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ORIGINAL ARTICLE
Year : 2012  |  Volume : 8  |  Issue : 2  |  Page : 238-242

Effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer


1 Department of Sport Sciences, Kish International Campus, University of Tehran, Kish Island, Iran
2 Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
3 Department of Sport Sciences, Islamic Azad University, Shiraz Branch, Shiraz, Iran
4 Department of Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Isfahan, Isfahan, Iran
5 Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
6 Department of Radiation-therapy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication26-Jul-2012

Correspondence Address:
Reza Nuri
Department of Sport Sciences, Kish International Campus, Mirmohana BLV, Department of Sport Sciences University of Tehran, Kish Island
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.98977

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 > Abstract 

Context: Studies have shown that physical activity or exercise training may decrease the metabolic syndrome.
Aim: The aim of the present study is to clarify the effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer.
Setting and Design: Twenty nine postmenopausal women (58.27 ΁ 6.31 years) with breast cancer were divided into two groups randomly as experimental group (n=14) and control group (n=15).
Materials and Methods: Subjects of experimental group were performed 15 weeks combination exercise training including walking (2 sessions per week) and resistance training (2 sessions per week that was different from walking days). Before and after 15 weeks, fasting insulin and glucose, insulin resistance, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were calculated. Also, Vo2peak, rest heart rate (RHR), systolic blood pressure (SBP), body weight (BW), body mass index (BMI) and waist to hip ratio (WHR) were measured in two groups.
Statistical Analysis Used: Mean values of two groups in pre and post test were compared by independent and paired t-test for all measurements (P≤ 0.05).
Results: Significant differences were observed for VO2peak, RHR, BW, BMI, WHR, SBP, fasting insulin and glucose, HDL-C and TG between experimental and control groups after 15 weeks (P< 0.05).
Conclusions: Combination exercise training can improve metabolic syndrome parameters in postmenopausal women with breast cancer.

Keywords: Breast cancer, exercise training, metabolic syndrome, postmenopausal women


How to cite this article:
Nuri R, Kordi MR, Moghaddasi M, Rahnama N, Damirchi A, Rahmani-Nia F, Emami H. Effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer. J Can Res Ther 2012;8:238-42

How to cite this URL:
Nuri R, Kordi MR, Moghaddasi M, Rahnama N, Damirchi A, Rahmani-Nia F, Emami H. Effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer. J Can Res Ther [serial online] 2012 [cited 2020 Jun 4];8:238-42. Available from: http://www.cancerjournal.net/text.asp?2012/8/2/238/98977


 > Introduction Top


The concept of metabolic syndrome includes a number of metabolic disturbances linked by insulin resistance, which increase cardiovascular disease [1] and breast cancer risk. [1],[2] The National Cholesterol Education Program (NCEP) has defined metabolic syndrome as meeting at least three of the following criteria: 1) waist circumference greater than 102 cm for men and greater than 88 cm for women; 2) triglyceride (TG) levels of 150 mg/dl or more; 3) high density lipoprotein cholesterol (HDL-C) levels less than 40 mg/dl for men and less than 50 mg/dl for women; 4) blood pressure (BP) of 130/85 mmHg or higher; and 5) fasting glucose levels of 110 mg/dl or more. [3] Each of the metabolic abnormalities associated with the syndrome is interrelated and also appears to be independent risk factors for the development of atherosclerosis and cardiovascular disease. [4] For instance, elevated fasting levels of plasma insulin and impaired glucose tolerance have been widely recognized as major independent risk factors for development of coronary heart disease. [5] On the other hand, some evidences suggest that hyperinsulinemia and its features can increase the promotion of mammary carcinogenesis. [6] The aggressive treatment of metabolic syndrome is important because the prevalence of metabolic syndrome is high and increasing in parallel with an increasing breast cancer incidence worldwide. [2] The evidence supports an association between metabolic syndrome and the risk of breast cancer, which appears to be more consistent among postmenopausal than among premenopausal women. [7] In a large cohort of 38,823 Norwegian women, low serum HDL-C, as a part of the metabolic syndrome, was associated with increased postmenopausal breast cancer risk. [2] It is currently recommended that individuals with metabolic syndrome be targeted for therapeutic lifestyle changes, which consist mainly of increases in physical activity and improvements in diet. [8] Studies have shown that physical activity may decrease the metabolic syndrome. [9],[10] Physical activity can improve insulin action, reduces adiposity, enhances cardio-respiratory fitness, and induces a favorable lipoprotein particle distribution. [11] Also, increased physical activity can reduce BMI and insulin as a potential mediator of breast cancer and other chronic diseases. [12] For instance, Stone and Saxon, reported that exercise is a key component of effective treatment of the metabolic syndrome. [13] Ross et al., indicated that exercise-induced weight loss and diet-induced weight loss provide similar reductions in abdominal obesity, visceral fat, and insulin resistance. [14] Also, Frank et al., found that regular moderate-intensity exercise can be used to improve metabolic risk variables such as insulin and leptin in overweight/obese postmenopausal women. [15] It seems that exercise training, especially combination exercise training, have positive effects for breast cancer survivors. Ligibel et al., found that combination exercise training decreases insulin levels and hip circumference in breast cancer survivors. However, a study demonstrated the effect of exercise on metabolic syndrome in postmenopausal women. [15] Although, some authors studied the effect of exercise on insulin and insulin resistance in breast cancer survivors, [16],[17],[18] but there are no studies on the effect of combination exercise training on metabolic syndrome in breast cancer survivors. Therefore, we evaluated the effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer.


 > Materials and Methods Top


Subjects

Subjects of the current study were selected from the Center of Oncology and Radiation therapy. The name and medical records list of 1341 women with breast cancer who came to this center for treatment from 2005 to 2008 were given to primary survey. After primary survey, 342 women of 50 to 65 years old were selected. They received surgery, chemotherapy and radiation therapy and they had current hormone therapy. These patients were being in stage I to IIIB. They didn't have specific illness and didn't have any experience of menstrual cycle in the past six months. Also, they had not participated in any exercise training or physical activity and their BW has not changed in the past six months as much as 10% of their whole BW. Thirty eight women indicated their readiness to participate in this study. Physical activity readiness questionnaire (PAR-Q) and inform consent were completed by all subjects. By surveying the questionnaire, it was specified that 32 of them had conditions for taking part in the current study. They were divided into two groups randomly as experimental group and control group. At the end of exercise training program, 29 subjects (15 subjects in control group and 14 subjects in experimental group) completed the relevant measurements of the post test.

Measurements of Height, BW, BMI, WHR, SBP and Vo2peak

Height was measured by stadiometer (Seca model, made by German). BW was measured without shoes by a digital scale (Pand Electronic model, made by Iran). BMI was measured by using the following formula: BMI= weight (kg) / height 2 (m). Waist circumference was measured at the bending line, and hip circumference measurement was recorded at the point of maximum girth. Waist-to-hip ratio was calculated as follows: waist-to-hip ratio= waist (cm) / hip (cm). SBP was measured with a Japanese sphygmomanometer model ALPK2 in seated position. All the measurements were obtained twice and were recorded by one same staff who was blinded to subjects in pre and post test. Vo 2peak was measured by modified Bruce protocol in two groups. All measurements were obtained from subjects 48 h before blood sampling.

Blood samples

Blood samples were collected after a 10-minrecumbence between 07.00 and 9.00 h after an overnight fasting (12 h fasting). Furthermore, the subjects were told to abstain from vigorous exercise 48 h before blood sampling. Two 10-ml redtop tubes were collected for serum. After the blood was clotted, the samples were centrifuged at 10,000 rpm for 10 min at 4°C. Serum was then separated and stored at -80°C until all samples were collected. Duplicate measurements were made for each sample, and the mean of the duplicate measurements was assigned as the sample value. Blind duplicates were used for determining coefficients of variation (CV).

Laboratory Analyses

Insulin was measured using electrochemiluminescent immunoassay (ECLIA, Roche Diagnostics) method in μU/ml (1 μU/ml = 6.954 pmol/l). The mean intra-assay CV was 3.2% for insulin. Glucose was measured using a hexokinase ultraviolet assay. The intra-assay CV for glucose measurements was 1.2%. Insulin resistance was calculated by the homeostatic model assessment (HOMA); HOMA= [insulin (μU/ml)×glucose(mg/dl)]/22.5. High-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured enzymatically (Diagnostic, Pars Kits).

Exercise training protocol

Experimental groups were participated in supervised walking program for two times per week. Walking program started at 45% of target heart rate (THR) for 25 min in first five weeks. Duration of walking in second five weeks was 35 min and intensity was 55% THR. In last five weeks, duration of walking was 45 min and intensity was 65% THR. Heart rate was controlled by polar heart rate belt. Also, experimental group subjects were participated in a 60-min resistance training that held twice weekly for 15 weeks, which was different from walking days. They were performed three sets each of nine common resistance training; subjects lifted as much weight as they could for 10 repetitions per set in first five weeks, 12 repetitions per set in second five weeks and 14 repetitions per set in last five weeks. Subjects built up to three sets per exercise. The nine resistance training exercises included exercises performed on Cybex strength training equipment (Smith press squats, leg press, leg extension, seated leg curl, lat pulldowns) and with free weights (bench press, overhead press, biceps curls, and triceps kickbacks). Exercise training protocol was held in 10-11 A.M. The control group subjects were participated in measurements only, did not train and were asked not to begin a structured exercise program. All subjects were asked to avoid changes in dietary habits for weight loss purposes for the duration of the study.

Statistical analysis

Results were expressed as mean ± SD and distributions of all variables were assessed for normality. Independent t-test and paired t-test were used to evaluate changes in variables. The level of significance in all statistical analyses was set at P≤0.05. Data analysis was performed using SPSS software for windows (version 13, SPSS, Inc., Chicago, IL).


 > Results Top


Physical and physiological characteristics of the subjects at baseline and week 15 are presented in [Table 1]. BW, BMI, WHR and SBP were decreased significantly (P<0.05) after intervention in the experimental group compared with the control group. After 15 weeks of combination exercise training, maximum oxygen consumption was increased significantly (P<0.05) in experimental group, while no significant change in the control group was found.
Table 1: Physical and physiological characteristics (mean ± SD) of the subjects at baseline and after training

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Results showed that TG was decreased significantly in the experimental group (P<0.05, 7.4%) and was increased significantly in the control group (P<0.05, 28.5%) after 15 weeks. On the other hand, HDL-C was increased significantly in the experimental group (P<0.05, 4.6%) and was decreased significantly in the control group (P<0.05, 7.3%) after 15 weeks. Significant difference, also, was observed between two groups after 15 weeks (P<0.05). Fasting glucose was reduced in the experimental group (P<0.05, 9.1%) while there was virtually no change in the control groups. Similarly, fasting insulin concentration was significantly reduced in the experimental group (P<0.05, 14.1%) after 15 weeks compared with the control group. For insulin resistance determined by HOMA-IR, no significant difference was found between groups [Table 2].
Table 2: Metabolic characteristics (mean ± SD) of the subjects at baseline and after training

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 > Discussion Top


The aim of the present study is clarify the effect of combination exercise training on metabolic syndrome parameters in postmenopausal women with breast cancer. The main findings of the current study are the following: BW and BMI were reduced in experimental group from an average of 70.3±12.7 kg to 69.4 ± 13.5 and from an average of 27.9±3.5 to 27.7±4.7, respectively. SBP was declined from an average of 129.1±5.2 mmHg to 123.6±3.7 mmHg in experimental group after 15 weeks of combination exercise training. TG was dropped from an average of 190.2±6.3 to 180.7±63.3 mg/dl in experimental group after 15 weeks of combination exercise training. In experimental group, HDL-C was increased from an average of 52.8±6.7 to 55.2±7.4 mg/dl, and was decreased in control group from an average of 55.4±7.5 to 51.1±6.6 mg/dl. Fasting blood glucose and insulin levels were declined over the 15 weeks combination exercise training in experimental group from an average of 102.6±15.4 to 93.2±14.2 mg/dl and from an average of 12.7±3.3 to 10.9±3.1 mg/dl, respectively. Insulin resistance was decreased from an average of 3.1±1.2 to 2.7±1.6 in experimental group. However, decreased insulin resistance was not significant. Combination exercise training program in postmenopausal women with breast cancer resulted in significant decreases in insulin and glucose concentrations (P<0.05). Elevated concentrations of insulin and glucose are associated with increased risk type 2 diabetes, several cancers (such as breast cancer) and cardiovascular disease. [15] On the other hand, some studies have indicated that increased fasting insulin levels, which are often seen in obese and inactive individuals, are associated with an increased risk of recurrence and death in patients with early-stage breast cancer. [19] Also, the associations seen among physical activity and insulin levels have found for women with established cancers as well. Higher fasting insulin levels and obesity independently predicted increased recurrence risk and decreased survival in breast cancer patients. [12] Insulin increases cell proliferation and inhibits cell apoptosis resulting in occurrence and recurrence of breast cancer. [20] Insulin levels are strongly associated with obesity and low levels of physical activity. [16] In the current study, insulin and glucose levels were decreased in experimental group (17 and 9%, respectively) and were increased in control group (27 and 8.5%, respectively). This finding is in agreement with Ligibel et al. They found that 15 weeks combination exercise training can reduce insulin and glucose levels in breast cancer survivor. [19] Also, Irwin et al., reported that aerobic exercise reduces insulin levels in breast cancer survivors. [16] Messier et al., showed that high levels of cardio-respiratory fitness are associated with lower levels of insulin and glucose in overweight and obese postmenopausal women. [21] Also, there is relationship between BW and fasting insulin levels. [16] Chlebowski et al., suggested that strategies to reduce BW involving either or both increasing physical activity and decreasing caloric intake will reduce insulin levels in postmenopausal women. [12] However, Schmitz et al., randomly assigned 85 breast cancer survivors to a strength training intervention or to a delayed exercise control group. Women in the exercise group significantly increased lean body mass and decreased body fat compared with controls, but there was no significant change in insulin levels in either group. [18] In the present study, after 15 weeks, BW was decreased in experimental group and was increased in control group, significantly. There is inverse association between physical activity, BMI and WHR; higher physical activity, lower BMI and WHR. [22] Doyle et al., demonstrated that decreased BMI can reduce insulin levels. [23] For this reason, another probable mechanism for decreased insulin levels in experimental group can be reduced BMI. In general, there are some mechanisms by which exercise training has been shown to reduce insulin and glucose, including elevated oxidative enzymes and glucose transporters in the muscle. However, Fairey et al., reported that exercise training has no significant physiological effect on fasting insulin and glucose in postmenopausal breast cancer survivors that is in contrast to present study. In their study, exercise training did not induce weight loss, which is known to reverse the hyperinsulinemia. [17] In general, it seems that if combination exercise training can reduce BW and BMI resulting in a decrease in fasting insulin and glucose levels in postmenopausal women with breast cancer.

The other finding of the current study indicated that 15 weeks combination exercise training can't improve insulin resistance in postmenopausal women with breast cancer. In this study, insulin resistance was reduced in the experimental group (3.1±1.2 to 2.7±1.6, 13%). However, the changes of insulin resistance between the two groups were not significantly different. This finding is in agreement with Fairey et al (2003) finding. In the present study and Fairey et al's study, blood collection was performed after a period of at least 48 h without exercise. It is known that acute exercise is associated with substantial improvements in insulin resistance when measured within 48 h of the last exercise session. [17] Another probable reason for absence statistical significance difference between two groups may be due to a relatively small subject number (type II error).

Increased TG is associated with lower levels of HDL-C, obesity and diabetes mellitus, all of which are strong cardiac risk factors. [4] It is documented that regular physical activities or exercise training improve blood pressure and lipid profiles. [24] The effects of exercise or physical activity on lipids and lipoprotein profiles are well known. Active individuals have higher levels of HDL-C and lower levels of TG, LDL and VDLL-C, if compared to inactive individuals. [25] In the present study, lipoprotein-lipid profile was improved, as there was a reduction in TG and an increase in HDL-C following the 15 weeks combination exercise training. Fairey et al., revealed that exercise training may have beneficial effects on cardiovascular risk factors in postmenopausal breast cancer survivors. In their study, subjects trained on cycle ergometers 3 times per week for 15 weeks. After 15 weeks, SBP and TG were decreased and HDL-C was increased significantly. [26] It has been suggested that exercise is associated with improvements in blood pressure. [27] There is inverse correlation between hypertension and HDL-C. In the current study, SBP was reduced in experimental group after 15 weeks of combination exercise training. It seems that decreased SBP related to increased HDL-C. A mechanism for improvement of TG and HDL-C is that exercise increases cholesterol absorption resulting in cholesterol metabolism and highlights the complex relationship between exercise training and cholesterol homeostasis. Also, improvements in TG and HDL-C in this study are more closely related to reductions in BW. Higher HDL-C and lower TG, on the other hand, is related to aerobic capacity. In the present study, both BW and aerobic capacity (Vo 2peak ) were improved and, therefore, reduced BW and elevated aerobic capacity resulted in improvement of HDL-C and TG. However, BW reduction can improve HDL-C and TG more than aerobic fitness. [28]

The current study has some limitations. The limitations of present study include the small sample size of subjects, short exercise intervention with no long-term follow-up and without dietary control in exercise training period. It has been shown that physical activity or physical fitness is inversely associated with incidence of metabolic syndrome. [29] For instance, Lakka and Laaksonen (2007) in randomized controlled trials indicated that exercise training has a mild or moderately favorable effect on many metabolic risk factors. [30] In general, 15 weeks combination exercise training has positive effects on metabolic syndrome in postmenopausal women with breast cancer.

In conclusion, changes in body weight and cardio-respiratory fitness are important factors mediating the change in metabolic syndrome components. If exercise training can improve the metabolic risk profiles, it might indirectly reduce recurrences of breast cancer risk and cardiac disease in breast cancer patients. As a suggestion, exercise training in postmenopausal women with breast cancer can improve metabolic syndrome resulting in reduction of recurrences of breast cancer and cardiac disease.

 
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    Tables

  [Table 1], [Table 2]


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