Abstract
Background
Given the importance of anxiety and quality of life for the mental health of children with type 1 diabetes (T1D), exercise prescription can be of crucial significance. The present study aims to explore the effect of concurrent resistance-aerobic training on serum cortisol level, anxiety, and quality of life among pediatric T1D.
Methods
Forty children (aged 8–14 years) were randomly assigned to experimental (n = 20) and control groups (n = 20) for 16 weeks. The exercise training program was composed of 16 weeks of interval concurrent resistance-aerobic training with a duration of 60 min performed three times a week. The subjects first performed the resistance training (20 min of Pilates exercises and 20 min of body weight-bearing exercises). Then, the aerobic exercises were performed with an intensity of 50–75% of maximum heart rate. Before and after the training, blood tests including cortisol were carried out on the subjects by RIA kit. Anxiety and quality of life were measured by the Revised Children’s Manifest Anxiety Scale (RCMAS) and Pediatric Quality of Life (PedsQL), respectively. Body composition was measured by InBody. Data were analyzed by paired and independent t-test at p < 0.05 significance level.
Results
Sixteen weeks of concurrent resistance-aerobic exercise significantly reduced the anxiety index (p = 0.001) and increased the quality of life (p = 0.003). Although the cortisol index was increased, it did not reveal any significant differences between the experimental and control groups (p = 0.781). No significant differences were observed in the indices of quality of life, anxiety, and cortisol in the control group.
Conclusions
A 16-week program of concurrent resistance-aerobic training can improve the quality of life and anxiety among children suffering from T1D, but it may not influence the cortisol level (p > 0.05).
Acknowledgments
We gratefully acknowledge the contribution of the participants.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. The authors have no financial relationships or conflicts of interest to disclose.
References
1. Giwa AM, Ahmed R, Omidian Z, Majety N, Karakus KE, et al. Current understandings of the pathogenesis of type 1 diabetes: genetics to environment. World J Diabetes 2020;15:13–25.10.4239/wjd.v11.i1.13Search in Google Scholar PubMed PubMed Central
2. Stanescu DE, Lord K, Lipman TH. The epidemiology of type 1 diabetes in children. Endocrinol Metab Clin North Am 2012;41:679–94.10.1016/j.ecl.2012.08.001Search in Google Scholar PubMed
3. Absil H, Baudet L, Robert A, Lysy PA. Benefits of physical activity in children and adolescents with type 1 diabetes: a systematic review. Diabetes Res Clin Prac 2019;8:107810.10.1016/j.diabres.2019.107810Search in Google Scholar PubMed
4. Shah LL, Ersig AL, Paik A. Social network factors and anxiety among adolescents with type 1 diabetes and their parents. J Fam Nurs 2019;25:395–418.10.1177/1074840719863719Search in Google Scholar PubMed
5. Murillo M, Bel J, Pérez J, Corripio R, Carreras G, et al. Health-related quality of life (HRQOL) and its associated factors in children with type 1 diabetes mellitus (T1DM). BMC Pediatr 2017;17:16.10.1186/s12887-017-0788-xSearch in Google Scholar PubMed PubMed Central
6. Jaser SS, Grey M. A pilot study of observed parenting and adjustment in adolescents with type 1 diabetes and their mothers. J Pediatr Psychol 2010;35:738–47.10.1093/jpepsy/jsp098Search in Google Scholar PubMed PubMed Central
7. Davies D. Child development. New York, NY: Guilford Press; 2011.Search in Google Scholar
8. Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL. Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2014;15:232–44.10.1111/pedi.12191Search in Google Scholar PubMed
9. Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med 2009;26:153–61.10.1111/j.1464-5491.2008.02648.xSearch in Google Scholar PubMed
10. Golden SH, Malhotra S, Wand GS, Brancati FL, Ford D, et al. Adrenal gland volume and dexamethasone-suppressed cortisol correlate with total daily salivary cortisol in African-American women. J Clin Endocrinol Metab 2007;92:1358–63.10.1210/jc.2006-2674Search in Google Scholar PubMed
11. McEwen BS, Tucker P. Critical biological pathways from chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment. Am J Public Health 2011;101:S131–9.10.2105/AJPH.2011.300270Search in Google Scholar PubMed PubMed Central
12. Stewart JG, Mazurka R, Bond L, Wynne-Edwards KE, Harkness KL. Rumination and impaired cortisol recovery following a social stressor in adolescent depression. J Abnorm Child Psychol 2013;41:1015–26.10.1007/s10802-013-9740-1Search in Google Scholar PubMed
13. Suzuki H, Belden AC, Spitznagel E, Dietrich R, Luby JL. Blunted stress cortisol reactivity and failure to acclimate to familiar stress in depressed and sub-syndromal children. Psychiatry Res 2013;210:575–83.10.1016/j.psychres.2013.06.038Search in Google Scholar PubMed PubMed Central
14. Mosbah AA, Abd-Ellatif NA, Sorour EI. Influence of serum cortisol levels on glycemic control in children with type 1 diabetes. J Egypt Soc Parasitol 2011;41:777–84.Search in Google Scholar
15. Meßler CF, Holmberg HC, Sperlich B. Multimodal therapy involving high-intensity interval training improves the physical fitness, motor skills, social behavior, and quality of life of boys with ADHD: a randomized controlled study. J Atten Disord 2018;22:806–12.10.1177/1087054716636936Search in Google Scholar PubMed
16. Minnock D, Krause M, Le Roux CW, De Vito G. Effects of acute exercise on glucose control in type 1 diabetes: a systematic review. Transl Sports Med 2019;2:49–57.10.1002/tsm2.64Search in Google Scholar
17. Dudgeon WD, Phillips KD, Durstine JL, Burgess SE, Lyerly GW, et al. Individual exercise sessions alter circulating hormones and cytokines in HIV-infected men. Appl Physiol Nutr Metab 2010;35:560–8.10.1139/H10-045Search in Google Scholar PubMed
18. Fu MR, Axelrod D, Guth AA, Cleland CM, Ryan CE, et al. Comorbidities and quality of life among breast cancer survivors: a prospective study. J Pers Med 2015;5:229–42.10.3390/jpm5030229Search in Google Scholar PubMed PubMed Central
19. Kendir C, van den Akker M, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity: a cross-sectional study in the Netherlands. Eur J Gen Pract 2018;24:45–50.10.1080/13814788.2017.1398318Search in Google Scholar PubMed PubMed Central
20. Hornsby E, Johnston LM. Effect of Pilates intervention on physical function of children and youth: a systematic review. Arch Phys Med Rehabil 2020;101:317–28.10.1016/j.apmr.2019.05.023Search in Google Scholar PubMed
21. Tunar M, Ozen S, Goksen D, Asar G, Bediz CS, et al. The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus. J Diabetes Complications 2012;26:348–51.10.1016/j.jdiacomp.2012.04.006Search in Google Scholar PubMed
22. Sukala WR, Page RA, Rowlands DS, Lys I, Krebs JD, et al. Exercise intervention in New Zealand Polynesian peoples with type 2 diabetes: cultural considerations and clinical trial recommendations. Australas Med J 2012;5:429–35.10.4066/AMJ.2012.1311Search in Google Scholar PubMed PubMed Central
23. Sigal RJ, Kenny GP. Physical activity and diabetes. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Can J Diabetes 2003;27:24–6.Search in Google Scholar
24. Galassetti P, Riddell MC. Exercise and type 1 diabetes (T1DM). Compre Physiol 2013;3:1309–36.10.1002/cphy.c110040Search in Google Scholar PubMed
25. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23.10.1136/adc.45.239.13Search in Google Scholar PubMed PubMed Central
26. Mashhadi A, Soltanishal R, Mirdoraghi F, Bahrami B. Psychometric properties of the Multidimensional Anxiety Scale. J Appl Psychol 2012;6:70–87.Search in Google Scholar
27. Varni JW, Delamater AM, Hood KK, Driscoll KA, Wong JC, et al. Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes. Pediatr Diabetes 2018;19:1322–30.10.1111/pedi.12713Search in Google Scholar PubMed PubMed Central
28. Boyaci A, Tutar M, Biyikli T. The effect of dynamic and static core exercises on physical performance in children. Online Submission 2018;4:50–61.Search in Google Scholar
29. Erlandson MC, Hounjet S, Treen T, Lanovaz JL. Upper and lower limb loading during weight-bearing activity in children: reaction forces and influence of body weight. J Sports Sci 2018;36:1640–7.10.1080/02640414.2017.1407438Search in Google Scholar PubMed
30. Rokka S, Kouli O, Bebetsos E, Goulimaris D, Mavridis G. Effect of dance aerobic programs on intrinsic motivation and perceived task climate in secondary school students. Int J Instr 2019;12:641–54.10.29333/iji.2019.12141aSearch in Google Scholar
31. Shiju R, Thomas D, Al Arouj M, Sharma P, Tuomilehto J, et al. Effect of Sudarshan Kriya Yoga on anxiety, depression, and quality of life in people with type 2 diabetes: a pilot study in Kuwait. Diabetes Metab Syndr 2019;13:1995–9.10.1016/j.dsx.2019.04.038Search in Google Scholar PubMed
32. Abd-Elmonem AM, Al-Tohamy AM, Galal RE, Abd-Elhalim FA. Effects of progressive resistance exercises on quality of life and functional capacity in pediatric patients with chronic kidney disease: a randomized trail. J Musculoskelet Neuronal Interact 2019;19:187.Search in Google Scholar
33. Mcauley G. Physical activity, fitness and anxiety. Hum Kinet 1994;57:551–68.Search in Google Scholar
34. Rosenbaum S, Tiedemann A, Stanton R, Parker A, Waterreus A, et al. Implementing evidence-based physical activity interventions for people with mental illness: an Australian perspective. Australas Psychiatry 2016;24:49–54.10.1177/1039856215590252Search in Google Scholar PubMed
35. Yucel H, Uysal O. Pilates-based mat exercises and parameters of quality of life in women with Type 2 diabetes. Iranian Red Crescent Med J 2018;20(S2).10.5812/ircmj.21919Search in Google Scholar
36. Carter T, Morres ID, Meade O, Callaghan P. The effect of exercise on depressive symptoms in adolescents: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2016;55:580–90.10.1016/j.jaac.2016.04.016Search in Google Scholar PubMed
37. Kamath J. Cancer-related fatigue, inflammation and thyrotropin-releasing hormone. Curr Aging Sci 2012;5:195–202.10.2174/1874609811205030005Search in Google Scholar PubMed
38. Imayama I, Alfano CM, Neuhouser ML, George SM, Smith AW, et al. Weight, inflammation, cancer-related symptoms and health-related quality of life among breast cancer survivors. Breast Cancer Res Treat 2013;140:159–76.10.1007/s10549-013-2594-ySearch in Google Scholar PubMed PubMed Central
39. Meneses-Echávez JF, Correa-Bautista JE, González-Jiménez E, Río-Valle JS, Elkins MR, et al. The effect of exercise training on mediators of inflammation in breast cancer survivors: a systematic review with meta-analysis. Cancer Epidemiol Prev Biomarkers 2016;25:1009–17.10.1158/1055-9965.EPI-15-1061Search in Google Scholar PubMed
40. Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ther 2013;93:310–20.10.2522/ptj.20120190Search in Google Scholar PubMed
41. Wegner M, Koutsandréou F, Müller-Alcazar A, Lautenbach F, Budde H. Effects of different types of exercise training on the cortisol awakening response in children. Front Endocrinol 2019;10:463.10.3389/fendo.2019.00463Search in Google Scholar PubMed PubMed Central
42. Mahon AD, Duncan GE, Howe CA, Craig BW. The effect of exercise on serum and salivary cortisol in male children. Med Sci Sports Exerc 1994;26:1297–301.Search in Google Scholar
43. Engel F, Härtel S, Strahler J, Wagner MO, Bös K, et al. Hormonal, metabolic, and cardiorespiratory responses of young and adult athletes to a single session of high-intensity cycle exercise. Pediatr Exerc Sci 2014;26:485–94.10.1123/pes.2013-0152Search in Google Scholar PubMed
44. Rosa G, Dantas EH, de Mello DB. The response of serum leptin, cortisol and zinc concentrations to concurrent training. Hormones 2011;10:215–21.10.14310/horm.2002.1311Search in Google Scholar PubMed
45. Heidarianpour A, Shokri E, Baghian T, Shokri B. Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol. J Pediatr Endocrinol Metab 2019;32: 1005–11.10.1515/jpem-2018-0484Search in Google Scholar PubMed
46. Michailidis Y. Stress hormonal analysis in elite soccer players during a season. J Pediatr Endocrinol Metab 2014;3:279–83.10.1016/j.jshs.2014.03.016Search in Google Scholar
47. Budde H, Voelcker-Rehage C, Pietraßyk-Kendziorra S, Ribeiro P, Tidow G. Acute coordinative exercise improves attentional performance in adolescents. Neurosci Lett 2008;441:219–23.10.1016/j.neulet.2008.06.024Search in Google Scholar PubMed
48. Vega SR, Strüder HK, Wahrmann BV, Schmidt A, Bloch W, et al. Acute BDNF and cortisol response to low intensity exercise and following ramp incremental exercise to exhaustion in humans. Brain Res 2006;1121:59–65.10.1016/j.brainres.2006.08.105Search in Google Scholar PubMed
©2020 Walter de Gruyter GmbH, Berlin/Boston
