Journal of the Korean Applied Science and Technology (한국응용과학기술학회지)

The Korean Society of Applied Science and Technology (한국응용과학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Combined Exercise on Irisin, Body Composition and Glucose Metabolism in Obese Elderly Women with Type 2 Diabetes Mellitus

복합운동이 제2형 당뇨병 비만 여성노인의 Irisin, 신체조성 및 당 대사에 미치는 영향

  • Ha, Soo-Min (Department of Physical Education, Pusan National University) ;
  • Kim, Jung-Sook (Department of Physical Education, Pusan National University) ;
  • Ha, Min-Seong (Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sports Sciences, University of Tsukuba) ;
  • Kim, Bo-Sung (Department of Physical Education, Pusan National University) ;
  • Kim, Do-Yeon (Department of Physical Education, Pusan National University)
  • 하수민 (부산대학교 체육교육과) ;
  • 김정숙 (부산대학교 체육교육과) ;
  • 하민성 (츠쿠바 대학교 건강스포츠과학부) ;
  • 김보성 (부산대학교 체육교육과) ;
  • 김도연 (부산대학교 체육교육과)
  • Received : 2019.12.03
  • Accepted : 2019.12.30
  • Published : 2019.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to investigate the effects of combined exercise on irisin, body composition and glucose metabolism in obese elderly women with type 2 diabetes mellitus. The subjects were thirty-six obese elderly women with type 2 diabetes volunteers, aged 65 to 85 years, composed of the combined exercise type 2 diabetes mellitus group (n=20) and non-exercise type 2 diabetes mellitus group (n=16). The 60 minute combined exercise program (outdoor walking exercise & elastic-band exercise) was performed 3 times per week for 12 weeks. Exercise intensity of outdoor walking exercise was performed as medium intensity (RPE 5~6) and elastic-band exercise was progressively increased every four weeks (1-4 weeks: OMNI-RES 3~4, 5-8 weeks: OMNI-RES 5~6, 9-12 weeks: OMNI-RES 7~8). The results of the study in the combined exercise type 2 diabetes mellitus group were as follows; Irisin and skeletal muscle mass had significantly increased (p<.001), percentage of body fat had significantly decreased (p<.001). Further, HbA1c (p=.020) and fasting glucose (p<.001) was significantly decreased, and HOMA-β was significantly increased (p<.001). Correlation results showed that change of irisin had a significant negative correlation between percentage of body fat mass (r=-.423, p=.010), HbA1c (r=-.351, p=.036) and fasting glucose (r=-.424, p=.010). Also, irisin changes showed a positive correlation with aerobic endurance (r=.355, p=.034) and HOMA-β (r=.411, p=.013). In conclusion, the practice of regular combined exercise was found to increase the level of irisin in elderly women with type 2 diabetes and have a positive effect on body composition changes. In addition, HbA1c, fasting glucose and insulin secretion was improved, which helped to regulate glucose metabolism. Walking exercise and elastic band exercise are recommended as effective exercise for the prevention and management of diabetes in obese elderly women with type 2 diabetes mellitus.

본 연구는 만 65세 이상 85세 이하의 제2형 당뇨병 비만 여성 노인을 대상으로 12주간 복합운동 후 irisin, 신체조성 및 당 대사에 미치는 영향을 구명하기 위하여 복합운동군(n=20), 대조군(n=16)으로 구분하여 실시하였다. 복합운동 프로그램은 야외 걷기 운동과 탄성 밴드 운동을 12주간 주 3회, 1회 60분간 실시하였으며, 야외 걷기 운동의 운동강도는 중강도(RPE 5~6)로 수행되었으며, 탄성 밴드 운동은 1~4주는 저강도(OMNI-RES 3~4), 5~8주는 중강도(OMNI-RES 5~6), 9~12주는 고강도(OMNI-RES 7~8)로 점진적으로 운동강도를 증가시켰다. 그 결과 복합운동군의 irisin이 유의하게 증가하였고(p<.001), 체지방률은 유의하게 감소하였으며(p<.001), 골격근량은 유의하게 증가하였다(p<.001). 당 대사 관련 인자 중 HbA1c(p=.020), 혈당(p<.001)은 유의하게 감소하였고, HOMA-β는 유의하게 증가하였다(p<.001). Irisin의 변화는 체지방률의 변화와 부적 상관이 있는 것으로 나타났고(r=-.423, p=.010), 유산소성 지구력 변화와 정적 상관이 있었다(r=.355, p=.034). 또한, HbA1c(r=-.351, p=.036)와 혈당(r=-.424, p=.010)의 변화는 부적 상관이 있었으며, HOMA-β는 정적 상관이 있는 것으로 나타났다(r=.411, p=.013). 결론적으로 규칙적인 복합운동의 실천은 제2형 당뇨병 비만 여성노인의 혈중 irisin의 수준을 증가하고, 신체조성 변화에 긍정적인 영향을 주는 것으로 나타났다. 그리고 당화혈색소, 공복혈당 및 인슐린 분비능을 개선하여 당 대사 조절 능력에 도움을 주어 당뇨 예방 및 관리를 위해 효과적인 운동으로 권장될 것으로 사료된다.

Keywords

References

  1. H. Toplak, D. R. Leitner, J. Harreiter, F. Hoppichler, T. C. Wascher, K. Schindler, B. Ludvik, ""Diabesity"-Obesity and type 2 diabetes (Update 2019)." Wiener klinische Wochenschrift, Vol.131 No.Suppl 1 pp. 71-76, (2019). https://doi.org/10.1007/s00508-018-1418-9
  2. M. F. Gregor, G. S. Hotamisligil, "Inflammatory mechanisms in obesity." Annual Review Immunology, Vol. 29 pp. 415-445, (2011). https://doi.org/10.1146/annurev-immunol-031210-101322
  3. S. E. Shoelson, J. Lee, A. B. Goldfine, "Inflammation and insulin resistance." Journal of Clinical Investigation, Vol. 116 No. 7 pp. 1793-1801, (2006). https://doi.org/10.1172/JCI29069
  4. K. Lois, S. Kumar, "Obesity and diabetes." Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion Vol.56 Suppl 4 pp. 38-42, (2009). https://doi.org/10.1016/S1575-0922(09)73516-8
  5. P. S. Leung, "The potential of irisin as a therapeutic for diabetes." Future Medical Chemistry, Vol. 9 No. 6 pp. 529-532, (2017). https://doi.org/10.4155/fmc-2017-0035
  6. J. P. Kirwan, J. Sacks, S. Nieuwoudt, "The essential role of exercise in the management of type 2 diabetes." Cleveland Clinical Journal of Medicine, Vol. 84 No. 7 Suppl 1 pp. S15-S21, (2017). https://doi.org/10.3949/ccjm.84.s1.03
  7. B. K. Pedersen, "Muscle as a secretory organ." Comprehensive Physiology, Vol. 3 No. 3 pp. 1337-1362, (2013). https://doi.org/10.1002/cphy.c120033
  8. L. Gamas, P. Matafome, R. Seica, "Irisin and myonectin regulation in the insulin resistant muscle: implications to adipose tissue: muscle crosstalk." Journal of Diabetes Research, Vol. 2015 pp. 359159, (2015). https://doi.org/10.1155/2015/359159
  9. I. Y. Martinez Munoz, E. D. S. Camarillo Romero, J. d. J. Garduno Garcia, "Irisin a Novel Metabolic Biomarker: Present Knowledge and Future Directions." International Journal of Endocrinol, Vol. 2018 pp. 7816806, (2018). https://doi.org/10.1155/2018/7816806
  10. B. K. Pedersen, M. A. Febbraio, "Muscles, exercise and obesity: skeletal muscle as a secretory organ." Nature Reviews Endocrinology, Vol. 8 No. 8 pp. 457-465, (2012). https://doi.org/10.1038/nrendo.2012.49
  11. S. Cinti, "Between brown and white: novel aspects of adipocyte differentiation." Ann Med, Vol. 43 No. 2 pp. 104-115, (2011). https://doi.org/10.3109/07853890.2010.535557
  12. P. Bostrom, J. Wu, M. P. Jedrychowsky, A. Korde, L. Ye, J. C. Lo, K. A. Rasbach, E. A. Bostrom, J. H. Choi, J. Z. Long, S. Kajimura, M. C. Zingaretti, B. F. Vind, H. Tu, S. Cinti, K. Hojlund, S. P. Gygi, B. M. Spiegelman, "A PGC1-${\alpha}$-dependent myokine that drives brown-fat-like development of white fat and thermogenesis." Nature, Vol. 481 No. 7382 pp. 463-468, (2012). https://doi.org/10.1038/nature10777
  13. J. M. Moreno-Navarrete, F. Ortega, M. Serrano, E. Guerra, G. Pardo, F. Tinahones, W. Ricart, J. M. Fernandez-Real, "Irisin is expressed and produced by human muscle and adipose tissue in association with obesity and insulin resistance." The Journal of Clinical Endocrinology & Metabolism, Vol. 98 No. 4, pp. E769-E778, (2013). https://doi.org/10.1210/jc.2012-2749
  14. F. Li, Y. Li, Y. Duan, C.-A. A. Hu, Y. Tang, Y. Yin, "Myokines and adipokines: Involvement in the crosstalk between skeletal muscle and adipose tissue." Cytokine Growth Factor Reviews, Vol. 33 pp. 73-82, (2017). https://doi.org/10.1016/j.cytogfr.2016.10.003
  15. A. Shoukry, S. M. Shalaby, S. El-Arabi Bdeer, A. A. Mahmoud, M. M. Mousa, A. Khalifa, "Circulating serum irisin levels in obesity and type 2 diabetes mellitus." IUBMB Life, Vol. 68 No. 7 pp. 544-556, (2016). https://doi.org/10.1002/iub.1511
  16. M. I. Hernandez-Alvarez, H. Thabit, N. Burns, S. Shah, I. Brema, M. Hatunic, F. Finucane, M. Liesa, C. Chiellini, D. Naon, A. Zorzano, J. J. Nolan, "Subjects with early-onset type 2 diabetes show defective activation of the skeletal muscle PGC-1{alpha}/Mitofusin-2 regulatory pathway in response to physical activity." Diabetes Care, Vol. 33 No. 3 pp. 645-651, (2010). https://doi.org/10.2337/dc09-1305
  17. R. J. Sigal, G. P. Kenny, N. G. Boule, G. A. Wells, D. Prud'homme, M. Fortier, R. D. Reid, H. Tulloch, D. Coyle, P. Phillips, A. Jennings, J. Jaffey, "Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial." Annals of Internal Medicine, Vol. 147 No. 6 pp. 357-369, (2007). https://doi.org/10.7326/0003-4819-147-6-200709180-00005
  18. W. R. Martins, R. J. de Oliveira, R. S. Carvalho, V. de Oliveira Damasceno, V. Z. M. da Silva, M. S. Silva, "Elastic resistance training to increase muscle strength in elderly: a systematic review with meta-analysis." Archives of Gerontology and Geriatrics, Vol. 57 No. 1 pp. 8-15, (2013). https://doi.org/10.1016/j.archger.2013.03.002
  19. A. Jose, S. Dal Corso, "Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial." Journal of Physiotherapy, Vol. 62 No. 2 pp. 96-102, (2016). https://doi.org/10.1016/j.jphys.2016.02.014
  20. B. K. Pedersen, B. Saltin, "Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases." Scandinavian Journal of Medicine & Science in Sports, Vol. 25 Suppl 3 pp. 1-72, (2015).
  21. J. C. Colado, F. M. Pedrosa, A. Juesas, P. Gargallo, J. J. Carrasco, J. Flandez, M. U. Chupel, A. M. Teixeira, F. Naclerio, "Concurrent validation of the OMNI-Resistance Exercise Scale of perceived exertion with elastic bands in the elderly." Experimental Gerontology, Vol. 103 pp. 11-16, (2018). https://doi.org/10.1016/j.exger.2017.12.009
  22. F. Faul, E. Erdfelder, A.-G. Lang, A. Buchner, "G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences." Behavior research methods, Vol. 39 No. 2 pp. 175-191, (2007). https://doi.org/10.3758/BF03193146
  23. R. Rikli, C. Jones, "Senior Fitness Test Manual-2nd Edition." Human Kinetics.
  24. D. R. Matthews, J. P. Hosker, A. S. Rudenski, B. A. Naylor, D. F. Treacher, R. C. Turner, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man." Diabetologia, Vol. 28 No. 7 pp. 412-419, (1985). https://doi.org/10.1007/BF00280883
  25. J. H. Lee, "New Guidelines for Elderly Diabetic Patients." Journal of Korean Diabetes, Vol. 16 No. 2 pp. 89-100, (2015). https://doi.org/10.4093/jkd.2015.16.2.89
  26. E. Ferriolli, F. P. A. S. Pessanha, J. C. L. S. Marchesi, "Diabetes and exercise in the elderly." Medicine and Sport Science, Vol. 60 pp. 122-129, (2014). https://doi.org/10.1159/000357342
  27. Y. Saisho, "${\beta}$-cell dysfunction: Its critical role in prevention and management of type 2 diabetes." World Journal of Diabetes, Vol. 6 No. 1 pp. 109-124, (2015). https://doi.org/10.4239/wjd.v6.i1.109
  28. N. Perakakis, G. A. Triantafyllou, J. M. Fernandez-Real, J. Y. Huh, K. H. Park, J. Seufert, C. S. Mantzoros, "Physiology and role of irisin in glucose homeostasis." Nature Reviews Endocrinology, Vol. 13 No. 6 pp. 324-337, (2017). https://doi.org/10.1038/nrendo.2016.221
  29. K. H. Park, L. Zaichenko, M. Brinkoetter, B. Thakkar, A. Sahin-Efe, K. E. Joung, M. A. Tsoukas, E. V. Geladari, J. Y. Huh, F. Dincer, C. R. Davis, J. A. Crowell, C. S. Mantzoros "Circulating irisin in relation to insulin resistance and the metabolic syndrome." Journal of Clinical Endocrinology & Metabolism, Vol. 98 No. 12 pp. 4899-4907, (2013). https://doi.org/10.1210/jc.2013-2373
  30. Y. K. Choi, M. K. Kim, K. H. Bae, H. A. Seo, J. Y. Jeong, W. K. Lee, J. G. Kim, I. K. Lee, K. G. Park, "Serum irisin levels in new-onset type 2 diabetes." Diabetes research and clinical practice, Vol. 100, No, 1 pp. 96-101, (2013). https://doi.org/10.1016/j.diabres.2013.01.007
  31. D. Loffler, U. Muller, K. Scheuermann, D. Friebe, J. Gesing, J. Bielitz, S. Erbs, K. Landgraf, I. V. Wagner, W. Kiess, A. Korner, "Serum irisin levels are regulated by acute strenuous exercise." The Journal of clinical endocrinology and metabolism, Vol.100 No.4 pp. 1289-1299, (2015). https://doi.org/10.1210/jc.2014-2932
  32. J. Y. Huh, G. Panagiotou, V. Mougios, M. Brinkoetter, M. T. Vamvini, B. E. Schneider, C. S. Mantzoros, "FNDC5 and irisin in humans: I. Predictors of circulating concentrations in serum and plasma and II. mRNA expression and circulating concentrations in response to weight loss and exercise." Metabolism: clinical and experimental, Vol.61 No.12 pp. 1725-1738, (2012). https://doi.org/10.1016/j.metabol.2012.09.002
  33. S. Soyal, F. Krempler, H. Oberkofler, W. Patsch, "PGC-1${\alpha}$: a potent transcriptional cofactor involved in the pathogenesis of type 2 diabetes." Diabetologia, Vol.49, No.7 pp. 1477-1488, (2006). https://doi.org/10.1007/s00125-006-0268-6
  34. B. Egan, J. R. Zierath, "Exercise metabolism and the molecular regulation of skeletal muscle adaptation." Cell metabolism, Vol.17 No.2 pp. 162-184, (2013). https://doi.org/10.1016/j.cmet.2012.12.012
  35. C. Planella-Farrugia, F. Comas, M. Sabater-Masdeu, M. Moreno, J. M. Moreno-Navarrete, O. Rovira, W. Ricart, J. M. Fernandez-Real, "Circulating Irisin and Myostatin as Markers of Muscle Strength and Physical Condition in Elderly Subjects." Frontiers in physiology, Vol.10 pp. 871, (2019). https://doi.org/10.3389/fphys.2019.00871
  36. M. G. Novelle, C. Contreras, A. Romero-Pico, M. Lopez, C. Dieguez, "Irisin, two years later." International journal of endocrinology, Vol.2013 pp. 746281-746281, (2013). https://doi.org/10.1155/2013/746281
  37. J. Y. Huh, F. Dincer, E. Mesfum, C. S. Mantzoros, "Irisin stimulates muscle growth-related genes and regulates adipocyte differentiation and metabolism in humans." International Journal of Obesity, Vol.38 No.12 pp. 1538-1544, (2014). https://doi.org/10.1038/ijo.2014.42
  38. I. L. P. Bonfante, M. P. T. Chacon-Mikahil, D. T. Brunelli, A. F. Gaspari, R. G. Duft, W. A. Lopes, V. Bonganha, C. A. Libardi, C. R. Cavaglieri, "Combined training, FNDC5/irisin levels and metabolic markers in obese men: A randomised controlled trial." European journal of sport science, Vol.17 No.5 pp. 629-637, (2017). https://doi.org/10.1080/17461391.2017.1296025
  39. H. J. Lee, J. O. Lee, N. Kim, J. K. Kim, H. I. Kim, Y. W. Lee, S. J. Kim, J. I. Choi, Y. Oh, J. H. Kim, S. Y. Hwang, S. H. Park, H. S. Kim, "Irisin, a Novel Myokine, Regulates Glucose Uptake in Skeletal Muscle Cells via AMPK." Molecular Endocrinology, Vol.29 No.6, pp. 873-881, (2015). https://doi.org/10.1210/me.2014-1353
  40. C. Xin, J. Liu, J. Zhang, D. Zhu, H. Wang, L. Xiong, Y. Lee, J. Ye, K. Lian, C. Xu, L. Zhang, Q. Wang, Y. Liu, L. Tao, 1"Irisin improves fatty acid oxidation and glucose utilization in type 2 diabetes by regulating the AMPK signaling pathway." International journal of obesity, Vol.40 No.3, pp. 443-451, (2016). https://doi.org/10.1038/ijo.2015.199
  41. A. Natalicchio, N. Marrano, G. Biondi, R. Spagnuolo, R. Labarbuta, I. Porreca, A. Cignarelli, M. Bugliani, P. Marchetti, S. Perrini, L. Laviola, F. Giorgino, "The Myokine Irisin Is Released in Response to Saturated Fatty Acids and Promotes Pancreatic ${\beta}$-Cell Survival and Insulin Secretion." Diabetes, Vol.66 No.11, pp. 2849-2856, (2017) https://doi.org/10.2337/db17-0002
  42. S. Liu, F. Du, X. Li, M. Wang, R. Duan, J. Zhang, Y. Wu, Q. Zhang, "Effects and underlying mechanisms of irisin on the proliferation and apoptosis of pancreatic ${\beta}$ cells." PLoS One, Vol.12 No.4 pp. e0175498-e0175498, (2017). https://doi.org/10.1371/journal.pone.0175498
  43. M. Gizaw, P. Anandakumar, T. Debela, "A review on the role of irisin in insulin resistance and Type 2 diabetes mellitus." Journal of pharmacopuncture, Vol.20 No. 4 pp. 235-242, (2017). https://doi.org/10.3831/KPI.2017.20.029