Razi Journal of Medical Sciences
Year:2022 | Volume:29 | Issue:9|Papers Count:3

Background & Aims: Diabetes is a metabolic disease characterized by chronic hyperglycemia and impaired metabolism of carbohydrates, lipids and proteins. This disease is caused by defects in insulin secretion, insulin function, or both (1, 2). This chronic disease can have serious short-term and long-term consequences that affect the health and quality of life (QOL) of patients (3). Type 2 diabetes accounts for approximately 90% of all cases of diabetes and is associated with a variety of immutable and modifiable risk factors (4). QOL refers to a person's individual perception of physical, emotional, and social status (5, 6). Patients with type 2 diabetes have a lot of stress to treat and their QOL is lower than healthy people (7, 8). Also, for chronic diabetics, complete cure cannot be achieved and clinical interventions can provide a good estimate of disease control, but the ultimate goal of diabetes care is to prevent the patient's QOL from worsening (3). It is important to understand the predictors and identify risk factors for QOL, and these factors may be targeted for prevention (5). Since the improvement of QOL is one of the important goals of treatment of diabetic patients (3, 10) and studies have shown that diabetes can have negative effects on physical function, development of complications, mental and psychological and personal, family and social relationships (15, 16),Therefore, understanding the factors related to QOL is of particular importance in the treatment programs of these patients (5). Cardiorespiratory endurance is one of the health-related physical fitness factors (2). Cardiorespiratory endurance is defined as the ability of the circulatory and respiratory systems to supply oxygen during physical activity and is usually defined as the maximum oxygen consumption (VO2max) during submaximal or maximal tests. The main determinants of VO2max are cardiovascular function, cardiac output, pulmonary diffusion capacity, oxygen carrying capacity, liver function, and other environmental constraints such as muscle diffusion capacity, mitochondrial enzymes, and capillary density, all of which are examples of determinants. Are VO2max (2, 21). VO2max is associated with functional capacity and human function and has been shown to be a strong and independent predictor of mortality from all specific causes and diseases (22). Physical activity and the resulting cardiorespiratory fitness are associated with several health benefits, including reduced risk of diabetes, cardiovascular complications, and mortality (23). In view of the above, cardiorespiratory fitness is a variable related to mortality prediction and as a health-related variable in diabetic patients (23),Therefore, cardiorespiratory fitness can be considered in determining the strategies of primary and secondary prevention programs of cardiovascular diseases in patients with type 2 diabetes,Considering the importance of factors related to the prediction and identification of risk factors for QOL (5),It is necessary to measure the relationship between cardiorespiratory fitness as a health-related physical fitness variable with QOL in patients with type 2 diabetes. In view of the above, the aim of this study was to investigate the relationship between QOL and cardiorespiratory endurance in patients with type 2 diabetes. Methods: In this cross-sectional correlational study, 150 patients with type 2 diabetes mellitus were randomly selected from patients that had referred to health centers in Zabol city, which included 75 women and 75 men. QOL, demographic characteristics and history of diabetes in patients were measured using a questionnaire. Blood variables were measured on an empty stomach. Cardiorespiratory fitness was also measured using the Tecumseh step test. Pearson correlation coefficient was used for statistical analysis. Results: There was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. There was also a significant negative relationship between cardiorespiratory endurance with glycemic control, age and history of type 2 diabetes. Conclusion: In the study of the relationship between cardiorespiratory endurance and QOL, the results showed that there was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. In a study of patients with type 2 diabetes, Leite et al. (2009) reported that a decrease in VO2max is associated with impaired insulin sensitivity, and that the most common abnormality in the population is at risk for insulin resistance and type 2 diabetes, and a decrease in VO2max is one. Is an important risk factor for disease progression (28). Low resting heart rate and VO2max are associated with a reduction in cardiovascular events (29). Cardiorespiratory disorders are more common in diabetic patients and may partly explain the morbidity and mortality in these patients. There are several potential causes for dysfunction in diabetics: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular dysfunction, myocardial dysfunction, and skeletal muscle changes. These changes are somewhat reversible, and improvement in each of these components may increase functional capacity in diabetic patients (30). Interventional studies indicate an increase in VO2max in adaptation to exercise in patients with type 2 diabetes (2, 31, 32). It can be said that with increasing cardiorespiratory endurance, the level of health increases and with increasing health, patient satisfaction with treatment and satisfaction with QOL improve (27). Also, The results of the present study showed that there was a significant negative relationship between aerobic fitness and HbA1c levels in patients with type 2 diabetes. Jekal et al. (2010) in a study that examined aerobic fitness and HbA1c levels, stated that people with higher cardiorespiratory fitness had better weight and lower HbA1c levels than people with lower endurance (25), which It was consistent with the results of the present study. Abushamat et al. (2020) also stated in their research that diabetes leads to decreased cardiorespiratory function, which is associated with poor glycemic control and its complications (35). Physical activity is effective in controlling blood glucose in diabetics,because it increases insulin sensitivity and glucose tolerance and decreases the level of hyperglycemia in these patients (36). Adaptations in insulin signaling as well as insulin receptors can lead to better blood glucose uptake by muscles. Increasing the number of GLUT4 carriers and increasing muscle mass, which plays a major role in blood glucose uptake, increases the body's response to insulin (38). The results of the present study also showed that there was a significant negative relationship between aerobic fitness and history of diabetes in patients with type 2 diabetes. Hadipoor et al. (2014) also introduced the years of diabetes as one of the factors affecting the physical dimension and QOL of these patients (45). Due to the fact that type 2 diabetes is associated with aging (46) and also the complications of diabetes, including cardiovascular complications with a history of diabetes and poor glycemic control are increased (47),with an increased history of diabetes, it reduces cardiorespiratory endurance in these people. On the other hand, due to having an active lifestyle and higher level of physical fitness, in addition to controlling blood sugar, the potential benefits of physical activity on reducing the complications of diabetes can be enjoyed (44, 50), which can improve QOL in patients with Type 2 diabetes is effective (50, 51). Overall, the results of our study showed that cardiorespiratory fitness was associated with improved QOL in patients with type 2 diabetes, which was negatively associated with age, duration of diabetes, and HbA1c levels.

Background & Aims: Performing normal daily activities requires sufficient muscle size and strength, and atrophy has a negative effect on the overall quality of life,So that the decrease in skeletal muscle mass leads to a decrease in human performance, long-term health and low quality of life. Diabetes is associated with the development of secondary complications in various organs, especially skeletal muscle atrophy. The aim of this study was to evaluate the effect of aerobic training and Tribulus terrestris extract on muscle atrophy indices and oxidant-pro-oxidant balance in extensor digitorum longus muscles of type 2 diabetic desert rats. Skeletal muscle is an important organ for glucose storage and metabolism, apart from being a power-producing machine. Considering the important role of exercise and physical activity along with herbal supplements in health and prevention and treatment of complications caused by diabetes, especially in the vital organs of the body such as skeletal muscles, it seems that investigating the effects of sports activities and herbal supplements on The markers of muscle atrophy are of great importance, but according to the investigations, the data in this regard are very limited. Methods: For implementation of this experimental research, 42 male wistar desert rats 2 months old (average weight 180±, 20 g) were randomly divided into 7 groups. In order to induce muscle atrophy, Dexamethasone (750 μ, g/kg/day) was injected intraperitoneally into desert rats. desert Rats were diabetic using peritoneal injection nicotinamide-STZ. desert Rats in supplemented groups received Tribulus terrestris hydroalcoholic extract with doses of 5 and 10 mg per day by gavage method. Aerobic training was performed on a treadmill at a speed of 23 m/min, 30 min/day, 5 days/week for eight weeks. Using Real Time PCR and PAB methods, plantar muscle tissue was measured using immunoassay method. Shapiro-Wilk test was used to ensure the normal distribution of variables. Two-way analysis of variance and Bonferroni's post hoc test were used to compare the average changes of the investigated factors in the groups. The significance level was considered as p≤, 0. 05 in all cases. All statistical operations were performed with SPSS software version 23. Results: Thistle plant extract (F=136. 305, P=0. 001, μ, =0. 901) and the interaction between training and thistle plant extract (F=419. 949, P=0. 001, μ, =0. 966) had a significant effect on the level of MURF-1 in extensor digitorum longus muscle. . Also, the amount of MURF-1 in the long extensor muscle of the toes with the 5-gram dose was significantly lower than the 10-gram dose group (P=0. 0001). The results showed that aerobic training, Tribulus extract and combined intervention of Tribulus extract with aerobic training resulted in a significant decrease in the expression genes of Atrogin-1, MURF-1, MiR-29b (p=0. 001) and significant increase in methyl guanine (p=0. 001) and oxidant-pro-oxidant balance (PAB) levels in male wistar desert rats exposed to dexamethasone (p=0. 001). Conclusion: The findings of this research show that aerobic training led to a significant decrease in Atrogin-1, MURF-1 and MiR-29b gene expression and a significant increase in methylguanine levels and oxidant-prooxidant balance in type 2 diabetic rats. Aerobic exercise has been shown to reduce DNA damage caused by oxidants. Decreased insulin and increased oxidative stress seem necessary for protein breakdown and muscle atrophy. Therefore, negative regulation of anabolic processes as well as oxidative stress occurred in STZ-treated animals can activate muscle proteolysis and increase MuRF1 expression. Regarding the effect of exercise on the expression of MuRF1 in type 2 diabetic samples, there have been few studies that have expressed different mechanisms in the interpretation of the results,The response of MuRF1 to sports activity can change under the influence of various factors, including the subjects' training history, the intensity and duration of the activity, or the effect of repeated activities. On the other hand, it seems that Hsp25 is one of the mediators that regulate the atrophy pathway, which plays an important role in dealing with atrophy in diabetic conditions, so that increasing its amount due to exercise reduces atrophy and decreases the expression of MuRF1. The mechanism of MiR-29b changes due to exercise training is not well defined. However, miR-29 targets have been found to include IGF-1, p85a, and myeloblastosisrelated protein B (B-myb) in mouse muscle tissue. IGF-1 and p85a are important regulatory proteins for protein translation via miR-29 to inhibit myogenin and protein synthesis, thereby reducing protein components during muscle atrophy. The effect of exercise on redox status depends on many factors, such as type of exercise, exercise load, as well as age, gender, risk factors, and physical condition. Short-term exercises may increase oxidative stress and imbalance between ROS production and antioxidant agents and ultimately lead to mitochondrial dysfunction. However, longterm exercise may enable ROS detoxification by increasing cellular antioxidant activity or stimulating the expression of genes such as Mn-SOD. Other findings of the research show that milk thistle extract and the interaction of exercise and milk thistle extract reduce Atrogin-1, MURF-1 and MiR-29b gene expression and increase methylguanine levels and oxidant-prooxidant balance in the extensor toes long muscle tissue in rats. He had type 2 diabetes. Other findings of the research show that milk thistle plant extract and the interaction of milk thistle plant extract with the reduction of Atrogin-1, MURF-1 and MiR-29b gene expression and the increase of methylguanine levels and the oxidant-prooxidant balance of the extensor digitorum longus muscle tissue in diabetic rats. Type 2 was included. It has been determined that the extract of this plant has hypoglycemic and hypolipidemic properties in the experimental model of diabetes mellitus induced by streptozotocin. In the present study, the hydroalcoholic extract of thistle plant with doses of 5 and 10 mg per kilogram of body weight per day was able to help reduce muscle atrophy in type 2 diabetic rats, and the lower dose brought more benefits. Due to the presence of large amounts of alkaloids, polyphenols, flavonoids, as well as the antioxidant, hypoglycemic and hypolipidemic properties of milk thistle, and based on the findings of this research, it can be said that the presence of antioxidants in milk thistle can reduce muscle atrophy. The inhibitory effect of regular exercise is also at least partly due to adaptation to oxidative stress. The process of adaptation related to exercise is not only related to the production of ROS levels, but also causes an increase in antioxidants and the activity of enzymes that restore the damage caused by oxidative damage (43). Therefore, the interaction of exercise and milk thistle extract with antioxidant effects and reduction of lipid peroxidation helps to improve muscle atrophy indicators in diabetic subjects. In general, according to the few studies conducted in this regard, research on the effect of sports activity and milk thistle plant extract on muscle atrophy indicators in type 2 diabetic subjects needs more research. There were also limitations in the current research, among which we can mention the lack of measurement of other indicators of oxidative damage. In summary, the results of this research showed that aerobic exercise, milk thistle plant extract and the combined intervention of aerobic exercise and milk thistle plant extract can probably be effective in the treatment of muscle atrophy caused by type 2 diabetes and the intervention of a lower dose of this plant extract can give better results. to be accompanied. Aerobic training, Tribulus extract and combined intervention aerobic training and Tribulus extract can probably be effective in treating muscle atrophy due to type 2 diabetes and lower dose intervention of this herbal extract can have better results. Diabetes leads to changes in cellular proteins, oxidative stress and disruption of the cellular defense system. It seems that the reduction of oxidative stress caused by exercise in diabetic subjects in the present study has a positive effect on the negative regulation of MuRF1 expression at the end of the exercise period. The mechanism of Atrogin-1 changes following exercise is not well defined. Therefore, the interaction of exercise and milk thistle extract with antioxidant effects and reduction of lipid peroxidation helps to improve muscle atrophy indicators in diabetic subjects. In general, according to the few studies conducted in this regard, the research on the effect of sports activity and milk thistle plant extract on muscle atrophy indicators in type 2 diabetic subjects needs more research. There were also some limitations in the current research, including the lack of measurement of other indicators of oxidative damage.