,4,Naruemon Leelayuwat4,5

1Exercise and Sport Sciences program, Graduate School, Khon Kaen University, Khon Kaen, Thailand, 2Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University,Bangkok, Thailand, 3Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen,Thailand, 4Exercise and Sport Sciences Development and Research Group, Khon Kaen University,5Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen,Thailand

ABSTRACT

Songsaengrit B, Benjapornlert P, Pisprasert V, Ploypailin Aneknan, Yupaporn Kanpettha, Arisa Sespheng,Leelayuwat N. Effects of Traditional and Modified Arm Swing Exercise on Abdominal Obesity, Hemodynamics and Quality of Life in Patients with Metabolic Syndrome. JEPonline2017;20(6):83-93. Arm swing exercise (ASE) is an interesting exercise modality because it is feasible for most individuals under the home-based exercise condition. It may improve abdominal obesity, hemodynamics, and quality of life (QOL). Therefore, we determined and compared the training effects of ASE pattern on waist circumference, hemodynamics, and QOL in patients with metabolic syndrome (MetS). In a randomized control trial with single-blinded design, 63 women with MetS performed traditional ASE (TASE) (n=32) and modified ASE (MASE) (n=31) 30 min·d-1, 6 d·wk-1 for 12 wks. Anthropometry, resting heart rate (HR), and blood pressure (BP) along with the Short Form 36 (SF-36) for assessing data on waist circumference, hemodynamics, and QOL were collected before and after exercise interventions. Comparing with before training, both groups had lowered waist circumference (P<0.05). The TASE group also had higher physical role and general health (P<0.01), and social functioning and emotional role scores than before training (P<0.05). Moreover, the TASE group had a greater increase in social functioning than the MASE group (P<0.05). In addition, The TASE group had lowered HR andSBP as a result of training. There were no significant differences between the groups in waist circumference and hemodynamics. These results indicate that both patterns of ASE training reduced waist circumference. The TASE group had more improvement in social functioning than the MASE group. However, the mode of ASE training did not influence the subjects’ waist circumference and hemodynamics.

Key Words: Blood Pressure, Heart Rate, Low-Intensity Exercise,Social Functioning, Waist Circumference

INTRODUCTION

The worldwide prevalence of obesity is increasing (18), which is directly correlated with the prevalence of metabolic syndrome (MetS) (4). The International Diabetes Federation (IDF) estimates that the prevalence of the world’s adult population with metabolic syndrome is around 20 to 25% (9). MetS is a complex disorder that includes abdominal obesity, insulin resistance, dyslipidemia, and hypertension (2). Singly or collectively, the disorders associated with MetS result in numerous adverse effects on many systems of the human body (13). Often, the result is an increasein the risk of many subsequent diseases. Recent study has shown that the patients with MetS who had high blood pressure (BP) and abdominal obesity were associated with lower health-related quality of life (QOL) than patients without MetS (11).

Low-intensity exercise training and/or physical activity has been shown to reduce waist circumference (6,23) in healthy adult and reduce BP in healthy and hypertensive subjects (5,7,10). Only one previous study found the hypotensive effect in MetS male Wistar rats (17). Additionally, the improvement of cardiovascular disease (CVD) risk factors included reduction in waist circumference after weight loss and low intensity exercise program for 6 months (12). The impressiveness of changes in body shape derived from weight loss could improve QOL (25). Furthermore, most studies that have investigatedthe effect of exercise training on QOL were performed in the western exercise pattern while relatively few studies have determined the effects of eastern exercise pattern on QOL in patients with MetS. Apparently, there are no studies in individualswith MetS that examined the effects of low-intensity exercise training on heart rate (HR) and BP.

Arm swing exercise (ASE) is a traditional Chinese exercise (14). It is an interesting exercise modality because it is feasible for most individuals under home-based exercise non-supervised conditions. It is also a good exercise modality because it minimizes the risk of musculoskeletal injury. In addition, the traditional ASE (TASE) training for 8 wks decreased glycated haemoglobin (HbA1c) and oxidative stress in patients with type 2 diabetes mellitus (T2DM) (14). Moreover, TASE has been shown to improve cognitive performance, aerobic capacity, and oxidative stress inolder women with mild cognitive impairment (19). It also improves exercise capacity and oxygen consumption in overweight and normal weight sedentary young adults(21),and improves aerobic capacity, functional mobility,and health related QOL in pre-frail elderly women (20). In addition, arm swing exercise training improves exercise capacity to an extent comparable with that of leg cycling exercise training (22).

However, there has been no study investigating the effects of TASE on abdominal obesity, hemodynamics, and QOL in MetS patients. We created the modified ASE (MASE) to increase effort by increasing muscle contraction and joint movement, including shoulder flexion, fist, abdominal muscle contraction, and knee extension. The increased exercise-induced physiological response may be appropriate for patients with MetS, which is linked to the more complicated components than diabetes mellitus or hypertension alone.

Thus, this study investigated and compared the effects of TASE and MASE on abdominal obesity, hemodynamics, and QOL in patients with MetS. We hypothesized that TASE and MASE training could reduce waist circumference, improve HR, BP, and QOL in MetS patients with more benefits from MASE.

METHODS

Subjects

Adults who met the inclusion criteria (e.g., women aged between 35 to 70 yrs, MetS diagnosed by the guidelines of IDF 2006, and non-regular exercise less than 3 d·wk-1) were recruited from Khon Kaen province, Thailand. The exclusion criteria included patients with known cardiovascular diseases, respiratory diseases, neuromuscular disorders, liver and kidney disorders, orthopedic problems that involved shoulder movement, and chronic infection. If the subjects were medicated for T2DM, hypertension, and dyslipidaemia, pharmacology therapies would continue during the study. All subjects provided informed consent according to the Ethical Committee of KhonKaen University in accordance with the 1964 Declaration of Helsinki (HE 571357). All subjects consented to participate in the study after receiving both verbal and written explanations.

Experimental Design and Protocol

All subjects participated in the screening measurements before the experiment, which included a medical history, electrocardiography, blood sample for routine blood chemistry and hematology, physical measurement (BP and HR), anthropometric measurement, and body fat distribution. All subjects were a simple random sampling assigned to 1 of 2groups, either the TASE group or the MASE group. The subjects performed the ASE training 10 min·d-1duringthe 1st week, 20 min·d-1during the 2nd wk, and 30 min·d-1 during the 3rd wk until the end of study duration, 6 d·wk-1 for 12 wks. The ASE was checked for accuracy inthe laboratory at week 2 and follow up by telephone at week 4, 6, 8, 10, and 12. The health related SF-36 questionnaire was obtained from all subjects pre- and post-intervention at the 1st and 85th day of the study.

Parameters Measurement

Anthropometry and Body Composition

A stadiometer (DETECTO, US) was used to measure the subjects’ weight in kilograms and height in meters. Body mass index (BMI) was calculated by kilograms per square meter. Waist circumference (WC) was measured at the midpoint between the lower rib margin and iliac crest at the end of inspiration, while hip circumference (HC) was measured at the trochanter level. Waist to hip ratio (WHR) was computed as WC per HC for each subject. Body composition included fat mass and muscle, which were measured by dual-energy x-ray absorptiometry (LUNAR Prodigy, US) software version 14.10.

Hemodynamics Measurement

The subjects’ HR and BP were measured by an automatic sphygmomanometer (UA-767 Plus, UK) with the cuff wraps around the upper right arm while in the sitting position.

Quality of Life (QOL)

QOL was determined at rest by the SF-36 questionnaire, which consists of 2 scales. The mental and physical component scales assess eight health domains: physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health.

Physical Activity and Dietary Assessments

All subjects were asked to maintain their daily physical activity and dietary habits during the exercise training period. During the1st and 12th wk during the exercise training period, the subjects were asked to keep a physical activity and a food diary for three days that included two weekdays and one weekend day. The record was used to analyze energy intake (8).

Statistical Analyses

All data were expressed as the means and standard error of mean (means ± SE). Statistical analyses were performed using SPSS for Windows (version 17.0, USA).The Kolmogorov-Smirnov Test was used to normalize the distribution. The Dependent-Samplet Test was used to compare differences of parameter between before and after training within group. The ANCOVA was used to detect differences in parameters between groups. Statistical probability (p-value) less than 0.05 was considered as the statistical significance.

RESULTS

Subject Characteristics

Of the 105 potential women who were recruited for this study (given that 41 women did not meet the inclusion criteria and 5 subjects dropped out because of incomplete exercise program), 63 subjects finished the exercise training program (Figure 1). Subjects who were receiving medication did so for T2DM (n = 4), hypertension (n = 9), and dyslipidemia (n = 4), pharmacology therapies.

Anthropometry

After the exercise training program, the TASE group had the tendency to reduce weight (P = 0.06) and BMI (P = 0.07) compared with before the intervention. However, there was no significant weight change between groups after training program (Table 1). The subjects’ WC was significantly lower after the training program in both groups (P<0.05) (Table 1).

Quality of life

Physical role, general health, social functioning, and emotional role aspect of the SF-36 score were significantly increased after exercise training in the TASE group, while after the MASE training there was the tendency to be increased in physical functioning (P = 0.09) and general health (P = 0.08). Moreover, social functioning of the SF-36 was higher in the TASE than in the MASE after exercise training (Table 2). There was no significant difference in dietary composition between groups both before and after training. At the end of 12-wk exercise training program, total energy expenditure was significantly higher in both groups, without difference between groups when compared to the beginning of the study (data not shown).

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MASE
Before / After1 / TASE
Before / After1 / Mean difference
(95%CI) / P value2
Age (yrs) / 51.1±7.0 / - / 47.6±7.1 / - / - / -
Weight (kg)
BMI (kg·m-2)
Waist circumference (cm)
Fat mass (kg)
Lean mass (kg) / 66.4±7.9
28.8±3.3
92.9±6.1
27.5±5.1
35.8±3.1 / 66.3±7.9
28.8±3.3
90.0±7.8*
27.5±5.2
35.9±3.4 / 76.9±13.7
31.6±0.8
97.0±9.4
34.0±8.9
40.0±6.4 / 76.1±13.2
31.3±4.7
95.0±8.5*
33.5±8.4
39.5±6.1 / 0.24(-0.92, 1.41)
0.12(-0.34, 0.59)
-0.55(-2.91, 1.79)
0.09(-0.82, 1.01)
0.35(-0.38, 1.09) / .67
.59
.63
.83
.33

Table 1. Effects of MASE and TASE Training on Anthropometry and Body Composition in MetS Subjects.

Data are expressed as mean ± SD, n=32 in the MASE group and n=31 in the TASE group. Abbreviations: ASE = arm swing exercise, MetS = Metabolic syndrome, MASE = modified arm swing exercise, TASE = traditional arm swing exercise, 95%CI = 95 percentage of confidence interval, BMI = body mass index,1Test for significant differences within group,2Test for significant differences between groups, *P<0.05; Significantly different from before training within group

Table 2. Effects of MASE and TASE training on SF-36 score in MetS subjects

MASE
Before / After1 / TASE
Before / After1 / Mean difference
(95%CI) / P value2
Physical Component Scale
Physical Functioning
Physical Role
Bodily Pain
General Health
Mental Component Scale
Vitality
Social Functioning
Emotional Role
Mental Health / 75.1±19.1
72.6±35.5
68.9±22.0
61.4±19.9
68.9±15.1
82.8±17.3
65.6±41.8
77.5±11.6 / 80.1±13.3
78.9±30.5
72.9±15.7
66.8±20.5
71.4±13.6
86.3±16.3
72.9±35.3
79.3±15.0 / 79.1±18.2
66.1±36.2
69.1±20.7
60.6±19.9
66.6±12.8
85.8±19.5
51.6±36.3
74.4±14.6 / 81.7±14.6
79.0±25.8*
75.4±22.8
68.0±20.2*
69.3±17.4
95.1±11.4**
73.1±31.5
75.6±14.0 / -0.11(-6.50, 6.28)
-1.69(-15.5, 12.1)
-2.48(-12.2, 7.06)
-1.67(-9.81, 6.47)
0.55(-5.90, 7.00)
7.53(-13.5, -1.52)
-3.82(-20.3, 12.7)
1.60(-4.08, 7.29) / 0.97
0.80
0.60
0.68
0.86
<0.05
0.64
0.57

Data are expressed as mean±SD, n=32 in MASE group and n=31 in the TASE group. Abbreviations: ASE = arm swing exercise, MetS = Metabolic syndrome, MASE = modified arm swing exercise, TASE =; traditional arm swing exercise, 95%CI = 95 percentage of confidence interval,1Test for significant differences within group,2Test for significant differences between groups, *P<0.05and **P<0.01; Significantly different from before training within group

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Hemodynamics

Heart rate and SBP were decreased in theTASE groupafter training. However, there were no significant differences in HR and BP between the groups (Table 3).

Table 3. Effects of MASE and TASE Training on Heart Rate and Blood Pressure in MetS Subjects.

MASE
Before / After1 / TASE
Before / After1 / Mean difference
(95%CI) / P value2
HR
(b·min-1)
SBP (mmHg)
DBP (mmHg) / 69.1±9.1
122.6±18.5
71.9±11.2 / 67.4±9.3
120.8±11.5
73.8±8.4 / 72.9±11.0
122.2±12.6
71.3±12.3 / 69.1±10.4*
116.7±9.4*
71.8±11.2 / 0.83(-2.90, 4.57)
3.88(-0.54, 8.32)
1.63(-2.05, 5.33) / 0.65
0.08
0.37

Data are expressed as mean±SD, n=32 in the MASE group and n=31 in the TASE group. Abbreviations: ASE = arm swing exercise, MetS = Metabolic syndrome, MASE = modified arm swing exercise, TASE = traditional arm swing exercise, 95%CI = 95 percentage of confidence interval, HR = heart rate, SBP = systolic blood pressure, DBP = diastolic blood pressure,. 1Test for significant differences within group,2Test for significant differences between groups, *P<0.05; Significantly different from before training within group

Compliance and Training Exercise

The subjects completed an average of a total of 59±0.2 sessions in the TASE group and 58±0.2 sessions in the MASE group during the 12 training program, which was approximately 81% compliance for both groups. The ASE intensity during training was not different between the two groups. Both the TASE intensity and the MASE intensity were around 50% to 49% of HRmax before and after exercise training, respectively.

DISCUSSION

This study was the first to our knowledge that investigated the effects of TASE and MASE on abdominal obesity, hemodynamics, and QOL in patients with MetS. The results of this study did not support our hypothesis because the MASE training did not have more beneficial effects on the research parameters.Moreover, the MASE training resulted in only a decrease in abdominal obesity; whereas, the TASE training improved both the subjects’ physical and mental components (with a greater value in social functioning compared with MASE). The TASE training also decreased the subjects’ abdominal obesity, HR, and SBP.

The decrease in the subjects’ waist circumference withboth patterns of ASE training was also reported by Phoemsapthawee et al. (19) and Prasertsri and colleagues (21).Either low-intensityexercise (180 to 300 kcal·session-1) training for 5 wksfor women and men (23) or low-intensity activity (100 to 761 counts·min-1) have been reported to decrease the subjects’ waist circumference (6).

According to the SF-36 score, there was an improvement in the subjects’physical and mental functioning with greater social functioning after exercise training in the TASE group versus the MASE group. Similarly, Maser and Lenhard (16) reported improvement in their subjects’ mental component score (using the SF-36) after Tai Chi/Qigong exercise training that consisted of 1 to 1.5 hr·session-1, 3 sessions·wk-1 for 12 wks in adults with elevated blood glucose. Also, a recent study by Phoemsapthawee andLeelayuwat (20) has supported the beneficial effect of TASE on health-related quality of life in pre-frail elderly women. It is apparent that the weight loss-derived feeling of change in body shape (i.e., waist reduction) results in an improvement insocial functioning.

Furthermore, a previous study by Phoemsapthawee et al. (19) showed improved cognitive performance, aerobic capacity, and oxidative stress in older women with mild cognitive Impairment (19). These are important mental and physiological changesthat help to improve the subjects’ mentalwell-being (1).Also, the improvement in cognitive performance, aerobic capacity, and oxidative stress may be the explanation that helps to explain the increase in the MetS subjects’SF-36 mental component scores in this study.

Although the present study shows ASE is safe and accessible to the public sector, there are no studiesthat have examined the effect of low-intensity ASE exercise on HR and BP in MetS patients. Only a previous study by Morvan et al. (17) examined the hypotensive effect, but the subjects in their study were male MetS Wistar rat. Most human studies examining the effect of low-intensity exercise on BP were performed in hypertensive subjects (5,7,10).Thus, this study is the first to explore the effect of ASE and low-intensity exercise on these parameters. The effects may be due to improvement in the function of the parasympathetic nervous system or a decrease in the sympathetic nervous system since the improvement of autonomic disturbances have been shown to improve control hemodynamics (15,24). This is supported by the report of previous studies that demonstrated low-intensity exercise trainingdecreased the subjects’ total peripheral resistance, increased vascularization, increased peripheral vasodilation, improved tissue perfusion (5), and improved baroreflex (17).

Moreover, the improvement in the subjects’ parasympathetic function and/or the decrease in their sympathetic function may have been due to weight reduction since weight and BMIhad the tendency to decrease in the TASE group only. It is noted the advantages of TASE training on changes HR and SBP are little because most subjects in this study had normal BP. The hypotensive effect may be harmful for the normotensive subjects. Thus, investigation of the hypotensive effect of the TASE training and the MASE training for hypertensive patients or MetS with hypertension is interesting and should be performed.