Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Structured exercise as part of lifestyle modification plays an important role in the improvement of non-alcoholic fatty liver disease (NAFLD); however, its effectiveness has been shown to vary. This systematic review with meta-analysis investigated the effects of exercise on liver function and insulin resistance markers in patients with NAFLD. METHODS: Six electronic databases were searched using terms related to exercise and NAFLD up to March 2022. Data were analyzed using a random-effects model to estimate the standardized mean difference (SMD) and 95% confidence interval. RESULTS: The systematic search identified 2583 articles, of which a total of 26 studies met the inclusion criteria and were eligible. Exercise training had a moderate effect on reducing ALT (SMD: -0.59, p = 0.01) and small effects on reducing AST (SMD: -0.40, p = 0.01) and insulin (SMD: -0.43, p = 0.02). Significant reductions in ALT were found following aerobic training (SMD: -0.63, p < 0.01) and resistance training (SMD: -0.45, p < 0.001). Moreover, reductions in AST were found following resistance training (SMD: -0.54, p = 0.001), but not after aerobic training and combined training. However, reductions in insulin were found following aerobic training (SMD: -0.55, p = 0.03). Exercise interventions for <12 weeks compared to ≥12 weeks were more effective in reducing FBG and HOMA-IR, while interventions for ≥12 weeks compared to <12 weeks were more effective in reducing ALT and AST levels. CONCLUSIONS: Our findings support the effectiveness of exercise in improving liver function markers but not in blood glucose control in NAFLD patients. Additional studies are needed to determine the exercise prescription to maximize health in these patients.

Effects of Exercise Training on Inflammatory and Cardiometabolic Risk Biomarkers in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The interaction between type 2 diabetes mellitus (T2DM) and cardiometabolic morbidity and mortality stems from the progressive nature of inflammation underpinning both diseases. Exercise training is considered an effective treatment strategy for T2DM and cardiometabolic diseases. OBJECTIVE: The current systematic review and meta-analysis investigated the effects of exercise training on inflammatory and cardiometabolic risk biomarkers in patients with T2DM. DATA SOURCES: Electronic databases (PubMed/Medline, Embase, Cochrane Library, CINAHL, Google Scholar, Scopus, and Web of Science) were searched for randomized controlled trials (RCTs) from inception to January 2022. We used random effects models to estimate weighted mean differences with 95% confidence intervals. STUDY SELECTION: Twenty-five RCTs were included (N = 1257 participants; mean age = 52 years). Included studies had moderate to good overall methodological quality (TESTEX = 9 (range 7-13). RESULTS: Meta-analysis indicated that exercise training significantly increased adiponectin and decreased fasting insulin, homeostatic model assessment for insulin resistance, tumor necrosis factor-α, interleukin-6, and C-reactive protein (ps ≤ 0.05). Subgroup analysis by type of training indicated that aerobic exercise had the most consistent beneficial effects as compared to other types of exercise training; however, there was high heterogeneity among studies. CONCLUSION: Different types of exercise training increase adiponectin levels and decrease pro-inflammatory cytokines such as TNF-α, IL-6, and CRP, as well as fasting insulin and insulin resistance markers in patients with T2DM. However, these effects were not beneficial for more commonly measured cardiometabolic risk factors (i.e., lipid profiles). Additional relevant clinical trials are required to confirm these results. TRIAL REGISTRATION: This systematic review and meta-analysis was prospectively registered in the PROSPERO database (CRD42022307396).

Effects of exercise training on inflammatory and cardiometabolic health markers in overweight and obese adults: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: The improvements in inflammation and cardiometabolic health play an important role in the prevention and treatment of obesity. However, the interactions between different exercise training (ET) modalities with inflammatory and cardiometabolic biomarkers are not completely understood. This systematic review and meta-analysis investigated the effects of ET on inflammatory and cardiometabolic health markers in overweight and obese adults. EVIDENCE ACQUISITION: A systematic search was conducted in PubMed, CINAHL, MEDLINE, Cochrane, Google Scholar, Scopus and Web of Science up to December 15, 2021. Thirty-five studies including 2752 participants were included and analyzed using a random-effects model to estimate weighted mean differences (MD) with 95% confidence intervals (CI). EVIDENCE SYNTHESIS: The meta-analysis found that ET significantly (P<0.05) increased adiponectin (WMD: 0.72 µg/mL; 95% CI: 0.60 to 0.84; SMD=0.65) and maximal oxygen consumption levels (WMD: 5.26 mL.kg.min; 95% CI: 3.84, 6.69; SMD=1.21). Moreover, ET significantly (P<0.05) reduced fasting insulin (WMD: -2.40 µIU/mL; 95% CI: -3.43 to -1.37; SMD=-0.87), fasting blood glucose (WMD: -5.41 mg/dL; 95% CI: -7.91, -2.91; SMD=-0.66), insulin resistance (WMD: -0.66; 95% CI: -1.08, -0.24; SMD=-0.66) and triglyceride levels (WMD: -10.88 mg/dL; 95% CI: -17.61, -4.15; SMD=-0.91). No significant changes were observed in interleukin-6, tumor necrosis factor-α, leptin, C-reactive protein and cholesterol concentrations. Subgroup analysis by type of training indicated that aerobic and resistance exercise had the most consistent beneficial effects as compared to other modalities. CONCLUSIONS: Our findings suggest that ET may improve inflammation and cardiometabolic health in overweight and obese adults. Aerobic and resistance training appear to be more beneficial for improving adiponectin, fasting insulin, fasting blood glucose, insulin resistance index and triglyceride levels as compared to other exercise modalities. Further long-term studies are required to confirm and expand on these findings.

The effect of exercise interventions on Irisin level: a systematic review and meta-analysis of randomized controlled trials.

Irisin is a hormone that is offered to be a hopeful remedial target in obesity and type 2 diabetes. It has received striking attention recently, whereas, the interactions between exercise training and irisin are still unclear. Therefore, this systematic review and meta-analysis investigated the impacts of exercise interventions on circulating irisin in adults. A systematic search was conducted in PubMed, CINAHL, MEDLINE, Cochrane, Google Scholar, and Scopus up to July 15, 2021. Twenty-four studies, which assessed a total of 921 participants were included and analyzed using a random-effects model to estimate weighted mean differences (MD) with 95 % confidence intervals (CI). Overall, data revealed that exercise training significantly increased circulating irisin (MD: 0.01, 95 % CI: 0.00, 0.01, p = 0.005), and declined insulin (MD: -2.09, 95 % CI: -2.81, -1.37, p < 0.00001), glucose (MD: -12.89, 95 % CI: -16.52, -9.26, p < 0.00001), and insulin resistance (MD: -0.89, 95 % CI: -1.15, -0.62, p < 0.00001). Subgroup analysis revealed that irisin raised significantly when resistance training (p = 0.04) and combined training (p = 0.002) were applied, and for the type 2 diabetes and prediabetes (p = 0.002 for both) groups. Moreover, subgroup analysis by the type of intervention demonstrated that insulin reduced when aerobic training (p < 0.00001) and combined training (p = 0.0003) were employed, but glucose and HOMA-IR reduced after all three types of exercise training. These findings demonstrate that exercise interventions may produce ameliorations in circulating irisin. Further long-term studies are required to confirm these findings.

Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal. PURPOSE: This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women. METHODS: A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI). RESULTS: The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm2; 95% CI, 0.00 to 0.01], p = 0.0005; I2 = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm2, 95% CI, 0.01 to 0.02], I2 = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm2, 95% CI 0.00, 0.02]; p = 0.009; I2 = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD. CONCLUSION: Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.

Effects of Physical Exercise on Cardiometabolic Biomarkers and Inflammatory Markers in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The prevalence of obesity among children as well as the beneficial effects of physical exercise (PE) on weight loss has been determined by modulating the secretory factors of adipose tissue. PE has also been shown to have beneficial effects on obesity. OBJECTIVE: The objective of this systematic review and meta-analysis was to investigate the effects of physical exercise (PE) on adiponectin and other important health markers in children. DATA SOURCES: We searched 6 electronic databases (PubMed/Medline, Embase, Cochrane Library, Cinahl, Scopus, and Web of Science) and Google Scholar for randomized controlled trials from inception to December 15, 2021. We used random-effects models to estimate weighted mean difference (WMD) with 95% confidence intervals (CI). STUDY SELECTION: Fourteen studies were included (N = 468 participants; mean age: 14 years). RESULTS: In general, PE increased adiponectin (WMD: 0.91 µg/mL; 95% CI, 0.27 to 1.55, p = 0.005), high-density lipoprotein cholesterol (HDL-C) (WMD: 1.01 mg/dL; 95% CI, 0.33 to 1.69, p = 0.004), and VO2max (WMD: 2.52 mL.kg.min; 95% CI, 1.41 to 3.62, p = 0.00,001). The levels of c-reactive protein (WMD: -0.37 mg/L; 95% CI, -0.57 to -0.17, p = 0.0003), insulin (WMD: -4.61 µIU/ml; 95% CI, -5.46 to -3.76, p = 0.00,001), fasting glucose (WMD: -5.11 mg/dL; 95% CI, -7.88 to -2.34, p = 0.0003), and insulin resistance index (WMD: -1.44; 95% CI, -1.92 to -0.96, p = 0.00,001), decreased significantly. CONCLUSION: Our study showed that PE may increase the level of adiponectin, HDL-C, and VO2max in children.

The effect of six months aerobic exercise during dialysis on liver enzymes, cystatin C and quality of life of hemodialysis patients.

BACKGROUND: The purpose of this study was to investigate the effect of six-month aerobic exercise during dialysis on hepatic enzymes, cystatin c, glomerular filtration factors and the quality of life of hemodialysis patients. METHODS: The subjects of this study were 30 subjects randomly divided into two groups including experimental groups (N.=15) and control (N.=15). The aerobic exercise program consisted of six months of aerobic exercise, 3 sessions per week, and each session for 30 to 45 minutes with a maximum intensity of 50-70% of the maximum heart rate stored on the minibike. Paired sample t-test and repeated measures (ANOVA) were used to compare between- and within-group variance changes. Significance level was considered less than 0.05. RESULTS: Mass loss, Body Mass Index, body fat percentage, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, cystatin C significantly decreased while the maximum oxygen consumption at the end of the period increased significantly. Changes in intragroup mean in physical, psychological, general health, vitality, social activity, physical function, emotional function, and life satisfaction in the group of men with kidney disease increased significantly at the end of the training period. Phosphorus, calcium, sodium, potassium, urea, creatinine and bilirubin levels decreased significantly. CONCLUSIONS: The results indicate the positive effects of using aerobic exercise as a noninvasive and non-pharmacological method with minimal side effects that can be effective in improving the renal function of these patients. Therefore, due to this, this method can probably be used to improve the condition of patients under hemodialysis.

The effect of eight weeks resistance and aerobic training on myostatin and follistatin expression in cardiac muscle of rats.

Introduction: The clinical studies have shown that the myostatin gene expression and its serum density occur more frequently in heart patients than in healthy individuals. The purpose of this study is to investigate the influence of 8-week resistance and aerobic exercise on the myostatin and follistatin gene expression of myocardium muscle of healthy male Wistar rats. Methods: In this experimental study, 20 five-week-old adult Wistar rats (250 ± 26.5 g) were divided into three groups: healthy control group (n = 6), resistance exercise group (n = 7), and aerobic exercise group (n = 7). The resistance and aerobic exercise plan consisted of 8 weeks and 3 sessions per week. The resistance exercise group performed climbing a one-meter 26-stair ladder with a slope of 85 degrees for 3 sets of 5 repetitions per session. The aerobic exercise group performed running at a speed of 12 meters per minute for 30 minutes during the first sessions gradually increasing up to a speed of 30 meters per minute for 60 minutes during the final sessions (equivalent to 70% to 80% of maximum oxygen consumption). The differences between the groups were evaluated using a one-way analysis of variance (ANOVA) test. When appropriate, LSD post-hoc test was used. The significance level for the study was less than 0.05. Results: The results of this study shows that after 8 weeks of exercise, there is no significant difference between myostatin mRNA gene expression levels of the heart muscle among the three groups of control, resistance exercise, and aerobic exercise (P = 0.172, F = 1.953). However, the mean differences between follistatin mRNA levels of the heart muscle among the three groups of control, resistance exercise, and aerobic exercise are statistically significant (F = 38.022, P = 0.001). Furthermore, the ratio of follistatin to myostatin mRNA gene expression of the heart muscle (P = 0.001, F = 10.288) shows significant difference among the three groups. Conclusion: Our results indicate that the resistance and aerobic exercise could cause a decrease in myostatin and an increase in follistatin levels, thus preventing many muscular physiological disorders such as arthritis and muscle weakness.

The effects of ramadan fasting and physical activity on blood hematological-biochemical parameters.

UNLABELLED: Objective(s) : Fasting during the month of Ramadan is a religious obligation and belief for healthy adult Muslims. The aim of the present study was to determine the effects of Ramadan Fasting and physical activity on 'Blood Hematological-Biochemical Parameters'. MATERIALS AND METHODS: In this study, twenty-six healthy males in two experimental groups were compared in two different instances before and after the training period. The groups which were selected by convenience sampling method were divided into two non-active fasting (n=13) and active fasting (n=13) groups. For comparison purposes between groups, paired and independent sample t-test was performed, respectively, after ensuring their normality within a significance level of P≤0.05. RESULTS: HDL-C increased significantly in both active and non-active fasting groups, Moreover, amount of hematocrit (Hct), red blood cell count (RBC), TC, LDL, VLDL, LDL/HDL and TC/ HDL decreased significantly. Amount of hemoglobin (Hgb) and glucose reduced significantly in the active-fasting group. The variation of the means between the groups in the Hgb index and LDL/HDL were statistically significant. CONCLUSION: Fasting during the month of Ramadan by regular physical activity caused positive alterations in Hematological-Biochemical Index. These changes may be due to the alterations in diet, biology response of the body to the starving and physical activity during this month.

The effect of ramadan fasting and physical activity on body composition, serum osmolarity levels and some parameters of electrolytes in females.

BACKGROUND: So far, there have been a few and incoherent results about the effects of physical activities. Fasting in Ramadan has an effect on the level of osmolarity and the concentration of serum electrolytes both in active and inactive females. OBJECTIVES: The aim of this study was to observe the changes of serum electrolytes and osmolarity levels according to regular exercise during fasting. PATIENTS AND METHODS: TWENTY TWO HEALTHY FEMALES WHO WERE ELECTED BY CONVENIENCE SAMPLING METHOD WERE DIVIDED INTO TWO GROUPS: 1) fasting + exercise (FE; n = 11) and 2) fasting + non exercise (FNE; n = 15). The FE group participated in aerobic training for four sessions per week during the fasting. All measurements were done once before the first day, on the second week, on the fourth week and two weeks after fasting month and these measures were used to analyze test results. RESULTS: THE MEAN DIFFERENCES WERE AS FOLLOWS: significant weight loss, BMI, WHR, in two groups at the end of Ramadan (P < 0.05). The mean of weight, BMI, WHR, body fat, protein, mineral and total water showed no difference between groups (P > 0.05). Potassium, creatinine, urea and uric acid had been decreased significantly in both groups (P < 0.05). Variance between groups was significant only in variable urea (P < 0.05). Variations within group had been changed in FBS; sodium, phosphorus and osmolarity levels were not changed significantly. CONCLUSIONS: According to this result, regular exercise in case of fasting in Ramadan led to some changes in serum osmolarity index, electrolytes and water. Therefore, it is important for female athletes to consider applying a suitable nutritious diet and sufficient water consumption during Ramadan.

Influence of selected exercise on serum immunoglobulin, testosterone and cortisol in semi-endurance elite runners.

PURPOSE: The aim of this study was to compare the levels of serum immunoglobulin (IgA, IgM, IgG), testosterone and cortisol in semi-endurance elite runners during general preparation and competition phase of training. METHODS: Thirteen semi-endurance elite male runners with an average age of 18.92±1.7 years volunteered to take part in this study. The runners participated in the selected training for a period of 14 weeks and 12 sessions per week (in the morning and afternoon). Blood samples were collected during the three phases of training (before-preparation phase, after-preparation phase and before-competition phase). Data were analyzed by repeated measures and Bonferroni post hoc test, at a significance level of P<0.05. RESULTS: The levels of serum IgM in semi-endurance elite runners after preparation phase reduced significantly (P=0.004), while these levels during the competition phase increased even though significantly. The levels of serum IgG and IgA also reduced, however not significantly, during both phases. Moreover, after preparation phase, there was no significant change in serum IgA levels; though, these levels reduced, however not significantly, before competition phase. Cortisol levels significantly decrease after preparation phase (P=0.04); although, it increased before competition phase. Testosterone/cortisol ratio increases significantly after preparation phase (P=0.04), and it decreased before competition phase. Testosterone levels intangibility increased and decreased respectively after preparation and before competition phases. CONCLUSIONS: Findings indicated that long and intensive exercises weaken the immune system, while moderate and short drills strengthened this system.