The Effect of Aerobic and Combined, Aerobic-anaerobicexercise on Obese Diabetic Patients

The Effect of Aerobic and Combined, Aerobic-anaerobicexercise on Obese Diabetic Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Aerobic and Combined, Aerobic-anaerobicexercise on Obese Diabetic Patients Tamagne Awoke, D.r Alemmebrat Kiflu, D.r Aschenaki Tadesse This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4418547/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physical exercise is has been recommended as an important non-pharmacological therapeutic strategy for managing diabetes type2 mellitus (T2DM) and obesity. The purpose of this study was to compare the effects of17 weeks aerobic, and combined, both aerobic plus resistance training on HbAlc, bodyweight, body composition and others cardiorespiratory fitness (CRF) components among T2DM and obese patients. METHODS : positivism style of research paradigms and quantitative method of true randomize experimental design was used. 30 T2DM and obese male patients; aged 40–65 years (M=54.4, SD=6.96593), their BMI ≥30 kg/m 2 _ 39.9 kg/m 2 , were randomized to one of the two exercise interventions or a control group. All two exercise groups had an equal total exercise time lasting 60min aerobic or combined training (50-70% of MHR & 1RM). HbAlc, body mass index (BMI) Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein (HDL-C), Low density lipoprotein (LDL) and Waist circumference (WC) were measured. Paired sample T-test, Analysis of Variance (ANOVA) and post Hock was used. RESULTS: aerobic and combined groups showed significance improvement during pre and posttest in weights, BMI, HbAlc, TC, TG, LDL, HDL and WC, P <.001, than the control group. From the ANOVA (Post Hock) result: Aerobic training and combined group was revealing a greater statistical difference more than the Control group in weight (MD = -9 * , and MD = -7 * p < 0.05), BMI (MD= -3.68 * and -2.99 * , P< .001), HbAlc (MD = -8.17 * , and MD= -8.61 * , P < 0.001), TC (MD = -34.4 * and MD= -40.6 * , P < 0.001), LDL (MD = -47.3 * , and MD = -43.2 * , P < 0.001),WC (MD = -12.1 * , and MD= -15.4 * , P < 0.001), TG (MD = 73.2 * and MD= -82.4 * , P 0.05) than the control group. But the combined group was shown great statistical difference than the aerobic and control group with (MD= 6.4 * , P< .001) and (MD= 6.2 * , p < .001) respectively. Conclusion: Compared to aerobic exercise, a 17-week of combined aerobic-anaerobic exercise intervention was more successful in altering these parameters. DiabetesT2 Mellitus body mass index aerobic exercise combined exercise Introduction Obesity is associated with a striking reduction in life expectancy due to metabolic, cardiovascular and physiological constraints, which promote the development of cardiovascular disease, diabetes, depression and certain kinds of cancer. In particular, obesity-associated co-morbidities include impaired glucose tolerance, type2 diabetes 6 . Type2 diabetes mellitus (T2DM) is characterized by hyperglycemic resulting from hypo-secretion of insulin and/or insulin resistance 24 a global health problem and one of the leading causes of morbidity and mortality for 90–95% of all diabetic cases 4 . Data from the WHO show that more than half a billion worldwide is obese. Furthermore, obesity accounts for 50.9–98.6% of adults with T2DM in Europe and 56.1% in Asia 46 Obesity and diabetes are considered to be responsible for as much as 6% of global mortality 23 . It's still difficult to find strategies to help people manage their body weight and achieve ideal glycemic control. Based on the Ethiopian Demographic and Health Survey (EDHS) report the prevalence of obesity and overweight increased from 6 up to 8%, respectively among aged men 15–49% years old, between 2011 and 2016 12 . The prevalence of diabetes in Ethiopia was as higher as 5% among 35 years and above old people 18 , 6.6% among females and 6.4% among men 2 . As WHO, estimated the number of diabetes in Ethiopia about 800,000 cases by the year 2000, and the number is expected to increase to 1.8 million by the year 2030. In the multi-variable analysis, diabetes is associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive 14 . The Ethiopian Demographic and Health Survey reported that the age group 15–49 year reported 53% of men and 45% of women had lifetime history of alcohol consumption. Overweight and obesity also, associated with consumption of alcohol, and sedentary life style habits 34 . Most time those people with diabetes and obese, live with a sedentary lifestyle have face for the development of cardiovascular and blood glucose homeostasis disturbance 33 . The coexistence of excess body weight and diabetes further aggravates the quality of life of individuals and imposes a tremendous burden on the healthcare system. Individuals with T2DM have at least twice the risk for premature death, heart disease, and stroke compared with individuals without T2DM 40 . Weight loss and physical exercise represent the fundamental basis for obesity patients, and its regular implementation is recommended in every international treatment guideline for patients with diabetes 6 . But Successful treatment of obesity and diabetes is a complex and challenging task requiring multiple contemporaneous strategies including lifestyle optimization, adequate anti-diabetic medication, individual education and physical exercise 6 . Even though physical activity’s benefits are indisputable, there are some challenges that have to be addressed in order to enable and motivate patients with diabetes to participate in regular, structured physical exercise 21 . Although various exercise options are available for individuals with either T2DM or excess body weight, but individuals with T2D and concurrent overweight/obesity receive little attention. Physical Activity plays a salient role in the management of obesity and diabetes, and its benefits are well documented 11, 34 . However, it is challenging to assess the best or better of different physical activities program using RCTs. Furthermore, it is still unknown if combined exercise modes can improve body weight and glycemic management compared with other mode of exercise in those with T2DM who are also concurrently overweight or obese. Also, Clinical practice guidelines on the application of exercise intervention in Type-2 diabetes do not provide much detail regarding the duration and/or intensity of exercise that should be applied to maximize subsequent health benefits for different subpopulations 5 . Moreover, in addition to that the above all reasons, a raise in obesity among diabetics complicate the treatment regimens and increases overall medical costs and side effects, many people are suffered in Ethiopia. So the researcher was interested to see the effect of exercise on obese and diabetics patients. The study was conduct to compare the effects of Combine Aerobic-An aerobic Exercise with Aerobic Exercise on Obese, and diabetic patents. Methods 2.1. Study Design and Sampling This study was used the positivism style of research paradigms and quantitative method of true randomize experimental design. Supervised Applied Structured Physical Exercise Program (SPEP), motivational and nutritional counseling program was employed based on recommendation of 19 . Participants The study used 30 patients with obese and T2DM aged 40–65 years, their BMI ≥ 30 kg/m 2 _ 39.9 kg/m 2 17 . Those who was medically cheeked and confirmed that with obesity and type2 diabetes included. Participants who are interested at Bahirdar-city, Ethiopia were recruited primarily through newspaper advertising and potentially eligible respondents were invited to the Johns Bahirdar public Sport physical fitness center for screening. Written informed consent was obtained from all participants selected. The study was approved by the Collage of Natural & Computational Review Board (CNS-IRB), No. IRB/04/2015/2023 and was conducted between may/2023 and November/2023. Subjects were get orientation about the program, including its benefits, risks and recommendations they have to follow in the program. Stratified random sampling method were used by age and BMI to assign one of the three groups: aerobic training group 10-male, BMI 32.1 ± 1.28668 kg/m 2 , age 54.1 ± 7 years, combined (aerobic and resistance) training group 10-male, BMI 32.43 ± 1.36874 kg/m 2 , age 54.3 ± 7 years, or control group10 male, BMI 32.05 ± 1.43546 kg/m 2 , age 54.8 ± 7 years blind allocation of concealment was used. Exclusion criteria The following individuals were excluding from the study; Subjects suffering from any cardiovascular, pulmonary, orthopedic or neurological disorders, mentally ill patients, Individuals who were fasting, have an experience of engaged in regular exercise programs 3 or more times per week in the last 3 months before, with Physical or muscular injuries that limit different training, BMI greater than 40 kg/m 2 were excluded, patients with target organs damage like eye and kidney problem, and those who don’t like to sign the consent-form were excluded from the study. Exercise programming After a medical screening with inclusion criteria the first pretests were taken. The study was used 5times per a week supervised exercise, moderate intensity of training as intervention. In obese people, moderate physical activity has been shown to reduce appetite and raise satiety and fullness perceptions while subsequent food intake was not affected 41 which is very important to lose weight. The 2-week run in phase or pre experimental training was perform 3 sessions/week 29 with a progressive time of 20–40 minutes including warm-up & cooling down, aerobic exercise at a moderate intensity (45–50% of maximum heart rate), familiarizing them with the resistance training machines, 1–2 sets (50% 1RM) of different exercises, repeated 8–10 times was employed. In the week prior to the main-intervention training, subjects who show better adherence was selected join and to perform 17week exercise training protocol. Before the intervention training began (1RM) measurements was taken. Blood glucose level before 15–30 min to the training was always measured using blood glucose meter (Accu-check Guide Glucometer, CODE-Hs92716). Based on MFMER patient’s blood glucose level less than 100 milligrams per deciliter (mg/dL) or (5.6 mmol/L) they were recommended to eat a small snack containing 15 to 30 grams of carbohydrates (glucose tablets), fruit juice, fruit, crackers before they begin their workout, to increase their blood glucose. Blood glucose level that show 250 mg/dL (13.9 mmol/L) or higher level, was not to go in the exercise to prevent hyperglycemia but 100 to 250 mg/dL (5.6 to 13.9 mmol/L), it is good to go. 30 Structured physical exercise program (SPEP) was employed 25 included three phases, Phase 1: Ten min warm-up, Phase 2: The main Exercise protocol lasting 45 min was employed in previous studies 36 involving aerobic or combined aerobic and anaerobic training with moderate intensity (50–70% of MHR and the intervention were supervised 5 times per a week. The exercise duration were followed the principle of progression by increasingly gradually: 30–35 min in week 1st -2nd, 35–40 min in weeks 3th -5th, and 45 min in weeks 6th -17th. Phase 3: Finally, 5 min cool down period comprised of slow walking for a gradual recovery. However, they could supply the water required by their bodies in the sessions. Aerobic exercise group The aerobic training group exercise on treadmills or bicycle ergo-meters. Heart rate monitors by (Polar Electro Oy, Kempele, Finland) to adjust workload to achieve the target HR 15 . Participants progressed from 30 to 35min per session at 50% of the Max-HR to 45min/session at 70% Max-HR 32 as determined by using a maximal treadmill, and cycling exercise test for 45 min, 5times/week which has been employed in previous studies 1,45 for 17 weeks 42 Combined/Aerobic-Anaerobic exercise group The combined group exercise strength training followed by full aerobic exercise training the aerobic do 48 . Participants progressed from 30 to 35min /session at 50% Max-HR to 45min session at 70% Max-HR determined by using a maximal treadmill and cycling exercise test plus resistance training at 50% − 70%, 1RM performed 10 different exercises Chest flay, Bicep curl, Triceps extension, Lower back( back extension), leg raise, squatting, dumbbell supine, leg extension, dumbbell curl and trunk flexion and vertical bench press on weight machines each session, progressing to 2 to 3 sets of each exercise at the maximum weight that could be lifted 8 to 12 times. Weeks 1–8, 50% -60%of 1RM used for 8–10 repetitions. In weeks 9–17, 60%-70% 1RM were used for 10–12 repetitions. Each session lasted for 30–45 min 15,36,44 for 5 times per week. Control group Control groups were instructed not to change their usual lifestyle, including physical activity. Only nutritional council was given the same like other groups. Enhanced lifestyle counseling Nutritional and psychological counseling Briefly lifestyle education and motivational counseling to motivate participants not to drop out from the training and nutrition counseling was conducted for participant who was offered two class sessions with 30–60 min in length at the beginning and at the middle weeks of the intervention was done by lifestyle coaches, certified at recognized university or collage. Participants were encouraged to lose weight between 5-8kg/week by reducing calorie intake and increasing energy expenditure until the end of the intervention program. Primary Outcome: Before and after the program, 10mL of blood sample (Silvia, 2018) was draw from the antecubital-vein under fasting, stable conditions. HbA1c measurements was made in duplicate at baseline and at the end of the intervention using ‘FINECARE’ HbA1c analyzer, Biochemical Apparatus Type: - Fluorescence Immunoassay Analyzer, Certification: - CE, FDA, ISO13485).Secondary outcome: The Levels of Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein cholesterol (HDL-C), and Low-density lipoprotein cholesterol (LDL-C) was and triglyceride analyzed enzymatically using auto-analyzer (Hitachi 7600 − 110/7170 Analyzer, Tokyo, Japan). Body Mass Index by BMI (kg/m 2 ) was calculated dividing the individual’s weight in Kg by the square of height in meters (W/ h 2 ). Waist circumference (WC) was measured the waist circumference should be measured at the midpoint between the lower margin of the last palpable ribs and the top of the iliac crest, using a stretch-resistant tape that provides constant 100 g (3.53 oz) tension according to the 43 . Statistical analysis Data Pre and posttest of each group were compared with the baseline information at the end of the study. T-test for independent samples was used, T-test was considered significant if P ≤ 0.05. Analysis of Variance (ANOVA) and post Hock (Tukey, HSD) was used to compare the means of different groups and determine which group is significantly different from the others after training with baseline scores. Results Table 1 participants back ground information The study used 30 male participants, all of whom completed the intervention program. First the age distribution was trying to balance across the group. The study variables did not differ significantly prior to the intervention. Additionally, normality test of data (Shapiro-Wilk Test) across the groups revealed that the data was normally distributed. Table 1:- Descriptive statistic shows that the aerobic group, combined group and control groups participant’s age score with was mean value (M = 54.1 SD = 7.48999, M = 54.3000 SD = 7.13442 and M = 54.8, SD = 7.00476) respectively. And their years of lifetime with disease after they medically checked was relatively the same in all groups (M = 6.2, SD = 2.4404, M = 5.9, SD = 2.72641 and M = 5.8, SD = 2.14994) respectively. As the ANOVA table reveals that there is no significance difference between groups before the interventions started by age and years of life time with the disease F ( 2 , 27 ) = 0.025, with p = 0.975 and F ( 2 , 27 ) = 0.72, with respectively ( p > 0.05) level. Table 2 pre and post T test Paired t-test was used to compare intragroup changes in weight, BMI, glycemic hemoglobin (HbAlc), Total cholesterol (TC), low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG), and waist circumference (WC). The results of paired t-test showed that there was a statically significant difference P < .001 between the pre-test and posttest of study parameters in all aerobic and combined intervention groups but there is no significance difference in control group. Additionally table-2: paired t-test showed that there was a significance statistical differences between pre-test and posttest in aerobic group on weight (W) t ( 9 ) = 12.208, P .001, HbAlc t( 9 ) = 18.557, P < .001, Total cholesterol (TC) t ( 9 ) = 14.853, P < .001, low density lipoprotein (LDL) t ( 9 ) = 41.887, P < .001, High density lipoprotein (HDL) t ( 9 ) = -7.364, p < .001, Triglyceride (TG) t( 9 ) = 32.955, P < .001, and waist circumference (WC) t( 9 ) = 17.333, P < .001 and the combined training group showed a significance statistical differences on weight (W) t( 9 ) = 17.238, p < .001, BMI t ( 9 ) = 16.896, P < .001, HbAlc t ( 9 ) = 26.465, p < .001, Total cholesterol (TC) t ( 9 ) = 23.401, P < .001, low density lipoprotein (LDL) t ( 9 ) = 6.683, P < .001, High density lipoprotein (HDL) t ( 9 ) = -4.708, p < .001, Triglyceride (TG) t( 9 ) = 45.258, P < .001, and waist circumference (WC) t ( 9 ) = 26.047, P < .001. Generally, there was a statistically significant difference between the pretest and post-test of all measured variables in all two different intervention training protocols at (p < 0.01). Table 3, ANOVA result between the Groups The objective of this study is to determine which intervention training are most effective modalities to enhance the study variables. The ANCOVA table 3, and Post hoc test table 4, was used to determine which training intervention had the greatest impact. There were significant differences of two types of intervention training after 17weeks compared with control group for weight (W) (F ( 2 , 27 ) = 6.196, P < 0.05), BMI (F ( 2 , 27 ) = 20.018, P < 0 .001), HbAlc (F ( 2 , 27 ) = 317.529, P < 001), TC (F2, 27) = 73.927, P < .001), LDL (F ( 2,27) = 49.884, p < .001, HDL (F ( 2 , 27 ) = 38.03, P < .001), TG (F ( 2 , 27 ) = 702.577, P < .001). Table 4; post Hock table From table 4, multiple group pairwise comparisons of the post hoc of weight, BMI, HbAlc, Total cholesterol (TC), low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG), and waist circumference (WC) mean differences between the two interventions and a control groups are displayed. Both two intervention training groups have shown a reduction in those variables. However, the most effective intervention training was combined resistance plus aerobic training. From the post Hock result, Aerobic intervention group vs. control group showed significant differences (p < 0.05) with reductions in Weight (MD = -9 * , p < 0.05) BMI (MD= -3.68 * , P < .001), HbAlc (MD = -8.17 * , p < 0.001), TC (MD = -34.4 * , p < 0.001), LDL (MD = -47.3 * , p 0.05) -13.3%) TG (MD = -73.2 * , p < 0.001), WC MD = -12.1 * , p < 0.001). The combined intervention group vs. control group showed significant differences (p < 0.05) with reductions in Weight( MD = -7 * , p < 0.05), BMI (MD= -2.99 * , P < .001), HbAlc (MD= -8.61 * , P < 0.001), TC(MD= -40.6 * , P < 0.001), LDL(MD= -43.2 * , P < 0.001), HDL (M = 6.2 * , p < .001) TG (MD= -82.4 * , P < 0.001), WC (MD= -15.4 * , P < 0.001). The combined group show an improvement statistically significant difference in HDL with (M = 6.4 * , P < .000), decrease in waist circumference with (MD = -3.3 * , P < .001), decrease in triglyceride level with (9.2, P = .002) more compared to aerobic group. Also, the Combined group decease in HbAlc (MD = .44), TC (MD = 6.2) more compared to Aerobic group but the result was did not showed statistically significant (p > 0.05) level. The aerobic group decrease on TG statistically significant difference with (MD = 9.2, P < .05) compared with the combined group. The aerobic group decrease more weight with (MD = -2.0, P = .739), LDL and (MD = -4.1, P = .717), than the combined group but was no statistically significant difference with, (P > 0.05) level. Discussion The objective of the study was to compare the effect seventeen ( 17 ) week of aerobic training with combined exercise training on indices of obesity and diabetes type-2. As the result reveal that there was statistically significance difference or change in HbAlc, weight, BMI, total cholesterol(TC), low density lipoprotein(LDL) high density lipoprotein (HDL), Triglyceride(TR), and waist circumference( WC) between the pre and posttest results in aerobic and combined group with (p < .001 ) but there was no change in control group. This study find that aerobic and combined experimental group was shown a greater statistically significant difference in glycemic hemoglobin value than Control group after the intervention. Consistence result was reported by 22 assessed the effect of combined exercise compared with aerobic exercise among patients with T2DM. The results showed a significant reduction of HbA1c by 0.31%. A contradicted result were reveals, a meta- analysis by 50 identified 13 eligible studies investigating the effect of exercise on patients with T2DM and obesity, and the result showed that exercise had no effect on HbA1c in the 3months intervention subgroup, but similar result with our study also, reported in this meta-analysis that exercise was significantly reduced HbA1c by 0.25%, 0.93% and 0.26% when intervention duration were 4months, 6 months and 12 months respectively. Again an opposite result with our study were reveal by 13 the study compared combined aerobic and resistance training with aerobic training alone find no difference s in HbA1c values between the groups, but the low average baseline hemoglobin HbA1c value (6.7%) limited the power to detect a difference. In addition to that the study was used women as a participant which was a different sample with our study i.e. male. Seventeen ( 17 ) weeks exercise intervention was observed statistically significance difference on losing weights and improve BMI between pretest and posttest on aerobic and combined training group but the control group was not shown. The result also reveals that there was no statistically significant difference between the Aerobic group and weight more than the combined in weight loss. Similar results was reveal on a studies used supervised structured aerobic exercise training (SSAET), the result shows that aerobic exercise were effective at reducing BMI 3,35 or body composition 27 . Moreover, similarly with this study aerobic and resistance training with motivational counseling was significantly improved physical fitness and weight loss 7, 49 . Another studies also reported in a review by 47 , eight studies reported there was a changes in BMI in people with type-2 diabetes. The pooled results showed that combined exercise significantly reduced BMI in the intervention group as opposed to the control group (MD = − 0.98 kg/m 2 , 95% CI: −1.41 to − 0.56, p < 0.001). Additionally Cuff et al., 2003 were the first to compare combined (aerobic and resistance) training with aerobic training group as well as a non-exercising control group. The result reveals that both training regimes show statistically significant reductions in body weight and abdominal adiposity. Another study a randomized trial by 36 on the effects of aerobic training, resistance training or both on glycemic control in type2 diabetes the result show the combined exercise was more effective than either aerobic or resistance training alone in reducing HbA1c, Changes in body composition of the combined exercise group did not differ from those in the aerobic training groups. But different result were reported in line with the current study, a meta-analysis that exercise intervention of at least 8 weeks of supervised regular aerobic exercise in type-2 diabetic individuals has showed a statistically little effect on body weight 10 . This result might be because of that the training session per week was only 3times and it was not enough to come up a change or meet at the level of physical fitness to see a change especially for these special populations. Most guides of physical exercise for physical fitness recommends that 5times /week is crucial for fitness improvement. As 39 also suggested that short-term exercise training exerted no significant effect on body weight, BMI and body fat. In addition to that the aerobic and combined experimental group was showed a greater statistically significant difference by decreasing in total cholesterol (TC), low density lipoprotein (LDL), triglyceride (TG) and waist circumference (WC) than Control group with P < 0.001 level. Again our study reveals that combined group has shown great statistical significant difference on improving HDL than the aerobic and control group with MD = 6.400 * , P < .001 and MD = 6.2 * , p < .001 but the aerobic group was not shown any statistical significance difference with control group. There was also no statistically significant difference between aerobic and combined group on TC and LDL (p > 0.05). Similarly RCTs involving type 2 diabetes patients have reported that intensive diet and aerobic training decreases, LDL-cholesterol, 26 Total cholesterol (TC) and triglycerides (TG) but failed to include controls and opposite to our result the aerobic group rises on HDL cholesterol 26,8,9 than the control group. Another studies reported with a randomized trials 36 used in aerobic training, resistance training or both types of exercise groups, Waist circumference decreased more in the aerobic training and resistance training groups than in the control group. In addition to that our study reveals, the combined group decrease in triglyceride (TG) and waist circumference (WC) more compared to aerobic group which was statistically significant with P < .001 level. Similar result were reveals that combined exercise group showed a more significant reduction in TG than the other groups (control, aerobic, and resistance), showing MDs of 20.39 (95% CI: 12.03 to 28.74), 10.5 (95% CI: 2.37 to 18.17), and 13.28 (95% CI: 4.94, 21.76) respectively. Moreover, combined exercise was regarded as the most efficacious protocol for improving TG, according to the SUCRA values 99.8%. 28 In the Look Action for Health in Diabetes (AHEAD) study, intensive lifestyle participants exhibited similar result with this study that greater decreases in triglycerides (TG) and increases in HDL than the control group while both the intensive lifestyle and usual care groups decreased LDL cholesterol. Randomized trials have reveal that supervised exercise interventions improve triglycerides (TG) and total cholesterol 7 in people with type 2 diabetes 37 compared to no-exercise comparison groups. A gain a meta-analysis by 16 reported that seven studies representing 220 men and women (112 are in exercises, 108 are in controls) were available for pooling. Using a random-effects model, a statistically significant reduction of about 5% was reveals for LDL-C which was similar with our study, whereas an opposite to our result was reported with aerobic exercise was not showed statistically significant improvements on TC, HDL-C, TG but similar result with our study in HDL-C than the control group. Conclusion The current study tries to show the benefit of aerobic and combined regular exercise in T2DM patients with obesity. Generally, aerobic exercise and combined training have positive effects in the prevention or management of obesity with blood glucose control and other risk factors. Moreover this benefit may be effective and efficient in the combination of aerobic plus strength exercise training. Weight, Body composition (BMI), TC, HDL, LDL, TG and WC significantly decreased in combined (aerobic plus strength) or alone, suggesting that combined exercise intervention was more effective in changing these measures. Adverse events: Two studies reported the prevalence of adverse events during training and after training most adverse events were sports injuries and hypoglycemia but not sever. Declarations Competing Interests I need a sponsorship organization, as well as if the journal publish this paper with free payment as a sponsor of me . Author Contribution Tamagne Awoke Sisay is the first person or Authors who is a student at Addis Ababa university and write the hole paper work collect data and analysis, interpretation and presentation .Alemmebrat Kiflu (PhD) an associate professor at Addis Ababa university, who is the second author and control, guide & direct, construct the experimental protocol for the intervention training procedures, follow up the work how it was going on.Aschenaki Tadess(PhD)an associate professor at Addis Ababa university, the 3rd author and who see and give critical correction on the general paper work and work on data encoding with SPSS analysis and interpretation. Acknowledgement we would like to the almighty God for finishing all the process and pass the challenges with this work. References Abby C. King,William L. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4418547","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305996995,"identity":"76e15427-a699-48e9-bd07-0925bed7ac19","order_by":0,"name":"Tamagne Awoke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYFADHgYGA8k/NkAWY+MBAgoRrALLhjSQlgbitXyobDgMZuPVYs9+OvHj1x12if08hw9uuLnjvN3a9sNAW2psonHawpO7WVr2THLizN62ZMOZZ24nbzuTCNRyLC23AafDcjdIS7Yx5244z2NmLMF2O9nsAFALY8Nh3Fr4327+LdlWD9TC//33H7ZzyWbnHxLQIpG7TfJj2+HcDWd7gIHcdsDO7AYhW2683WbN2Ha8fmbPMQMDiTPJCWY3gLYk4PELe3/u5ps/26qN+XmSHxhIVNjZm51Pf/jgQ40NTi0gwMyDxEkEq0zAoxwEGH8gcewJKB4Fo2AUjIIRCACc/2j+3SKhlwAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Tamagne","middleName":"","lastName":"Awoke","suffix":""},{"id":305996996,"identity":"ec81e225-293c-4e63-ae14-ad973746d49d","order_by":1,"name":"D.r Alemmebrat Kiflu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"D.r","middleName":"Alemmebrat","lastName":"Kiflu","suffix":""},{"id":305996997,"identity":"d89d7efd-2ec2-419f-8787-dbae8bea123f","order_by":2,"name":"D.r Aschenaki Tadesse","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"D.r","middleName":"Aschenaki","lastName":"Tadesse","suffix":""}],"badges":[],"createdAt":"2024-05-14 10:40:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4418547/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4418547/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65116378,"identity":"3248fa6a-b951-488d-b738-145e2096ba13","added_by":"auto","created_at":"2024-09-23 19:53:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":442986,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4418547/v1/abc89d7a-658a-4192-975c-99f392ea3b46.pdf"},{"id":57058012,"identity":"5857352a-c978-410b-a3b3-76dbacb832a1","added_by":"auto","created_at":"2024-05-24 05:17:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":55393,"visible":true,"origin":"","legend":"","description":"","filename":"researchconcentformm.docx","url":"https://assets-eu.researchsquare.com/files/rs-4418547/v1/c9955e4adcbbd8712b59d804.docx"}],"financialInterests":"Competing interest reported. I need a sponsorship organization, as well as if the journal publish this paper with free payment as a sponsor of me .","formattedTitle":"\u003cp\u003eThe Effect of Aerobic and Combined, Aerobic-anaerobicexercise on Obese Diabetic Patients\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is associated with a striking reduction in life expectancy due to metabolic, cardiovascular and physiological constraints, which promote the development of cardiovascular disease, diabetes, depression and certain kinds of cancer. In particular, obesity-associated co-morbidities include impaired glucose tolerance, type2 diabetes\u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e. Type2 diabetes mellitus (T2DM) is characterized by hyperglycemic resulting from hypo-secretion of insulin and/or insulin resistance\u003csup\u003e\u003cb\u003e24\u003c/b\u003e\u003c/sup\u003e a global health problem and one of the leading causes of morbidity and mortality for 90\u0026ndash;95% of all diabetic cases\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eData from the WHO show that more than half a billion worldwide is obese. Furthermore, obesity accounts for 50.9\u0026ndash;98.6% of adults with T2DM in Europe and 56.1% in Asia \u003csup\u003e\u003cb\u003e46\u003c/b\u003e\u003c/sup\u003e Obesity and diabetes are considered to be responsible for as much as 6% of global mortality \u003csup\u003e\u003cb\u003e23\u003c/b\u003e\u003c/sup\u003e. It's still difficult to find strategies to help people manage their body weight and achieve ideal glycemic control. Based on the Ethiopian Demographic and Health Survey (EDHS) report the prevalence of obesity and overweight increased from 6 up to 8%, respectively among aged men 15\u0026ndash;49% years old, between 2011 and 2016\u003csup\u003e\u003cb\u003e12\u003c/b\u003e\u003c/sup\u003e. The prevalence of diabetes in Ethiopia was as higher as 5% among 35 years and above old people\u003csup\u003e\u003cb\u003e18\u003c/b\u003e\u003c/sup\u003e, 6.6% among females and 6.4% among men\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e. As WHO, estimated the number of diabetes in Ethiopia about 800,000 cases by the year 2000, and the number is expected to increase to 1.8\u0026nbsp;million by the year 2030.\u003c/p\u003e \u003cp\u003eIn the multi-variable analysis, diabetes is associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive\u003csup\u003e\u003cb\u003e14\u003c/b\u003e\u003c/sup\u003e. The Ethiopian Demographic and Health Survey reported that the age group 15\u0026ndash;49 year reported 53% of men and 45% of women had lifetime history of alcohol consumption. Overweight and obesity also, associated with consumption of alcohol, and sedentary life style habits\u003csup\u003e\u003cb\u003e34\u003c/b\u003e\u003c/sup\u003e. Most time those people with diabetes and obese, live with a sedentary lifestyle have face for the development of cardiovascular and blood glucose homeostasis disturbance\u003csup\u003e\u003cb\u003e33\u003c/b\u003e\u003c/sup\u003e. The coexistence of excess body weight and diabetes further aggravates the quality of life of individuals and imposes a tremendous burden on the healthcare system. Individuals with T2DM have at least twice the risk for premature death, heart disease, and stroke compared with individuals without T2DM\u003csup\u003e\u003cb\u003e40\u003c/b\u003e\u003c/sup\u003e. Weight loss and physical exercise represent the fundamental basis for obesity patients, and its regular implementation is recommended in every international treatment guideline for patients with diabetes\u003csup\u003e6\u003c/sup\u003e. But Successful treatment of obesity and diabetes is a complex and challenging task requiring multiple contemporaneous strategies including lifestyle optimization, adequate anti-diabetic medication, individual education and physical exercise\u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e. Even though physical activity\u0026rsquo;s benefits are indisputable, there are some challenges that have to be addressed in order to enable and motivate patients with diabetes to participate in regular, structured physical exercise\u003csup\u003e\u003cb\u003e21\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough various exercise options are available for individuals with either T2DM or excess body weight, but individuals with T2D and concurrent overweight/obesity receive little attention. Physical Activity plays a salient role in the management of obesity and diabetes, and its benefits are well documented \u003csup\u003e\u003cb\u003e11, 34\u003c/b\u003e\u003c/sup\u003e. However, it is challenging to assess the best or better of different physical activities program using RCTs. Furthermore, it is still unknown if combined exercise modes can improve body weight and glycemic management compared with other mode of exercise in those with T2DM who are also concurrently overweight or obese. Also, Clinical practice guidelines on the application of exercise intervention in Type-2 diabetes do not provide much detail regarding the duration and/or intensity of exercise that should be applied to maximize subsequent health benefits for different subpopulations\u003csup\u003e\u003cb\u003e5\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, in addition to that the above all reasons, a raise in obesity among diabetics complicate the treatment regimens and increases overall medical costs and side effects, many people are suffered in Ethiopia. So the researcher was interested to see the effect of exercise on obese and diabetics patients. The study was conduct to compare the effects of Combine Aerobic-An aerobic Exercise with Aerobic Exercise on Obese, and diabetic patents.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e2.1. Study Design and Sampling\u003c/p\u003e \u003cp\u003eThis study was used the positivism style of research paradigms and quantitative method of true randomize experimental design. Supervised Applied Structured Physical Exercise Program (SPEP), motivational and nutritional counseling program was employed based on recommendation of \u003csup\u003e\u003cb\u003e19\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThe study used 30 patients with obese and T2DM aged 40\u0026ndash;65 years, their BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2 _\u003c/sup\u003e 39.9 kg/m\u003csup\u003e2 \u003cb\u003e17\u003c/b\u003e\u003c/sup\u003e. Those who was medically cheeked and confirmed that with obesity and type2 diabetes included. Participants who are interested at Bahirdar-city, Ethiopia were recruited primarily through newspaper advertising and potentially eligible respondents were invited to the Johns Bahirdar public Sport physical fitness center for screening.\u003c/p\u003e \u003cp\u003e Written informed consent was obtained from all participants selected. The study was approved by the Collage of Natural \u0026amp; Computational Review Board (CNS-IRB), No. IRB/04/2015/2023 and was conducted between may/2023 and November/2023. Subjects were get orientation about the program, including its benefits, risks and recommendations they have to follow in the program. Stratified random sampling method were used by age and BMI to assign one of the three groups: aerobic training group 10-male, BMI 32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28668 kg/m\u003csup\u003e2\u003c/sup\u003e, age 54.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7 years, combined (aerobic and resistance) training group 10-male, BMI 32.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36874 kg/m\u003csup\u003e2\u003c/sup\u003e, age 54.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7 years, or control group10 male, BMI 32.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43546 kg/m\u003csup\u003e2\u003c/sup\u003e, age 54.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7 years blind allocation of concealment was used.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe following individuals were excluding from the study; Subjects suffering from any cardiovascular, pulmonary, orthopedic or neurological disorders, mentally ill patients, Individuals who were fasting, have an experience of engaged in regular exercise programs 3 or more times per week in the last 3 months before, with Physical or muscular injuries that limit different training, BMI greater than 40 kg/m\u003csup\u003e2\u003c/sup\u003e were excluded, patients with target organs damage like eye and kidney problem, and those who don\u0026rsquo;t like to sign the consent-form were excluded from the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eExercise programming\u003c/h2\u003e \u003cp\u003eAfter a medical screening with inclusion criteria the first pretests were taken. The study was used 5times per a week supervised exercise, moderate intensity of training as intervention. In obese people, moderate physical activity has been shown to reduce appetite and raise satiety and fullness perceptions while subsequent food intake was not affected\u003csup\u003e\u003cb\u003e41\u003c/b\u003e\u003c/sup\u003e which is very important to lose weight.\u003c/p\u003e \u003cp\u003eThe 2-week run in phase or pre experimental training was perform 3 sessions/week \u003csup\u003e\u003cb\u003e29\u003c/b\u003e\u003c/sup\u003ewith a progressive time of 20\u0026ndash;40 minutes including warm-up \u0026amp; cooling down, aerobic exercise at a moderate intensity (45\u0026ndash;50% of maximum heart rate), familiarizing them with the resistance training machines, 1\u0026ndash;2 sets (50% 1RM) of different exercises, repeated 8\u0026ndash;10 times was employed. In the week prior to the main-intervention training, subjects who show better adherence was selected join and to perform 17week exercise training protocol.\u003c/p\u003e \u003cp\u003eBefore the intervention training began (1RM) measurements was taken. Blood glucose level before 15\u0026ndash;30 min to the training was always measured using blood glucose meter (Accu-check Guide Glucometer, CODE-Hs92716). Based on MFMER patient\u0026rsquo;s blood glucose level less than 100 milligrams per deciliter (mg/dL) or (5.6 mmol/L) they were recommended to eat a small snack containing 15 to 30 grams of carbohydrates (glucose tablets), fruit juice, fruit, crackers before they begin their workout, to increase their blood glucose. Blood glucose level that show 250 mg/dL (13.9 mmol/L) or higher level, was not to go in the exercise to prevent hyperglycemia but 100 to 250 mg/dL (5.6 to 13.9 mmol/L), it is good to go.\u003csup\u003e\u003cb\u003e30\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStructured physical exercise program (SPEP) was employed\u003csup\u003e\u003cb\u003e25\u003c/b\u003e\u003c/sup\u003e included three phases, Phase 1: Ten min warm-up, Phase 2: The main Exercise protocol lasting 45 min was employed in previous studies\u003csup\u003e\u003cb\u003e36\u003c/b\u003e\u003c/sup\u003e involving aerobic or combined aerobic and anaerobic training with moderate intensity (50\u0026ndash;70% of MHR and the intervention were supervised 5 times per a week. The exercise duration were followed the principle of progression by increasingly gradually: 30\u0026ndash;35 min in week 1st -2nd, 35\u0026ndash;40 min in weeks 3th -5th, and 45 min in weeks 6th -17th. Phase 3: Finally, 5 min cool down period comprised of slow walking for a gradual recovery. However, they could supply the water required by their bodies in the sessions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAerobic exercise group\u003c/h2\u003e \u003cp\u003eThe aerobic training group exercise on treadmills or bicycle ergo-meters. Heart rate monitors by (Polar Electro Oy, Kempele, Finland) to adjust workload to achieve the target HR\u003csup\u003e\u003cb\u003e15\u003c/b\u003e\u003c/sup\u003e. Participants progressed from 30 to 35min per session at 50% of the Max-HR to 45min/session at 70% Max-HR\u003csup\u003e\u003cb\u003e32\u003c/b\u003e\u003c/sup\u003e as determined by using a maximal treadmill, and cycling exercise test for 45 min, 5times/week which has been employed in previous studies \u003csup\u003e\u003cb\u003e1,45\u003c/b\u003e\u003c/sup\u003e for 17 weeks\u003csup\u003e\u003cb\u003e42\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCombined/Aerobic-Anaerobic exercise group\u003c/h2\u003e \u003cp\u003eThe combined group exercise strength training followed by full aerobic exercise training the aerobic do \u003csup\u003e\u003cb\u003e48\u003c/b\u003e\u003c/sup\u003e. Participants progressed from 30 to 35min /session at 50% Max-HR to 45min session at 70% Max-HR determined by using a maximal treadmill and cycling exercise test plus resistance training at 50% \u0026minus;\u0026thinsp;70%, 1RM performed 10 different exercises Chest flay, Bicep curl, Triceps extension, Lower back( back extension), leg raise, squatting, dumbbell supine, leg extension, dumbbell curl and trunk flexion and vertical bench press on weight machines each session, progressing to 2 to 3 sets of each exercise at the maximum weight that could be lifted 8 to 12 times. Weeks 1\u0026ndash;8, 50% -60%of 1RM used for 8\u0026ndash;10 repetitions. In weeks 9\u0026ndash;17, 60%-70% 1RM were used for 10\u0026ndash;12 repetitions. Each session lasted for 30\u0026ndash;45 min \u003csup\u003e\u003cb\u003e15,36,44\u003c/b\u003e\u003c/sup\u003e for 5 times per week.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eControl group\u003c/h2\u003e \u003cp\u003eControl groups were instructed not to change their usual lifestyle, including physical activity. Only nutritional council was given the same like other groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEnhanced lifestyle counseling Nutritional and psychological counseling\u003c/h2\u003e \u003cp\u003e Briefly lifestyle education and motivational counseling to motivate participants not to drop out from the training and nutrition counseling was conducted for participant who was offered two class sessions with 30\u0026ndash;60 min in length at the beginning and at the middle weeks of the intervention was done by lifestyle coaches, certified at recognized university or collage. Participants were encouraged to lose weight between 5-8kg/week by reducing calorie intake and increasing energy expenditure until the end of the intervention program.\u003c/p\u003e \u003cp\u003ePrimary Outcome: Before and after the program, 10mL of blood sample (Silvia, 2018) was draw from the antecubital-vein under fasting, stable conditions. HbA1c measurements was made in duplicate at baseline and at the end of the intervention using \u0026lsquo;FINECARE\u0026rsquo; HbA1c analyzer, Biochemical Apparatus Type: - Fluorescence Immunoassay Analyzer, Certification: - CE, FDA, ISO13485).Secondary outcome: The Levels of Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein cholesterol (HDL-C), and Low-density lipoprotein cholesterol (LDL-C) was and triglyceride analyzed enzymatically using auto-analyzer (Hitachi 7600\u0026thinsp;\u0026minus;\u0026thinsp;110/7170 Analyzer, Tokyo, Japan). Body Mass Index by BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) was calculated dividing the individual\u0026rsquo;s weight in Kg by the square of height in meters (W/ h\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eWaist circumference (WC) was measured the waist circumference should be measured at the midpoint between the lower margin of the last palpable ribs and the top of the iliac crest, using a stretch-resistant tape that provides constant 100 g (3.53 oz) tension according to the \u003csup\u003e\u003cb\u003e43\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis Data\u003c/h2\u003e \u003cp\u003ePre and posttest of each group were compared with the baseline information at the end of the study. T-test for independent samples was used, T-test was considered significant if P\u0026thinsp;\u0026le;\u0026thinsp;0.05. Analysis of Variance (ANOVA) and post Hock (Tukey, HSD) was used to compare the means of different groups and determine which group is significantly different from the others after training with baseline scores.\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;1 participants back ground information\u003c/p\u003e \u003cp\u003eThe study used 30 male participants, all of whom completed the intervention program. First the age distribution was trying to balance across the group. The study variables did not differ significantly prior to the intervention. Additionally, normality test of data (Shapiro-Wilk Test) across the groups revealed that the data was normally distributed.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1:- Descriptive statistic shows that the aerobic group, combined group and control groups participant\u0026rsquo;s age score with was mean value (M\u0026thinsp;=\u0026thinsp;54.1 SD\u0026thinsp;=\u0026thinsp;7.48999, M\u0026thinsp;=\u0026thinsp;54.3000 SD\u0026thinsp;=\u0026thinsp;7.13442 and M\u0026thinsp;=\u0026thinsp;54.8, SD\u0026thinsp;=\u0026thinsp;7.00476) respectively. And their years of lifetime with disease after they medically checked was relatively the same in all groups (M\u0026thinsp;=\u0026thinsp;6.2, SD\u0026thinsp;=\u0026thinsp;2.4404, M\u0026thinsp;=\u0026thinsp;5.9, SD\u0026thinsp;=\u0026thinsp;2.72641 and M\u0026thinsp;=\u0026thinsp;5.8, SD\u0026thinsp;=\u0026thinsp;2.14994) respectively. As the ANOVA table reveals that there is no significance difference between groups before the interventions started by age and years of life time with the disease F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;0.025, with p\u0026thinsp;=\u0026thinsp;0.975 and F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;0.72, with respectively ( p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) level.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 pre and post T test\u003c/p\u003e \u003cp\u003ePaired t-test was used to compare intragroup changes in weight, BMI, glycemic hemoglobin (HbAlc), Total cholesterol (TC), low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG), and waist circumference (WC). The results of paired t-test showed that there was a statically significant difference P\u0026thinsp;\u0026lt;\u0026thinsp;.001 between the pre-test and posttest of study parameters in all aerobic and combined intervention groups but there is no significance difference in control group.\u003c/p\u003e \u003cp\u003eAdditionally table-2: paired t-test showed that there was a significance statistical differences between pre-test and posttest in aerobic group on weight (W) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;12.208, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, BMI t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;11.005, p\u0026thinsp;\u0026gt;\u0026thinsp;.001, HbAlc t(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;18.557, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, Total cholesterol (TC) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;14.853, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, low density lipoprotein (LDL) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;41.887, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, High density lipoprotein (HDL) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) = -7.364, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, Triglyceride (TG) t(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;32.955, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, and waist circumference (WC) t(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;17.333, P\u0026thinsp;\u0026lt;\u0026thinsp;.001 and the combined training group showed a significance statistical differences on weight (W) t(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;17.238, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, BMI t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;16.896, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, HbAlc t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;26.465, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, Total cholesterol (TC) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;23.401, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, low density lipoprotein (LDL) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;6.683, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, High density lipoprotein (HDL) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) = -4.708, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, Triglyceride (TG) t(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;45.258, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, and waist circumference (WC) t (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;26.047, P\u0026thinsp;\u0026lt;\u0026thinsp;.001. Generally, there was a statistically significant difference between the pretest and post-test of all measured variables in all two different intervention training protocols at (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;3, ANOVA result between the Groups\u003c/p\u003e \u003cp\u003eThe objective of this study is to determine which intervention training are most effective modalities to enhance the study variables. The ANCOVA table 3, and Post hoc test table 4, was used to determine which training intervention had the greatest impact. There were significant differences of two types of intervention training after 17weeks compared with control group for weight (W) (F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;6.196, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), BMI (F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;20.018, P\u0026thinsp;\u0026lt;\u0026thinsp;0 .001), HbAlc (F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;317.529, P\u0026thinsp;\u0026lt;\u0026thinsp;001), TC (F2, 27)\u0026thinsp;=\u0026thinsp;73.927, P\u0026thinsp;\u0026lt;\u0026thinsp;.001), LDL (F ( 2,27)\u0026thinsp;=\u0026thinsp;49.884, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, HDL (F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;38.03, P\u0026thinsp;\u0026lt;\u0026thinsp;.001), TG (F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;702.577, P\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;4; post Hock table\u003c/p\u003e \u003cp\u003eFrom table 4, multiple group pairwise comparisons of the post hoc of weight, BMI, HbAlc, Total cholesterol (TC), low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG), and waist circumference (WC) mean differences between the two interventions and a control groups are displayed. Both two intervention training groups have shown a reduction in those variables. However, the most effective intervention training was combined resistance plus aerobic training.\u003c/p\u003e \u003cp\u003eFrom the post Hock result, Aerobic intervention group vs. control group showed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) with reductions in Weight (MD = -9\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) BMI (MD= -3.68\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;.001), HbAlc (MD = -8.17\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), TC (MD = -34.4\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), LDL (MD = -47.3\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but there was no statistically significant difference between aerobic and control group HDL ( MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.2, p\u0026thinsp;=\u0026thinsp;.969 that is P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) -13.3%) TG (MD = -73.2\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), WC MD = -12.1\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe combined intervention group vs. control group showed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) with reductions in Weight( MD = -7\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), BMI (MD= -2.99\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;.001), HbAlc (MD= -8.61\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), TC(MD= -40.6\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), LDL(MD= -43.2\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), HDL (M\u0026thinsp;=\u0026thinsp;6.2\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) TG (MD= -82.4\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), WC (MD= -15.4\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe combined group show an improvement statistically significant difference in HDL with (M\u0026thinsp;=\u0026thinsp;6.4\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;.000), decrease in waist circumference with (MD = -3.3\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;.001), decrease in triglyceride level with (9.2, P\u0026thinsp;=\u0026thinsp;.002) more compared to aerobic group. Also, the Combined group decease in HbAlc (MD\u0026thinsp;=\u0026thinsp;.44), TC (MD\u0026thinsp;=\u0026thinsp;6.2) more compared to Aerobic group but the result was did not showed statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) level.\u003c/p\u003e \u003cp\u003eThe aerobic group decrease on TG statistically significant difference with (MD\u0026thinsp;=\u0026thinsp;9.2, P\u0026thinsp;\u0026lt;\u0026thinsp;.05) compared with the combined group.\u003c/p\u003e \u003cp\u003eThe aerobic group decrease more weight with (MD = -2.0, P\u0026thinsp;=\u0026thinsp;.739), LDL and (MD = -4.1, P\u0026thinsp;=\u0026thinsp;.717), than the combined group but was no statistically significant difference with, (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) level.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of the study was to compare the effect seventeen (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) week of aerobic training with combined exercise training on indices of obesity and diabetes type-2. As the result reveal that there was statistically significance difference or change in HbAlc, weight, BMI, total cholesterol(TC), low density lipoprotein(LDL) high density lipoprotein (HDL), Triglyceride(TR), and waist circumference( WC) between the pre and posttest results in aerobic and combined group with (p\u0026thinsp;\u0026lt;\u0026thinsp;.001 ) but there was no change in control group.\u003c/p\u003e \u003cp\u003eThis study find that aerobic and combined experimental group was shown a greater statistically significant difference in glycemic hemoglobin value than Control group after the intervention. Consistence result was reported by\u003csup\u003e\u003cb\u003e22\u003c/b\u003e\u003c/sup\u003e assessed the effect of combined exercise compared with aerobic exercise among patients with T2DM. The results showed a significant reduction of HbA1c by 0.31%. A contradicted result were reveals, a meta- analysis by \u003csup\u003e\u003cb\u003e50\u003c/b\u003e\u003c/sup\u003e identified 13 eligible studies investigating the effect of exercise on patients with T2DM and obesity, and the result showed that exercise had no effect on HbA1c in the 3months intervention subgroup, but similar result with our study also, reported in this meta-analysis that exercise was significantly reduced HbA1c by 0.25%, 0.93% and 0.26% when intervention duration were 4months, 6 months and 12 months respectively. Again an opposite result with our study were reveal by\u003csup\u003e\u003cb\u003e13\u003c/b\u003e\u003c/sup\u003e the study compared combined aerobic and resistance training with aerobic training alone find no difference s in HbA1c values between the groups, but the low average baseline hemoglobin HbA1c value (6.7%) limited the power to detect a difference. In addition to that the study was used women as a participant which was a different sample with our study i.e. male.\u003c/p\u003e \u003cp\u003eSeventeen (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) weeks exercise intervention was observed statistically significance difference on losing weights and improve BMI between pretest and posttest on aerobic and combined training group but the control group was not shown. The result also reveals that there was no statistically significant difference between the Aerobic group and weight more than the combined in weight loss. Similar results was reveal on a studies used supervised structured aerobic exercise training (SSAET), the result shows that aerobic exercise were effective at reducing BMI\u003csup\u003e\u003cb\u003e3,35\u003c/b\u003e\u003c/sup\u003e or body composition\u003csup\u003e\u003cb\u003e27\u003c/b\u003e\u003c/sup\u003e. Moreover, similarly with this study aerobic and resistance training with motivational counseling was significantly improved physical fitness and weight loss\u003csup\u003e\u003cb\u003e7, 49\u003c/b\u003e\u003c/sup\u003e. Another studies also reported in a review by\u003csup\u003e\u003cb\u003e47\u003c/b\u003e\u003c/sup\u003e, eight studies reported there was a changes in BMI in people with type-2 diabetes. The pooled results showed that combined exercise significantly reduced BMI in the intervention group as opposed to the control group (MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.98 kg/m\u003csup\u003e2\u003c/sup\u003e, 95% CI: \u0026minus;1.41 to \u0026minus;\u0026thinsp;0.56, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAdditionally Cuff et al., 2003 were the first to compare combined (aerobic and resistance) training with aerobic training group as well as a non-exercising control group. The result reveals that both training regimes show statistically significant reductions in body weight and abdominal adiposity. Another study a randomized trial by\u003csup\u003e\u003cb\u003e36\u003c/b\u003e\u003c/sup\u003e on the effects of aerobic training, resistance training or both on glycemic control in type2 diabetes the result show the combined exercise was more effective than either aerobic or resistance training alone in reducing HbA1c, Changes in body composition of the combined exercise group did not differ from those in the aerobic training groups.\u003c/p\u003e \u003cp\u003eBut different result were reported in line with the current study, a meta-analysis that exercise intervention of at least 8 weeks of supervised regular aerobic exercise in type-2 diabetic individuals has showed a statistically little effect on body weight\u003csup\u003e\u003cb\u003e10\u003c/b\u003e\u003c/sup\u003e. This result might be because of that the training session per week was only 3times and it was not enough to come up a change or meet at the level of physical fitness to see a change especially for these special populations. Most guides of physical exercise for physical fitness recommends that 5times /week is crucial for fitness improvement. As \u003csup\u003e\u003cb\u003e39\u003c/b\u003e\u003c/sup\u003ealso suggested that short-term exercise training exerted no significant effect on body weight, BMI and body fat.\u003c/p\u003e \u003cp\u003eIn addition to that the aerobic and combined experimental group was showed a greater statistically significant difference by decreasing in total cholesterol (TC), low density lipoprotein (LDL), triglyceride (TG) and waist circumference (WC) than Control group with P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 level.\u003c/p\u003e \u003cp\u003eAgain our study reveals that combined group has shown great statistical significant difference on improving HDL than the aerobic and control group with MD\u0026thinsp;=\u0026thinsp;6.400\u003csup\u003e*\u003c/sup\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;.001 and MD\u0026thinsp;=\u0026thinsp;6.2\u003csup\u003e*\u003c/sup\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 but the aerobic group was not shown any statistical significance difference with control group. There was also no statistically significant difference between aerobic and combined group on TC and LDL (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eSimilarly RCTs involving type 2 diabetes patients have reported that intensive \u003cb\u003ediet and\u003c/b\u003e aerobic training decreases, LDL-cholesterol, \u003csup\u003e\u003cb\u003e26\u003c/b\u003e\u003c/sup\u003e Total cholesterol (TC) and triglycerides (TG) but failed to include controls and opposite to our result the aerobic group rises on HDL cholesterol \u003csup\u003e\u003cb\u003e26,8,9\u003c/b\u003e\u003c/sup\u003e than the control group. Another studies reported with a randomized trials\u003csup\u003e\u003cb\u003e36\u003c/b\u003e\u003c/sup\u003e used in aerobic training, resistance training or both types of exercise groups, Waist circumference decreased more in the aerobic training and resistance training groups than in the control group.\u003c/p\u003e \u003cp\u003eIn addition to that our study reveals, the combined group decrease in triglyceride (TG) and waist circumference (WC) more compared to aerobic group which was statistically significant with P\u0026thinsp;\u0026lt;\u0026thinsp;.001 level. Similar result were reveals that combined exercise group showed a more significant reduction in TG than the other groups (control, aerobic, and resistance), showing MDs of 20.39 (95% CI: 12.03 to 28.74), 10.5 (95% CI: 2.37 to 18.17), and 13.28 (95% CI: 4.94, 21.76) respectively. Moreover, combined exercise was regarded as the most efficacious protocol for improving TG, according to the SUCRA values 99.8%. \u003csup\u003e\u003cb\u003e28\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the Look Action for Health in Diabetes (AHEAD) study, intensive lifestyle participants exhibited similar result with this study that greater decreases in triglycerides (TG) and increases in HDL than the control group while both the intensive lifestyle and usual care groups decreased LDL cholesterol. Randomized trials have reveal that supervised exercise interventions improve triglycerides (TG) and total cholesterol\u003csup\u003e\u003cb\u003e7\u003c/b\u003e\u003c/sup\u003e in people with type 2 diabetes \u003csup\u003e\u003cb\u003e37\u003c/b\u003e\u003c/sup\u003ecompared to no-exercise comparison groups.\u003c/p\u003e \u003cp\u003eA gain a meta-analysis by\u003csup\u003e\u003cb\u003e16\u003c/b\u003e\u003c/sup\u003e reported that seven studies representing 220 men and women (112 are in exercises, 108 are in controls) were available for pooling. Using a random-effects model, a statistically significant reduction of about 5% was reveals for LDL-C which was similar with our study, whereas an opposite to our result was reported with aerobic exercise was not showed statistically significant improvements on TC, HDL-C, TG but similar result with our study in HDL-C than the control group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study tries to show the benefit of aerobic and combined regular exercise in T2DM patients with obesity. Generally, aerobic exercise and combined training have positive effects in the prevention or management of obesity with blood glucose control and other risk factors. Moreover this benefit may be effective and efficient in the combination of aerobic plus strength exercise training. Weight, Body composition (BMI), TC, HDL, LDL, TG and WC significantly decreased in combined (aerobic plus strength) or alone, suggesting that combined exercise intervention was more effective in changing these measures. Adverse events: Two studies reported the prevalence of adverse events during training and after training most adverse events were sports injuries and hypoglycemia but not sever.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eI need a sponsorship organization, as well as if the journal publish this paper with free payment as a sponsor of me .\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTamagne Awoke Sisay is the first person or Authors who is a student at Addis Ababa university and write the hole paper work collect data and analysis, interpretation and presentation .Alemmebrat Kiflu (PhD) an associate professor at Addis Ababa university, who is the second author and control, guide \u0026amp; direct, construct the experimental protocol for the intervention training procedures, follow up the work how it was going on.Aschenaki Tadess(PhD)an associate professor at Addis Ababa university, the 3rd author and who see and give critical correction on the general paper work and work on data encoding with SPSS analysis and interpretation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003ewe would like to the almighty God for finishing all the process and pass the challenges with this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbby C. 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Primary Care Diabetes, (), S175199181500128X\u0026ndash;.\u003c/em\u003e doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pcd.2015.10.003\u003c/span\u003e\u003cspan address=\"10.1016/j.pcd.2015.10.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"DiabetesT2 Mellitus, body mass index, aerobic exercise, combined exercise","lastPublishedDoi":"10.21203/rs.3.rs-4418547/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4418547/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Physical exercise is has been recommended as an important non-pharmacological therapeutic strategy for managing diabetes type2 mellitus (T2DM) and obesity. The purpose of this study was to compare the effects of17 weeks aerobic, and combined, both aerobic plus resistance training on HbAlc, bodyweight, body composition and others cardiorespiratory fitness (CRF) components among T2DM and obese patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e: positivism style of research paradigms and quantitative method of true randomize experimental design was used. \u0026nbsp;30 T2DM and obese male patients; aged 40–65 years (M=54.4, SD=6.96593), their BMI ≥30 kg/m\u003csup\u003e2 _ \u003c/sup\u003e39.9 kg/m\u003csup\u003e2\u003c/sup\u003e, were randomized to one of the two exercise interventions or a control group. All two exercise groups had an equal total exercise time lasting 60min aerobic or combined training (50-70% of MHR \u0026amp; 1RM). HbAlc, body mass index (BMI) Total cholesterol (TC), Triglycerides (TG), High-density lipoprotein (HDL-C), Low density lipoprotein (LDL) and Waist circumference\u003cstrong\u003e \u003c/strong\u003e(WC) were measured. Paired sample T-test, Analysis of Variance (ANOVA) and post Hock was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e aerobic and combined groups showed significance improvement during pre and posttest in weights, BMI, HbAlc, TC, TG, LDL, HDL and WC, P \u0026lt;.001, than the control group. From the ANOVA (Post Hock) result: Aerobic training and combined group was revealing a greater statistical difference more than the Control group in\u003cu\u003e \u003c/u\u003eweight (MD = -9\u003csup\u003e*\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eand MD = -7\u003csup\u003e* \u003c/sup\u003ep \u0026lt; 0.05), BMI (MD= -3.68\u003csup\u003e*\u003c/sup\u003e and\u0026nbsp; -2.99\u003csup\u003e* \u003c/sup\u003e,\u0026nbsp; P\u0026lt; .001), HbAlc (MD = -8.17\u003csup\u003e*\u003c/sup\u003e, and MD= -8.61\u003csup\u003e*\u003c/sup\u003e, P \u0026lt; 0.001), TC (MD = -34.4\u003csup\u003e*\u003c/sup\u003eand\u0026nbsp; MD= -40.6\u003csup\u003e*\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eP \u0026lt; 0.001), LDL (MD = -47.3\u003csup\u003e*\u003c/sup\u003e, and\u0026nbsp; MD =\u0026nbsp;\u0026nbsp;\u0026nbsp; -43.2\u003csup\u003e*\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eP \u0026lt; 0.001),WC (MD = -12.1\u003csup\u003e*\u003c/sup\u003e, and MD= -15.4\u003csup\u003e*\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eP \u0026lt; 0.001),\u0026nbsp; TG (MD = 73.2\u003csup\u003e*\u003c/sup\u003eand MD= -82.4\u003csup\u003e*\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eP \u0026lt; 0.001). But in HDL the aerobic group didn’t shown significance difference (MD= -.2, p = .969 that is P \u0026gt; 0.05) than the control group. But the combined group was shown great statistical difference than the aerobic and control group with (MD= 6.4\u003csup\u003e*\u003c/sup\u003e, P\u0026lt; .001) and (MD= 6.2\u003csup\u003e*\u003c/sup\u003e, p \u0026lt; .001) respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCompared to aerobic exercise, a 17-week of combined aerobic-anaerobic exercise intervention was more successful in altering these parameters.\u003c/p\u003e","manuscriptTitle":"The Effect of Aerobic and Combined, Aerobic-anaerobicexercise on Obese Diabetic Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-24 05:17:21","doi":"10.21203/rs.3.rs-4418547/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf12d7c6-fbf3-447e-9228-49750d127f9f","owner":[],"postedDate":"May 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T19:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-24 05:17:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4418547","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4418547","identity":"rs-4418547","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}