The Effect of Resistance Training on Brachial Ankle Index, Blood Pressure and Bone Morphogenetic Protein 4 in Type-2 Diabetic Women With Peripheral Neuropathy: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 M.Sc. in Sports Physiology, Department of Physical Education and Sports Sciences, School of Physical Education, Shahrood University of Technology, Shahrood, Iran.

2 Assistant Professor of Sports Physiology, Department of Physical Education and Sport Sciences, School of Physical Education, Shahrood University of Technology, Shahrood, Iran.

Abstract

Introduction: It seems that vascular function plays a role in the development of diabetes; the present study was conducted with aim to investigate the effect of resistance training on ankle-brachial index, blood pressure and bone morphogenetic protein 4 in women with diabetic peripheral neuropathy.
Methods: This randomized clinical trial study was conducted in 2024 on 28 type 2 diabetic women with peripheral neuropathy (Michigan Score higher than 7).The subjects were placed in two groups of resistance training (n=13) and control (n=15). The training group performed 12 weeks of 1RM training including 11 movements at intensity of 50-60% of maximum strength and 1-3 progressive sets (increasing by one set every 4 weeks) performed three days a week. Before the first session and 48 hours after the last training session, blood pressure, brachial plexus index (ABI), and anthropometric indices were measured and blood sampling was collected. Data analysis was performed using SPSS statistical software (version 27) and dependent t-test and analysis of covariance. P<0.05 was considered significant.
Results: In ankle-brachial index (P=0.011), systolic blood pressure (P=0.02), blood sugar (P=0.001), insulin resistance (P=0.001) and 4-BMP (P=0.001) based on the covariance values, there was a significant decrease in the values ​​of the training group compared to the control group; However, there was no significant difference for weight, body mass index, fat percentage and diastolic blood pressure (P>0.05).
Conclusion: According to the results, BMP-4 decreased during resistance training and it seems that the decrease may be related to exercise-induced arterial changes, but needs more research in this field.

Keywords

Main Subjects


  1. Kiani SHahvandi E, Donyai A. Investigating the Effect of 12 Weeks of Aerobic and Resistance Training on the Levels of Anger, Happiness, and Anxiety in Middle-Aged Women with Type-2 Diabetes. Journal of Sports and Motor Development and Learning 2023; 15(4):21-36.
  2. Guerrero Fernández de Alba I, Gimeno-Miguel A, Poblador-Plou B, Gimeno-Feliu LA, Ioakeim-Skoufa I, Rojo-Martínez G, et al. Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients. Scientific reports 2020; 10(1):19583.
  3. Donyaei A, Shabani F, Gholami F. Effect of combined training and subsequent detraining on plasma apelin levels in women with type 2 diabetes. Journal of Applied Health Studies in Sport Physiology 2022; 9(2):37-47.
  4. Boulton AJ. Management of diabetic peripheral neuropathy. Clinical diabetes 2005; 23(1):9-15.
  5. Gholami F, Khaki R, Mirzaei B, Howatson G. Resistance training improves nerve conduction and arterial stiffness in older adults with diabetic distal symmetrical polyneuropathy: a randomized controlled trial. Experimental Gerontology 2021; 153:111481.
  6. Rajabi H, Donyai A, Motamedi P, Dehkhoda MR. Effect of Aerobic Training on Blood Pressure, HbA1c and Arterial Stiffness in Postmenopausal Women with Type 2 Diabetes. Jundishapur Scientific Medical Journal 2018; 16(6):631-42.
  7. Son JW, Jang EH, Kim MK, Baek KH, Song KH, Yoon KH, et al. Serum BMP-4 levels in relation to arterial stiffness and carotid atherosclerosis in patients with Type 2 diabetes. Biomarkers in medicine 2011; 5(6):827-35.
  8. Donyaei A, Taghiabadi FS, Gholami F. The effect of different intensities of aerobic exercise before glucose ingestion on subsequent cardio-ankle vascular index in active and inactive women. Journal of Practical Studies of Biosciences in Sport 2022; 10(22):66-73.
  9. Park CS, Hong OK, Kim MK, Chung WB, Choi YS, Baek KH, et al. Serum Bone Morphogenic Protein-4 contributes to discriminating coronary artery disease severity. Medicine 2015; 94(39):e1530.
  10. Hong OK, Yoo SJ, Son JW, Kim MK, Baek KH, Song KH, et al. High glucose and palmitate increases bone morphogenic protein 4 expression in human endothelial cells. The Korean Journal of Physiology & Pharmacology: Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology 2016; 20(2):169.
  11. Li S, Guo S, He F, Zhang M, He J, Yan Y, et al. Prevalence of diabetes mellitus and impaired fasting glucose, associated with risk factors in rural Kazakh adults in Xinjiang, China. International journal of environmental research and public health 2015; 12(1):554-65.
  12. Sorescu GP, Song H, Tressel SL, Hwang J, Dikalov S, Smith DA, et al. Bone morphogenic protein 4 produced in endothelial cells by oscillatory shear stress induces monocyte adhesion by stimulating reactive oxygen species production from a nox1-based NADPH oxidase. Circulation research 2004; 95(8):773-9.
  13. Donyaei A, Kiani E, Bahrololoum H, Moser O. Effect of combined aerobic–resistance training and subsequent detraining on brain‐derived neurotrophic factor (BDNF) and depression in women with type 2 diabetes mellitus: A randomized controlled trial. Diabetic Medicine 2024; 41(3):e15188.
  14. Codella R, Ialacqua M, Terruzzi I, Luzi L. May the force be with you: why resistance training is essential for subjects with type 2 diabetes mellitus without complications. Endocrine 2018; 62(1):14-25.
  15. Miyachi M. Effects of resistance training on arterial stiffness: a meta-analysis. British journal of sports medicine 2013; 47(6):393-6.
  16. Gobeske KT, Das S, Bonaguidi MA, Weiss C, Radulovic J, Disterhoft JF, et al. BMP signaling mediates effects of exercise on hippocampal neurogenesis and cognition in mice. PloS one 2009; 4(10):e7506.
  17. Sadeghi Eshtehardi F, Peeri M, Azarbayjani MA. The effect of different intensity circuit resistance training on the levels of selected adipokines (WISP-1, WISP-2, BMP4) in obese postmenopausal women. Razi Journal of Medical Sciences 2022; 28(12):15-27.
  18. Yambe T, Yoshizawa M, Saijo Y, Yamaguchi T, Shibata M, Konno S, et al. Brachio-ankle pulse wave velocity and cardio-ankle vascular index (CAVI). Biomedicine & pharmacotherapy 2004; 58:S95-8.
  19. Badri N, Hamedinia MR, Hosseini Kakhk AR, Askari R, Azizi R. The Effect of Two Types of Combined Training on Physical Performance and Body Composition in Type 2 Diabetic Women with Peripheral Neuropathy. Journal of Health and Care 2019; 21(1):77-89.
  20. Misra A, Alappan NK, Vikram NK, Goel K, Gupta N, Mittal K, et al. Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes care 2008; 31(7):1282-7.
  21. Lambers S, Van Laethem C, Van Acker K, Calders P. Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Clinical Rehabilitation 2008; 22(6):483-92.
  22. Larose J. The effect of exercise training on physical fitness in type 2 diabetes mellitus (Doctoral dissertation, University of Ottawa (Canada)); 2009.
  23. Zarei M, Hamedinia M, Haghighi A, Noorafshar R, Amini S. Effect of three combined aerobic-resistance exercise training protocols with different intensities on metabolic control and visfatin levels in men with type 2 diabetes. Iranian Journal of Diabetes and Metabolism 2016; 16(1):63-76.
  24. Koroni R, Yonesyan A, Donyaei A. Comparison of the effect of 8 weeks of different exercises (endurance, resistance and combined) on serum levels of nesfatin-1 and insulin resistance index in women with type 2 diabetes. Journal of Applied Health Studies in Sport Physiology 2023; 10(1):83-96.
  25. Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologia 2007; 50(11):2239-44.
  26. Behjati Ardakani A, Qassemian A, Koushki M, Shakour E, Mehrez A. The effect of a resistance training course on blood pressure and nitric oxide levels in elderly women. Iranian Journal of Ageing 2018; 13(1):16-27.
  27. Helbing T, Arnold L, Wiltgen G, Hirschbihl E, Gabelmann V, Hornstein A, et al. Endothelial BMP4 regulates leukocyte diapedesis and promotes inflammation. Inflammation 2017; 40(6):1862-74.
  28. Christensen GL, Jacobsen ML, Wendt A, Mollet IG, Friberg J, Frederiksen KS, et al. Bone morphogenetic protein 4 inhibits insulin secretion from rodent beta cells through regulation of calbindin1 expression and reduced voltage-dependent calcium currents. Diabetologia 2015; 58(6):1282-90.