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Improved Metabolic Risk Markers Following Two 6-Month Physical Activity Programs Among Socioeconomic Marginalized Women of Native American Ancestry in Lima, Peru

¹ Department of Clinical Sciences, Division of Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
² Department of Medicine, Lund University, Lund, Sweden

Address correspondence and reprint requests to Folke Lindgärde, Department of Vascular Diseases, Malmö University Hospital, S-20502 Malmö, Sweden. E-mail: folke.lindgarde{at}insatnet.nu

	INTRODUCTION

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
It is known that ethnicity is a risk factor for diabetes. Thus, individuals of African, Latin American, and Asian descent are particularly susceptible (1). As an example, a health survey in six urban areas in Peru found a diabetes prevalence of 17% among women (2,3). It was also found that low socioeconomic status was associated with a high burden of noncommunicable diseases and appeared as an independent risk factor for diabetes. In several populations, it is known that increased physical activity reduces the risk for diabetes (4,5). Whether this applies for all populations is, however, not known. The aim of the present study was to explore if supervised endurance training is feasible among socioeconomically marginalized women of a poor urban area in Lima, Peru.

	RESEARCH DESIGN AND METHODS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
The study population consisted of 142 Amerindian women. They were all examined in 1999 (6) and had a normal fasting plasma glucose concentration (range 2.8–5.6 mmol/l). Five years later, a total of 83 women participated in a follow-up examination (7). Of these, 76 consented to take part in the present training study. Mean age was 41 years (range 25–64 years). The women were randomly assigned into group A (one training session per week) or group B (three training sessions per week). No economic compensation was given besides free athlete suits and shoes.

Exercise training
All exercise sessions were verified by the direct supervision by a physiotherapist and took place outdoors on a square with a concrete surface. A warm-up with stretching, light jogging, and flexibility movements was followed by a mixture of traditional folk and modern aerobic dances for a total of 60 min. This was undertaken once or three times per week for 6 months.

Laboratory and clinical measurements
Body weight and height, BMI, waist circumference, fasting plasma glucose, and cardiorespiratory capacity (VO_2max) were measured at baseline and after the intervention period. All subjects refrained from any severe physical activity 48 h before the measurements. Glucose was determined with the glucose oxidase technique. VO_2max was estimated indirectly after subjects ran around two cones, spaced 20 m apart, for 12 min, as previously decribed (8).

Statistical analyses
Comparisons within groups were performed by paired Student's t test and between groups by Mann-Whitney U test. Correlations were performed using Spearman rank correlations and multiple regression analysis for training sessions, changes of plasma glucose, body weight, BMI, waist circumference, and VO_2max. A P value of <0.05 was considered statistically significant.

	RESULTS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
Fifty-nine patients completed the study, with 33 in group A and 26 in group B. The mean total attendance was 21 in group A (maximal possible 27) and 64 in group B (maximal possible 77). During the 6-month study period, 20% in group A (one session per week) and 16% in group B (three sessions per week) discontinued the training sessions.

Effects of intervention
No significant differences were observed between groups A and B in 1999 before the start of the exercise program (P > 0.05) (Table 1). In both groups, plasma glucose decreased (P < 0.01), waist circumference decreased (P < 0.05), and VO_2max increased significantly (P < 0.05) after the training sessions. These effects were more pronounced among members of group B (P = 0.019).

	CONCLUSIONS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
The dramatic increase of type 2 diabetes in Latin America among subjects with Amerindian heritage (9–11) is seen mainly among populations with low socioeconomic status. For prevention and management, these at-risk populations require a tailored approach. This study shows that a supervised physical group activity is feasible among women living in poor urban areas. The attendance rate was high and the drop out rate acceptable. Furthermore, the study shows that after following such an activity for 6 months, circulating glucose and waist circumference are reduced and VO_2max increased. Furthermore, the number of exercise sessions independently contributed to the reduction of glucose concentrations. In fact, in group B, the mean plasma glucose concentration decreased to the same level as in 1999. Also, in group A, the glucose concentration was significantly reduced, although not to the same degree as in group B.

The exercise regime resulted in a reduction of waist circumference but with no significant change in body weight. Exercise in women is associated with a marked increase in lipolysis in the abdominal subcutaneous adipose tissue in comparison with the femoral adipose tissue (12). This suggests that exercise-induced weight loss would be associated with a preferential reduction in abdominal obesity.

Although encouraging, it may be surprising that only one exercise session per week significantly reduced fasting glucose. This supports results showing that marked changes of the metabolic potential of muscle occur with small variation in the level of physical activity (13). It is also known that men with impaired glucose tolerance normalize their glucose tolerance by increasing their weekly physical activity pattern, without any change in body weight (14).

The findings in this study are extremely encouraging in that supervised exercise may be a low-cost safe therapy with favorable benefits, exercise need not be strenuous or prolonged, and exercise does not have to be done every day.

	Acknowledgments

 
The study was supported by grants from Stiftelsen för forskning inom diabetes och kärlsjukdom, the Swedish Research Council (Grant 6834), the Albert Påhlsson Foundation, the Swedish Diabetes Foundation, the Region Skåne, and the Faculty of Medicine, Lund University, Lund, Sweden.

M. Benavente Ercilla, M. Tamashiro, and L. Retamozo at the Alternativa Center for Social Research and Popular Education in Lima, Peru, participated in the design and data collection and provided information to participants.

	Footnotes

 
Published ahead of print at http://care.diabetesjournals.org on 31 May 2007. DOI: 10.2337/dc06-2633.

A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

Received for publication January 3, 2007. Accepted for publication May 25, 2007.

	References

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 

1. Abate N, Chandalia M: The impact of ethnicity on type 2 diabetes. J Diabetes Complications 17:39–58, 2003[Medline]
   
2. Jacoby E, Goldstein J, Lopez A, Ninez E, Lopez T: Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities. Prev Med 37:396–405, 2003[Medline]
   
3. Goldstein J, Jacoby E, del Aguila R, Lopez A: Poverty is a predictor of non-communicable disease among adults in Peruvian cities. Prev Med 41:800–806, 2005[Medline]
   
4. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaaniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350, 2001[Abstract/Free Full Text]
   
5. Eriksson KF, Lindgärde F: No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö preventive trial with diet and exercise. Diabetologia 41:1010–1016, 1998[Medline]
   
6. Lindgärde F, Söderberg S, Olsson T, Ercilla MB, Correa LR, Ahrén B: Overweight is associated with lower serum leptin in Peruvian Indian than in Caucasian women: a dissociation contributing to low blood pressure. Metabolism 50:325–329, 2001[Medline]
   
7. Lindgärde F, Vessby B, Ahrén B: Serum cholesteryl fatty acid composition and plasma glucose concentrations in Amerindian women. Am J Clin Nutr 84:1009–1013, 2006[Abstract/Free Full Text]
   
8. Cooper KH: A means of assessing maximal oxygen intake: correlation between field and treadmill testing. JAMA 203:201–204, 1968[Medline]
   
9. World Health Organization, World Bank: The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability From Diseases, Injuries and Risk Factors in 1990 and Projected to 2020: Global Burden of Disease and Injury Series. Vol. 1. Murray CJL, Lopez A, Eds. Cambridge, MA, Harvard School of Public Health, 1999
   
10. Barcelo A, Rajpathak S: Incidence and prevalence of diabetes mellitus in the Americas. Rev Panam Salud Publica 10:300–308, 2000
    
11. King H, Aubert RE, Herman WH: Global burden of diabetes 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21:1414–1431, 1998[Abstract]
    
12. Horowitz JF, Leone TC, Feng W, Kelly DP, Klein S: Effect of endurance training on lipid metabolism in women: a potential role for PPARalpha in the metabolic response to training. Am J Physiol Endocrinol Metab 279:E348–E355, 2000[Abstract/Free Full Text]
    
13. Henriksson J, Reitman JS: Time course of changes in human skeletal muscle succinate dehydrogenase and cytochrome oxidase activities and maximal oxygen uptake with physical activity and inactivity. Acta Physiol Scand 99:91–97, 1977[Medline]
    
14. Saltin B, Lindgärde F, Houston M, Horlin R, Nygaard E, Gad P: Physical training and glucose tolerance in middle-aged men with chemical diabetes. Diabetes 28 (Suppl. 1):30–32, 1979
    

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This Article Extract Full Text (PDF) All Versions of this Article: dc06-2633v1 30/9/2230    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lindgärde, F. Articles by Ahrén, B. Search for Related Content PubMed PubMed Citation Articles by Lindgärde, F. Articles by Ahrén, B. Social Bookmarking                What's this?