اثر تمرینات ورزشی بر عوامل متابولیک در زنان مبتلا به سندرم تخمدان پلی‌کیستیک: مرور نظام‌مند فراتحلیل

نوع مقاله : مروری

نویسندگان

1 استادیار گروه تربیت بدنی و علوم ورزشی، دانشکده علوم انسانی، دانشگاه کاشان، کاشان، ایران.

2 دانشجوی کارشناسی ارشد تربیت بدنی و علوم ورزشی، دانشکده علوم انسانی، دانشگاه کاشان، کاشان، ایران.

چکیده

مقدمه: سندرم تخمدان پلی­ کیستیک (PCOS)، شایع­ ترین اختلال غدد درون‌ریز در سنین باروری زنان است که با مقاومت به انسولین مرتبط است. مطالعه مرور نظام ­مند و فراتحلیل حاضر با هدف بررسی اثر تمرینات ورزشی بر عوامل متابولیک در زنان مبتلا به PCOS انجام شد.
روش‌کار: در این مطالعه، جستجوی سیستماتیک در پایگاه ­های اطلاعاتی PubMed، Web of Science، SID، Magiran و Google scholar برای مقالات انگلیسی و فارسی منتشر شده تا سپتامبر 2022 انجام شد. فراتحلیل برای بررسی اثر تمرین ورزشی بر میزان گلوکز، انسولین ناشتا، شاخص مقاومت به انسولین (HOMA-IR)، درصد چربی و توده چربی بدن در زنان مبتلا به PCOS انجام شد. تفاوت میانگین استاندارد شده (SMD) یا تفاوت میانگین وزن (WMD) و فاصله اطمینان 95% (CI) با استفاده از مدل اثر تصادفی محاسبه شد. برای تعیین ناهمگونی از آزمون I2 و برای ارزیابی سوگیری انتشار از فونل پلات و تست Egger استفاده شد.
یافته ­ها: تمرین ورزشی سبب کاهش معنادار انسولین ]004/0=p، (15/0- الی 79/0-) 47/0- =[SMD، HOMA-IR ]01/0=p، (12/0- الی 02/1-) 57/0- = [WMDو درصد چربی بدن ]01/0=p، (42/0- الی 36/3-) 89/1- = [WMD در زنان مبتلا به PCOS شد، اما تمرین ورزشی سبب تغییر معنادار گلوکز ]65/0=p، (47/3 الی 17/2-) 65/0= [WMD و توده چربی بدن ]17/0=p، (7/0 الی 88/3-) 58/1- = [WMDنشد.
نتیجه گیری: تمرین ورزشی سبب کاهش درصد چربی بدن، انسولین ناشتا و مقاومت به انسولین در بیماران PCOS می­ شود. هر دو نوع تمرین هوازی و مقاومتی سبب کاهش انسولین ناشتا در این بیماران می ­شود، اما تأثیر تمرین مقاومتی نسبت به تمرین هوازی بیشتر است. بنابراین، تمرینات ورزشی به‌عنوان یک راهکار غیردارویی برای بهبود ترکیب بدن، کاهش مقاومت به انسولین و پیشگیری از دیابت برای زنان مبتلا به PCOS پیشنهاد می ­شود.

کلیدواژه‌ها

عنوان مقاله [English]

The effect of exercise training on metabolic factors in women with polycystic ovary syndrome: A systematic review and meta-analysis

نویسندگان [English]

  • Fatemeh Kazeminasab 1
  • Fatemeh Sabaghian 2
  • Mousa Khalafi 1
1 Assistant professor, Department of Physical Education and Sport Sciences, School of Humanities, University of Kashan, Kashan, Iran.
2 M.Sc. Student of Physical Education and Sport Sciences, School of Humanities, University of Kashan, Kashan, Iran.
چکیده [English]

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, which is associated with insulin resistance. The present systematic review and meta-analysis study was conducted with aim to investigate the effect of exercise training on metabolic factors in women with PCOS.
Methods: In this study, a systematic search was conducted in PubMed, Web of Science, SID, Magiran, and Google Scholar databases for English and Persian articles published until September 2022. Meta-analysis was performed to investigate the impact of exercise training on fasting blood glucose, insulin, insulin resistance index (HOMA-IR), fat percentage and body fat mass in women with PCOS. Standardized mean differences (SMD) or weighted mean difference (WMD) and 95% confidence interval (CI) were calculated using random effect model. Also, I2 test was used to determine heterogeneity, and funnel plot and Egger test were used to evaluate publication bias.
Results: Exercise training caused a significant decrease in insulin [SMD=-0.47, -0.79 to -0.15, P=0.004], HOMA-IR [WMD=-0.57, -1.02 to -0.12, P=0.01), and body fat percentage [WMD=-1.89, -3.36 to -0.42, P=0.01] in women with PCOS; but exercise did not change fasting glucose [WMD=0.65, -2.17 to 3.47, P=0.65] and body fat mass [WMD=-1.58, -3.88 to 0.7, P=0.17].
Conclusion: Exercise reduces body fat percentage, fasting insulin, and insulin resistance in PCOS patients. It is noteworthy that both types of aerobic and resistance training reduce fasting insulin in these patients, but the impact of resistance training is greater than aerobic exercise. Therefore, exercise is recommended as a non-drug solution to improve body composition, reduce insulin resistance and prevent diabetes for women with PCOS.

کلیدواژه‌ها [English]

  • Body fat percent
  • Exercise
  • Insulin resistance
  • Polycystic ovary syndrome

مراجع

  1. Benham JL, Booth JE, Corenblum B, Doucette S, Friedenreich CM, Rabi DM, et al. Exercise training and reproductive outcomes in women with polycystic ovary syndrome: A pilot randomized controlled trial. Clinical endocrinology 2021; 95(2):332-43.
  2. Bonab SB. The effect of 12-week pilates training and ginger supplementation on polycystic ovary syndrome in women. Studies in Medical Sciences 2020; 31.
  3. Vigorito C, Giallauria F, Palomba S, Cascella T, Manguso F, Lucci R, et al. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism 2007; 92(4):1379-84.
  4. Bruner B, Chad K, Chizen D. Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Applied physiology, nutrition, and metabolism 2006; 31(4):384-91.
  5. Patel V, Menezes H, Menezes C, Bouwer S, Bostick-Smith CA, Speelman DL. Regular mindful yoga practice as a method to improve androgen levels in women with polycystic ovary syndrome: a randomized, controlled trial. Journal of Osteopathic Medicine 2020; 120(5):323-35.
  6. Franks S. Diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. The Journal of Clinical Endocrinology & Metabolism 2006; 91(3):786-9.
  7. Kite C, Lahart IM, Afzal I, Broom DR, Randeva H, Kyrou I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Systematic reviews 2019; 8:1-28.
  8. Almenning I, Rieber-Mohn A, Lundgren KM, Shetelig Løvvik T, Garnaes KK, Moholdt T. Effects of high intensity interval training and strength training on metabolic, cardiovascular and hormonal outcomes in women with polycystic ovary syndrome: a pilot study. Plos one 2015; 10(9):e0138793.
  9. Patten RK, Boyle RA, Moholdt T, Kiel I, Hopkins WG, Harrison CL, et al. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Frontiers in physiology 2020: 606.
  10. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction 2018; 33(9):1602-18.
  11. Santos IK, Nunes FA, Queiros VS, Cobucci RN, Dantas PB, Soares GM, et al. Effect of high-intensity interval training on metabolic parameters in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Plos one 2021; 16(1):e0245023.
  12. Orio F, Muscogiuri G, Giallauria F, Savastano S, Bottiglieri P, Tafuri D, et al. Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial. Clinical Endocrinology 2016; 85(5):764-71.
  13. Dos Santos IK, Ashe MC, Cobucci RN, Soares GM, de Oliveira Maranhão TM, Dantas PM. The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis. Medicine 2020; 99(16).
  14. Kazeminasab F, Baharlooie M, Khalafi M. The Impact of Exercise on Serum Levels of Leptin and Adiponectin in Obese Children and Adolescents: A Systematic Review and Meta-Analysis. Iranian Journal of Endocrinology and Metabolism 2022; 23(6):409-25.
  15. Kazeminasab F, Sadeghi E, Afshari-Safavi A. Comparative impact of various exercises on circulating irisin in healthy subjects: a systematic review and network meta-analysis. Oxidative Medicine and Cellular Longevity 2022; 2022.
  16. Khalafi M, Malandish A, Rosenkranz SK, Ravasi AA. Effect of resistance training with and without caloric restriction on visceral fat: A systemic review and meta‐analysis. Obesity Reviews 2021; 22(9):e13275.
  17. Khalafi M, Alamdari KA, Symonds ME, Nobari H, Carlos-Vivas J. Impact of acute exercise on immediate and following early post-exercise FGF-21 concentration in adults: Systematic review and meta-analysis. Hormones 2021; 20:23-33.
  18. De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy 2009; 55(2):129-33.
  19. Khalafi M, Sakhaei MH, Kazeminasab F, Symonds ME, Rosenkranz SK. The impact of high-intensity interval training on vascular function in adults: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine 2022; 9:1046560.
  20. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj 2003; 327(7414):557-60.
  21. Wen H, Wang L. Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: A meta-analysis. Medicine 2017; 96(11).
  22. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj 1997; 315(7109):629-34.
  23. Parseh S, Shakerian S, Alizadeh AA. Effect of Chronic Aerobic/Resistive exercises with supplementation of cinnamon on insulin resistance in women with polycystic ovary syndrome in Ahvaz City in 2017. Journal of Arak University of Medical Sciences 2019; 22(1):15-26.
  24. Shakerian S, Alizadeh AA. Effect of Six Weeks of Aerobic/Resistance Training with Supplementation of Cinnamon on Glucose, Insulin and Fat Mass in Overweight Women with Polycystic Ovary Syndrome. Internal Medicine Today 2019; 25(2):93-101.
  25. Benham JL, Yamamoto JM, Friedenreich CM, Rabi DM, Sigal RJ. Role of exercise training in polycystic ovary syndrome: a systematic review and meta‐analysis. Clinical obesity 2018; 8(4):275-84.
  26. Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends in molecular medicine 2006; 12(7):324-32.
  27. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989; 38(9):1165-74.
  28. Marin CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in polycystic ovary syndrome (PCOS) patients using the homeostatic measurement assessment (HOMA-IR). Fertility and Sterility 2003; 80:274-5.
  29. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. The journal of clinical endocrinology & metabolism 1999; 84(1):165-9.
  30. Dunaif A, Book CB. Insulin resistance in the polycystic ovary syndrome. Clinical Research in Diabetes and Obesity 1993; 15:249-74.
  31. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JF, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes 2004; 53(2):294-305.
  32. Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes care 1998; 21(8):1353-5.
  33. Pattyn N, Coeckelberghs E, Buys R, Cornelissen VA, Vanhees L. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: a systematic review and meta-analysis. Sports medicine 2014; 44:687-700.
  34. Jelleyman C, Yates T, O'Donovan G, Gray LJ, King JA, Khunti K, et al. The effects of high‐intensity interval training on glucose regulation and insulin resistance: a meta‐analysis. Obesity reviews 2015; 16(11):942-61.
  35. Cassidy S, Thoma C, Houghton D, Trenell MI. High-intensity interval training: a review of its impact on glucose control and cardiometabolic health. Diabetologia 2017; 60(1):7-23.
  36. Olefsky J, Farquhar JW, Reaven G. Relationship between fasting plasma insulin level and resistance to insulin-mediated glucose uptake in normal and diabetic subjects. Diabetes 1973; 22(7):507-13.
  37. Phillips DI, Clark PM, Hales CN, Osmond C. Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion. Diabetic Medicine 1994; 11(3):286-92.
  38. Saremi A, Shavandi N, Karamali M, Kazemi M. Serum level of anti-mullerian hormone after exercise training in women with polycystic ovary syndrome: a randomized controlled trial. Iran J Obstet Gynecol Infertil 2013; 16(64):10-8.
  39. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. Bmj 1995; 311(6998):158-61.
  40. Gómez‐Ambrosi J, Silva C, Galofré JC, Escalada J, Santos S, Gil MJ, et al. Body adiposity and type 2 diabetes: increased risk with a high body fat percentage even having a normal BMI. Obesity 2011; 19(7):1439-44.
  41. Costa EC, Sá JC, Stepto NK, Costa IB, Farias Junior LF, Moreira SD, et al. Aerobic training improves quality of life in women with polycystic ovary syndrome. Med Sci Sports Exerc 2018; 50(7):1357-66.
  42. Ribeiro VB, Pedroso DC, Kogure GS, Lopes IP, Santana BA, Dutra de Souza HC, et al. Short-Term aerobic exercise did not change telomere length while it reduced testosterone levels and obesity indexes in PCOS: a randomized controlled clinical trial study. International Journal of Environmental Research and Public Health 2021; 18(21):11274.
  43. Vizza L, Smith CA, Swaraj S, Agho K, Cheema BS. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. BMC sports science, medicine and rehabilitation 2016; 8(1):1-2.
  44. Turan V, Mutlu EK, Solmaz U, Ekin A, Tosun O, Tosun G, et al. Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. Journal of physical therapy science 2015; 27(7):2293-7.
  45. Saremi A, Yaghoubi MS. Effect of resistance exercises with calcium consumption on level of anti-mullerian hormone and some metabolic indices in women with polycystic ovarian syndrome. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2016 Jan 21;18(180):7-15.
  46. Esmaelzadeh Toloee M, Afshar Nezhad T, Yazdani F, Ahmadi B. The effect of 8 weeks of resistance training on ovary morphology, glycemic control and body composition on women with polycystic ovary syndrome. medical journal of mashhad university of medical sciences 2015; 58(7):381-9.
  47. Tofighi A, Tartibian B, Ameri MH, Najafi Eliasabad S, Asemi A, Shargh A. Effect of aerobic exercise on hormonal level and lipid profile in polycystic ovary syndrome women. Studies in Medical Sciences 2010; 21(4):332-8.
  48. Khoshkam F, Taghian F, Jalali Dehkordi K. Effect of eight weeks of supplementation of omega-3 supplementation and TRX training on visfatin and insulin resistance in women with polycystic ovary syndrome. Iran J Obstet Gynecol Infertil 2018; 21(9):58-70.
  49. Saremi A, Bahrami A, Jamilian M, Moazami Goodarzi P. Effects of 8 weeks pilates training on anti-Mullerian hormone level and cardiometabolic parameters in polycystic ovary syndrome women. Arak Med Univ J (AMUJ) 2014; 17(9):59-69.
  50. Saremi A, Kazemi M. Eight-week aerobic training in women with polycystic ovary syndrome: Effects on chronic low-grade inflammation and lipid profiles; 2014.
  51. Saremi A, Rajabi M. Effect of resistance training and omega-3 supplementation on metabolic parameters and anti-Mullerian hormone level in women with polycyctic ovarian syndrome. Pajoohandeh Journal 2016; 21(3):114-21.
مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 6
شهریور 1402
صفحه 94-113

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