ارتباط بین تغییرات قدرت هندگریپ با شاخص‌های گلایسمیک/ التهابی پس از یک دوره مداخله تمرینی در زنان سالمند مبتلا به دیابت نوع 2

نوع مقاله : پژوهشی اصیل

نویسندگان

گروه فیزیولوژی ورزشی، دانشکده ی تربیت بدنی، دانشگاه خوارزمی، تهران، ایران

چکیده

مقدمه: سالمندی با ابتلا به دیابت،‌‌‌ سارکوپنی و التهاب همراه می­باشد. تمرینات مقاومتی با بهبود آمادگی عضلانی تا حدی به بهبود وضعیت تندرستی سالمندان کمک می‌کند اما به نظر می‌رسد تمرینات مقاومتی به تنهایی نمی‌تواند بیماری‌های دوران سالمندی را بهبود بخشد. بنابراین، هدف پژوهش حاضر بررسی ارتباط بین قدرت هندگریپ با شاخص‌های گلایسمیک/التهابی پس از یک دوره مداخله تمرینی در سالمندان مبتلا به دیابت نوع 2 بود.
روش پژوهش: 26 زن سالمند مبتلا به دیابت نوع 2 (5/5 ± 72 سال) به طور تصادفی به دو گروه تمرین ترکیبی و مقاومتی با کش (12 هفته) تقسیم شدند. در ابتدا و 48 ساعت پس از مداخله مقادیر سرمی شاخص‌های گلایسمیک، فاکتور نکروز دهنده تومور-آلفا و قدرت هندگریپ اندازه‌گیری شدند. برای تعیین ارتباط بین متغیرها از ضریب همبستگی پیرسون/ اسپیرمن استفاده شد.
یافته ها: بین تغییرات قدرت هندگریپ با فاکتور نکروز دهنده تومور-آلفا در مجموع آزمودنی‌ها همبستگی معکوس قوی و معنی­داری مشاهده شد. اما بین تغییرات قدرت هندگریپ با شاخص‌های گلایسمیک مجموع آزمودنی‌ها همبستگی معناداری وجود نداشت.
نتیجه گیری: قدرت هندگریپ، شاخصی از آمادگی عضلانی، با وضعیت التهابی در زنان سالمند مبتلا به دیابت نوع 2 ارتباط دارد و هر برنامه تمرینی که بتواند این شاخص را بهبود بخشد، می‌تواند در طراحی برنامه‌های تمرینی سالمندان مورد توجه قرار بگیرد اما قدرت هندگریپ به تنهایی نمی‌تواند پیشگوی مناسبی برای وضعیت سایر جنبه‌های سلامتی نظیر وضعیت گلایسمیک در آن‌ها باشد و احتمالاً سایر عوامل آمادگی مانند آمادگی قلبی عروقی در این زمینه موثر هستند.

کلیدواژه‌ها

موضوعات


Extended Abstract

Introduction: Aging is a complex and multifactorial process. The number of older adults has increased significantly over the past century, and the prevalence of type 2 diabetes mellitus among them has risen markedly in the last two decades. Furthermore, advancing age is associated with a reduction in muscle mass. Sarcopenia, characterized by reduced muscle strength and mass, is associated with type 2 diabetes mellitus. In addition to type 2 diabetes mellitus and aging, higher levels of pro-inflammatory cytokines are associated with sarcopenia. While aging itself leads to a decrease in muscle strength, particularly handgrip strength, tumor necrosis factor-alpha levels also increase with age and are higher in older adults with lower handgrip strength. On the other hand, exercise training generally reduces the incidence of type 2 diabetes mellitus in older adult. Both resistance and combined training improve body composition by reducing body mass index and lowering inflammatory factors such as tumor necrosis factor-α in older women. Resistance training is also associated with improved clinical status in terms of glycated hemoglobin levels   and muscle strength in older adults with type 2 diabetes mellitus and in postmenopausal women. Implementation of elastic band resistance training, as a simple, low-cost exercise program for older adults, and combined exercise training, respectively, leads to improvement in muscular strength, physical function, and metabolic status in older adults with type 2 diabetes mellitus.  Therefore, the aim of the present study was to investigate the relationship between changes in handgrip strength and changes in glycemic and inflammatory indicators in older women with type 2 diabetes mellitus following an elastic band resistance training and a combined training.

 

Methods: Twenty-six older women with type 2 diabetes mellitus (age: 72 ± 5.5 years; body mass index: 25.5±2) were selected from daycare department in the Kahrizak charity foundation care center, Iran and then randomly assigned to 12-week exercise training interventions: 1) elastic band resistance training group (medium intensity elastic band resistance training/thrice weekly/8 exercises/3 sets/10-15 reps/≈ 50 min; n = 13) and 2) combined training (a low intensity combined training ≈ 30 min; n = 13). Fasting serum levels of glycemic indices (insulin, glucose, glycated hemoglobin and insulin resistance), tumor necrosis factor-alpha, anthropometric indices (body weight and body mass index), and handgrip strength were measured using standard methods at baseline and 48 hours after the last session of interventions. Pearson/Spearman correlation coefficients (p ≤ 0.05) were used to determine the associations between the variables.

Results: A strong and significant inverse correlation was observed between changes in handgrip strength and tumor necrosis factor-alpha (r = -0.685, p = 0.002) in total participants (n = 26) (Figure 1) and a strong and a significant positive correlation was also observed between changes in handgrip strength and insulin resistance in elastic band resistance training group (r = 0.775, p = 0.04; n = 13), but no significant correlation was found between changes in handgrip strength and changes in fasting serum insulin, glucose, glycated hemoglobin, body weight and body mass index in any groups (p > 0.05).

Figure 1. Correlation between changes in Handgrip strength (HGS) and changes in tumor necrosis factor-α (TNF-α) in the total of elderly women with type 2 diabetes mellitus (n = 26)

 

Conclusion: Handgrip strength, as an indicator of muscular fitness, is associated with inflammatory status in older women with type 2 diabetes. Any exercise program capable of improving this index warrants consideration in the design of exercise protocols for elderly. Nevertheless, handgrip strength alone cannot serve as a suitable predictor for other aspects of health status, like glycemic status, in older women with type 2 diabetes. Probably other fitness components, such as cardiovascular fitness, also play a significant role in this regard which should be considered in future studies.

Footnotes:

Ethical approval: This study was approved and registered by the Research Ethic Committees of Kharazmi University of Tehran. Iran (IR.KHU.REC.1403.108) and by Iranian Registry of Clinical Trials (IRCT20241008063290N1).

Compliance with ethical guidelines: The research followed the ethical standards of the Declaration of Helsinki Ethical Principles for clinical research involving human subjects.

Funding: This work is based upon research funded by Iran National Science Foundation (INSF) under project No.4026206.

Authors’ contribution: Hamid Rajabi: Writing – review & editing, Writing - original draft, Supervision, Methodology, Conceptualization. Shokoufeh Kheradmand: Formal analysis, Conceptualization.

Conflict of interest: The authors declared no potential conflicts of interest relevant to this article.

Acknowledgments: The authors thank the participants of the study.

  1. Almeida JN, Prado WL, Terra CM, Oliveira MG, Garcia RA, Pinfildi CE, et al. Effects of photobiomodulation on muscle strength in post-menopausal women submitted to a resistance training program. Lasers in medical science. 2020;35:355-63.
  2. Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox biology. 2020;35:101513.
  3. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Therapy. 2017;8:459-73.
  4. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes. 2006;55(6):1813-8.
  5. Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nature Reviews Endocrinology. 2021;17(9):534-48.
  6. Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes care. 2007;30(6):1507-12.
  7. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes care. 2002;25(10):1749-54.
  8. Byun MK, Cho EN, Chang J, Ahn CM, Kim HJ. Sarcopenia correlates with systemic inflammation in COPD. International journal of chronic obstructive pulmonary disease. 2017:669-75.
  9. Visser M, Pahor M, Taaffe DR, Goodpaster BH, Simonsick EM, Newman AB, et al. Relationship of interleukin-6 and tumor necrosis factor-α with muscle mass and muscle strength in elderly men and women: the Health ABC Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(5):M326-M32.
  10. Kamper RS, Alcazar J, Andersen LL, Haddock B, Jørgensen NR, Hovind P, et al. Associations between inflammatory markers, body composition, and physical function: the Copenhagen Sarcopenia Study. Journal of Cachexia, Sarcopenia and Muscle. 2021;12(6):1641-52.
  11. Wearing J, Konings P, Stokes M, de Bruin ED. Handgrip strength in old and oldest old Swiss adults–a cross-sectional study. BMC geriatrics. 2018;18(1):266.
  12. Mendoza-Núñez VM, Rosado-Pérez J, Santiago-Osorio E, Ortiz R, Sanchez-Rodriguez MA, Galván-Duarte RE. Aging linked to type 2 diabetes increases oxidative stress and chronic inflammation. Rejuvenation research. 2011;14(1):25-31.
  13. Mcleod JC, Stokes T, Phillips SM. Resistance exercise training as a primary countermeasure to age-related chronic disease. Frontiers in physiology. 2019;10:645.
  14. Calle MC, Fernandez ML. Effects of resistance training on the inflammatory response. Nutrition research and practice. 2010;4(4):259-69.
  15. Bachi AL, Rocha GA, Sprandel MC, Ramos LR, Gravina CF, Pithon-Curi TC, et al. Exercise training improves plasma lipid and inflammatory profiles and increases cholesterol transfer to high-density lipoprotein in elderly women. 2015.
  16. Marques E, Carvalho J, Soares J, Marques F, Mota J. Effects of resistance and multicomponent exercise on lipid profiles of older women. Maturitas. 2009;63(1):84-8.
  17. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. Journal of the American Medical Directors Association. 2011;12(4):249-56.
  18. Suetta C, Haddock B, Alcazar J, Noerst T, Hansen OM, Ludvig H, et al. The Copenhagen Sarcopenia Study: lean mass, strength, power, and physical function in a Danish cohort aged 20–93 years. Journal of cachexia, sarcopenia and muscle. 2019;10(6):1316-29.
  19. Motalebi SA, Iranagh JA, Mohammadi F, Cheong LS. Efficacy of elastic resistance training program for the institutionalized elderly. Topics in Geriatric Rehabilitation. 2018;34(2):105-11.
  20. Zhang J, San Tam WW, Hounsri K, Kusuyama J, Wu VX. Effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life in middle-aged and older adults with type 2 diabetes mellitus: A systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2024;105(8):1585-99.
  21. Martins WR, de Oliveira RJ, Carvalho RS, de Oliveira Damasceno V, da Silva VZM, Silva MS. Elastic resistance training to increase muscle strength in elderly: a systematic review with meta-analysis. Archives of gerontology and geriatrics. 2013;57(1):8-15.
  22. Ryu H-E, Lee JH, Park B, Heo S-J, Kwon Y-J. Impact of Meal Frequency on Insulin Resistance in Middle-Aged and Older Adults: A Prospective Cohort Study. Diabetes & Metabolism Journal. 2025;49(2):311-20.
  23. Konopka AR, Wolff CA, Suer MK, Harber MP. Relationship between intermuscular adipose tissue infiltration and myostatin before and after aerobic exercise training. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2018;315(3):R461-R8.
  24. Calvani R, Marini F, Cesari M, Buford TW, Manini TM, Pahor M, et al. Systemic inflammation, body composition, and physical performance in old community‐dwellers. Journal of cachexia, sarcopenia and muscle. 2017;8(1):69-77.
  25. Zoico E, Rossi A, Di Francesco V, Sepe A, Olioso D, Pizzini F, et al. Adipose tissue infiltration in skeletal muscle of healthy elderly men: relationships with body composition, insulin resistance, and inflammation at the systemic and tissue level. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2010;65(3):295-9.
  26. Macêdo Santiago LÂ, Neto LGL, Borges Pereira G, Leite RD, Mostarda CT, de Oliveira Brito Monzani J, et al. Effects of Resistance Training on Immunoinflammatory Response, TNF‐Alpha Gene Expression, and Body Composition in Elderly Women. Journal of aging research. 2018;2018(1):1467025.
  27. Buford TW, Anton SD, Judge AR, Marzetti E, Wohlgemuth SE, Carter CS, et al. Models of accelerated sarcopenia: critical pieces for solving the puzzle of age-related muscle atrophy. Ageing research reviews. 2010;9(4):369-83.
  28. Ojulari LS, Agodirin OS, Sulaiman SE, Amali M. Systematic Review of the Relationship Between Handgrip Strength and Blood Glucose Levels in Young Adults and the Elderly. Pan-African Journal of Health and Environmental Science. 2024;3(2):132-46.
  29. Joo K-C, Son D-H, Park J-M. Association between relative handgrip strength and insulin resistance in Korean elderly men without diabetes: findings of the 2015 Korea national health nutrition examination survey. Korean journal of family medicine. 2022;43(3):199.
  30. Kalyani RR, Kim C, Ferrucci L, Laughlin GA, Kritz-Silverstein D, Kong S, et al. Sex differences in the association of fasting and postchallenge glucose levels with grip strength among older adults: the Rancho Bernardo Study. BMJ open diabetes research & care. 2015;3(1).
  31. Saha S, Schwarz PE. Impact of glycated hemoglobin (HbA1c) on identifying insulin resistance among apparently healthy individuals. Journal of public health. 2017;25(5):505-12.
  32. Eriksson J, Taimela S, Eriksson K, Parviainen S, Peltonen J, Kujala U. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. International journal of sports medicine. 1997;18(04):242-6.
  33. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Therapy. 2017;8(3):459-73.
  34. Feng M, Gu L, Zeng Y, Gao W, Cai C, Chen Y, et al. The efficacy of resistance exercise training on metabolic health, body composition, and muscle strength in older adults with type 2 diabetes: A systematic review and Meta-Analysis. Diabetes Research and Clinical Practice. 2025:112079.
  35. Martins WR, Safons MP, Bottaro M, Blasczyk JC, Diniz LR, Fonseca RMC, et al. Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial. BMC geriatrics. 2015;15(1):99.
  36. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports medicine. 2006;36(2):133-49.
  37. Bf H. Age, gender, and muscular strength. J Gerontol Biol Sci Med Sci. 1995;50:41-4.
  38. Miller AEJ, MacDougall J, Tarnopolsky M, Sale D. Gender differences in strength and muscle fiber characteristics. European journal of applied physiology and occupational physiology. 1993;66(3):254-62.
  39. Doherty TJ. The influence of aging and sex on skeletal muscle mass and strength. Current Opinion in Clinical Nutrition & Metabolic Care. 2001;4(6):503-8.
  40. Shabkhiz F, Khalafi M, Rosenkranz S, Karimi P, Moghadami K. Resistance training attenuates circulating FGF-21 and myostatin and improves insulin resistance in elderly men with and without type 2 diabetes mellitus: A randomised controlled clinical trial. European journal of sport science. 2021;21(4):636-45.
  41. de Almeida Silva N, de Menezes TN, de Melo RLP, Pedraza DF. Handgrip strength and flexibility and their association with anthropometric variables in the elderly. Revista da Associação Médica Brasileira (English Edition). 2013;59(2):128-35.
  42. Hardy R, Cooper R, Aihie Sayer A, Ben-Shlomo Y, Cooper C, Deary IJ, et al. Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme. PloS one. 2013;8(2):e56483.
  43. Shahida MN, Zawiah MS, Case K. The relationship between anthropometry and hand grip strength among elderly Malaysians. International Journal of Industrial Ergonomics. 2015;50:17-25.
  44. Ibañez J, Izquierdo M, ARGuelles I, Forga L, Larrión JL, García-Unciti M, et al. Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes care. 2005;28(3):662-7.
  45. Roh H-T, Cho S-Y, So W-Y. A cross-sectional study evaluating the effects of resistance exercise on inflammation and neurotrophic factors in elderly women with obesity. Journal of clinical medicine. 2020;9(3):842.