American Society of Exercise Physiologists



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Effects of Modified Arm Swing Exercise on Pulmonary and Autonomic Nervous Functions in Patients with Metabolic Syndrome

Arisa Sespheng1, 2, Benja Songsaengrit1, 2, Ploypailin Aneknan2, Terdthai Tong-Un3, Orathai Tunkamnerdthai2, 3, Naruemon Leelayuwat2, 3

1Exercise and Sport Sciences program, Graduate School, Khon Kaen University, Khon Kaen, Thailand, 2Exercise and Sport Sciences Development and Research Group, Khon Kaen University, 3Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

ABSTRACT

Sespheng A, Songsaengrit B, Aneknan P, Tong-Un T, Tunkamnerdthai O, Leelayuwat N. Effects of Modified Arm Swing Exercise on Pulmonary and Autonomic Nervous Functions in Patients with Metabolic Syndrome. JEPonline 2018;21(6):26-40. This study investigated and compared the training effects of modified arm swing exercise (MASE) and traditional arm swing exercise (TASE) on pulmonary function and heart rate variability (HRV) in patients with metabolic syndrome (MetS). Sixty-two female patients with MetS were randomly divided to perform TASE or MASE (n=31 each) for 30 min·d-1, 6 d·wk-1 for 12 wks. Pre-arm swing exercise pulmonary function was measured before and after the training. HRV was measured before, immediately after, and after the exercise before and after the 12-wk training. The repeated measures analysis of variance was used in the statistical analysis. The results showed that MASE training increased the forced vital capacity (FVC), forced expiratory volume in the 1st sec (FEV1), and maximum voluntary ventilation. TASE training increased FVC. Both exercise patterns showed no significant effect on the ratio of FEV1 and FVC. Only TASE training increased the square root of the mean of the sum of the squares of differences. The exercise patterns showed no significant effect on pulmonary function and HRV. The findings suggest that MASE training improved more components of pulmonary function than did TASE training. In addition, only TASE training improved the parasympathetic activity in patients with MetS. It is possible that both patterns of ASE may be applied to people who have impaired pulmonary function.

Key Words: Exercise, Forced Expiratory Volume, Heart Rate, Vital Capacity

INTRODUCTION

Metabolic syndrome (MetS) comprises the most dangerous cardiovascular risk factors, including diabetes, prediabetes, abdominal obesity, high cholesterol, and high blood pressure (10). In addition, many experimental studies have reported that MetS reduced lung function (6,22,36,37). Twisk (35) points out that MetS reduces forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) of forceful exhalation. Both lung function components are independently associated with each component of MetS (6,22,37).

One of the components of MetS, insulin resistance, which is the most important cardiovascular risk factor, was shown to be related to activity of the autonomic nervous system (ANS) (27,33). Moreover, a previous study showed high sympathetic nervous activity with obesity and MetS (31). Many previous studies have confirmed that MetS is associated with lower heart rate variability (HRV) in young adults (14) and elderly individuals (1).

Exercise training is a primary therapy that can improve pulmonary function (31). Moreover, HRV has been shown to be improved after a single session of stretching exercise (8), treadmill exercise (11), and cycle ergometer exercise (5). Interestingly, low-intensity exercise training improved HRV in patients with mild hypertension, which is one component of MetS (20).

Traditional arm swing exercise (TASE) is an interesting exercise modality because it is feasible for most individuals to perform as a home-based exercise, and it is a low-intensity exercise. TASE has been shown to improve hyperglycemia, oxidative stress (15), and pulmonary function (34) in patients with type 2 diabetes (T2D).

We created a novel pattern of modified arm swing exercise (MASE) that involves more movement for patients because MetS is more complicated than T2D. The additional movements of MASE include forward arm swinging to head level until 180° and forced inspiration, slight knee flexion, and making fists with both hands. The forward arm swinging and forced inspiration expand the chest, leading to an increase in airflow in the lungs, which may result in improved lung compliance.

Because pulmonary function has been reported to be affected by the autonomic control of cardiovascular function, the improved pulmonary function may reflect improved HRV for patients with MetS. Recently, Songsaengrit et al. (31) reported that TASE and MASE improved central adiposity and hemodynamics in patients with MetS. According to the association between the obesity component of MetS and lung function and ANS activity (6,21,36), TASE and MASE may improve lung function and ANS activity. However, no study has investigated these variables in relation to MASE and TASE in patients with MetS.

Therefore, the purpose of this study was to investigate and compare the training effects of MASE and TASE on the pulmonary function and HRV of patients with MetS. We hypothesized that both arm swing exercise (ASE) training patterns would improve pulmonary function and HRV and that greater beneficial effects would be provided by the MASE training than by the TASE training.

METHODS

Subjects

Sixty-two female Thai patients (mean ± SD, 49.3 ± 7.3 yrs) with MetS (according to the 2006 International Diabetes Federation criteria) were recruited in Khon Kaen, Thailand. The inclusion criteria were a non-regular exercise regimen (fewer than 3 d·wk-1) and no respiratory disease, neuromuscular disorder, orthopedic problem, or chronic infection. The exclusion criteria were neuromuscular disorder, cardiovascular disease, respiratory disease, orthopedic problem that involved shoulder movement, liver and kidney disorders, and chronic infection. The subjects were informed about the study verbally and in writing before signing a consent form. This study was approved by the Ethical Committee of Khon Kaen University, and it was in accordance with the 1964 Declaration of Helsinki (HE 571357).

Procedures

Before the experiment, all subjects underwent a routine medical examination that included a medical history, electrocardiography, blood sampling for routine blood chemistry and hematology, physical measurements (BP, blood pressure and HR, heart rate), anthropometric measurements (height, body mass, chest, waist circumference [WC], and hip circumference [HC]), and assessment of body fat distribution.

Body mass and height were measured using a beam scale. The body mass index was calculated from the ratio of body mass (kg) to height (m2). Waist circumference was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Hip circumference was measured at the widest portion of the hip. Heart rate and blood pressure were measured using an automatic sphygmomanometer (Rudolf Riester GmbH, Jungingen, Germany) with the cuff wraped around the right arm while the subjects were in the sitting position. Subjects’ medication was recorded throughout the study. If they were being treated for hypertension, T2D, and dyslipidemia, pharmacologic therapies were continued throughout the study. No subject intended to lose weight during the experiment.

Exercise Patterns

TASE Training

The subjects stood with their head erect but relaxed, their mouth closed naturally, and their trunk straight (Figure 1A). Their eyes looked forward and focused on a point in front of them with their mind concentrating on arm swinging. The subjects’ arms hung naturally at their sides with the palms of both hands facing backward and fingers spread naturally. Their buttocks and quadriceps were contracted firmly, and their feet were firmly placed on the ground, shoulder width apart. Both arms were swung forward approximately 30° with a smooth, even force; then, they were swung backward to ~60°. The speed of swinging was approximately 60 times·min-1. However, during the first week of training, the speed of swinging was ~30 times·min-1 or 1 time per 2 sec, to prevent shoulder injury. TASE training was performed 30 min·d-1, 6 d·wk-1 for 12 wks.

MASE Training

MASE was performed similarly to TASE, except that subjects also performed knee flexion and made fists with their hands (Figure 1B). They swung both arms backward to ~60°, forward to ~30° (two rounds), forward to ~180°, and then backward again to ~60°. MASE training was performed for 30 min·d-1, 6 d·wk-1 for 12 wks.

[pic]

Figure 1. Postures of Traditional Arm Swing Exercise (A) and Modified Arm Swing Exercise (B)

Experimental Protocol

Randomization

All subjects separately visited the laboratory on two occasions (before and after 12 wks) to randomly perform a single session of TASE or MASE. Allocation was performed through simple random sampling using the STATA software (Stata Corp., College Station, TX, USA). The Khon Kaen University Clinical Trials Research Unit set up and hosted a web-based randomization system for a two-arm trial with 31 subjects. The researchers and subjects were not blinded to the randomization.

Experiment

Before and after 12 wks, all subjects presented to the quiet laboratory with temperature and humidity ranging from 25°C to 27°C and 48% to 65%, respectively, at 8:00 a.m. after an overnight fast. They were not allowed to drink alcohol or caffeine for at least 8 hrs before arrival or to perform strenuous exercise on the day before the experiment. Pulmonary function was measured before exercise using Oxycon Mobile® (CareFusion; San Diego, CA, USA). Then, HRV was measured at rest before, immediately after, and 30 min after exercise. Electrocardiography was performed throughout the exercise.

Data Collection

Pulmonary Function

Pulmonary function was assessed using Oxycon Mobile® (CareFusion). To assess pulmonary function, FVC, FEV1, and the ratio of FEV1 to FVC (FEV1/FVC) were determined. Maximal voluntary ventilation (MVV) was calculated from FEV1 using the following equation: MVV = FEV1 (L) × 40 (4).

Heart Rate Variability

HRV was evaluated for 3 min using Medicore SA-3000P (Medicore Co., Ltd., Seoul, Korea) and expressed as the time domain and frequency domain. The time domain consists of standard deviation of normal to normal R-R intervals, where R is the peak of a QRS complex (heartbeat) (SDNN) and the square root of the mean of the sum of the squares of differences (rMSSD) between adjacent NN intervals. The frequency domain consists of power in the high-frequency (HF) range from 0.15 to 0.4 Hz, power in the low-frequency (LF) range from 0.04 to 0.15 Hz, and the LF/HF ratio (ms2).

Statistical Analyses

Power Calculation

Changes in pulmonary function and HRV from a pilot study with 5 subjects were used to calculate the sample size of the present study (35). It was determined that 80% power was required to achieve a significance level of 0.05. The higher sample size from both parameters (n=29) was implemented. The dropout rate was 10%. Therefore, at least 31 subjects were required to complete this study.

All data are expressed as mean ± SD. Differences in outcome parameters within and between groups were assessed using one-way repeated measures analysis of variance (ANOVA) for pulmonary function and two-way ANOVA for HRV. Intention-to-treat was used to analyze all parameters. SPSS statistical software (version 17; SPSS, Inc., Chicago, IL, USA) was used for statistical analysis and P ................
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