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Yoga Training Modulates Adipokines in Adults with High- Normal Blood

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Yoga Training Modulates Adipokines in Adults with High- Normal Blood Accepted: 28 November 2017 DOI: 10.1111/sms.13029 ORIGINAL ARTICLE Yoga training modulates adipokines in adults with high- normal blood pressure and metabolic syndrome Rashmi Supriya1 | Angus P. Yu2 | Paul H. Lee3 | Christopher W. Lai1 | Kenneth K. Cheng1 | Sonata Y. Yau4 | Lawrence W. Chan1 | Benjamin Y. Yung1 | Parco M. Siu2 1Department of Health Technology and Informatics, Faculty of Health and Social Metabolic syndrome (MetS) is associated with diabetes mellitus and cardiovascular Sciences, The Hong Kong Polytechnic diseases. Our previous study indicated that people with MetS showed a decrease in University, Kowloon, Hong Kong, China waist circumference and a decreasing trend in blood pressure after 1- year yoga. This 2 School of Public Health, Li Ka Shing study investigated the effect of yoga on MetS people with high- normal blood pres- Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China sure by exploring modulations in proinflammatory adipokines (leptin, chemerin, vis- 3School of Nursing, Faculty of Health fatin, and plasminogen activator inhibitor- 1 or PAI- 1) and an anti- inflammatory and Social Sciences, The Hong Kong adipokine (adiponectin). A total of 97 Hong Kong Chinese individuals aged Polytechnic University, Kowloon, Hong 57.6 ± 9.1 years with MetS and high- normal blood pressure were randomly assigned Kong, China 4 to control (n = 45) and yoga groups (n = 52). Participants in the control group were Department of Rehabilitation Sciences, Faculty of Health and Social not given any intervention but were contacted monthly to monitor their health status. Sciences, The Hong Kong Polytechnic Participants in the yoga group underwent a yoga training program with three 1- hour University, Kowloon, Hong Kong, China yoga sessions weekly for 1 year. The participants’ sera were harvested and assessed Correspondence for adipokines. Generalized estimating equation (GEE) was used to examine the in- Parco M. Siu, School of Public Health, The teraction effect between 1- year time (pre vs post), and intervention (control vs yoga). University of Hong Kong, Pokfulam, Hong Kong, China. GEE analyses revealed significant interaction effects between 1- year time and yoga Email: [email protected] intervention for the decreases in leptin and chemerin and the increase in adiponectin Funding information concentration in the sera examined. These results demonstrated that 1- year yoga Hong Kong Research Grants Council Hong training decreased proinflammatory adipokines and increased anti- inflammatory adi- Kong Ph.D. Fellowship Scheme, Grant/ Award Number: RTVX PF13-11753; Hong pokine in adults with MetS and high-normal blood pressure. These findings support Kong Polytechnic University Research the beneficial role of yoga in managing MetS by favorably modulating adipokines. Fund, Grant/Award Number: 1-ZE17; The University of Hong Kong Seed Fund for KEYWORDS Basic Research adipokine, high blood pressure, hypertension, metabolic syndrome, mind-body exercise 1 | INTRODUCTION might be another chief contributor to MetS as hyperten- sion increases the risk for obesity and insulin resistance.2,3 Metabolic syndrome (MetS) is a clinically significant predic- Approximately 65%- 75% of hypertensive individuals are tor of all- cause and cardiovascular mortality. MetS represents obese, and 50% of hypertensive individuals are insulin- a cluster of metabolic abnormalities including central obe- resistant.4 Notably, it has been shown that the prevalence of sity, high blood pressure, dyslipidemia, hypertriglyceridemia, elevated blood pressure or hypertension among people with and hyperglycemia. Central obesity and insulin resistance MetS could be as high as 85%.3 Thus, it has been proposed are considered important underlying contributors to MetS.1 that blood pressure control might be an important strategy in Furthermore, some researchers believe that hypertension reducing the risk of MetS in healthy individuals. Scand J Med Sci Sports. 2018;1–9. wileyonlinelibrary.com/journal/sms © 2017 John Wiley & Sons A/S. | 1 Published by John Wiley & Sons Ltd 2 | SUPRIYA ET AL. Lifestyle modification has been suggested to be the key- of proinflammatory adipokines and increasing anti- stone for successful management of MetS.5,6 Yoga is a blend inflammatory adipokines in adults with MetS and high- of physical exercise, controlled breathing, and relaxation prac- normal blood pressure. tice. Hatha yoga, a commonly practised yoga stream, consists of asana (control of postures) and pranayama (manipulation of respiration). Yoga appears to have an antihypertensive ef- 2 | METHODS fect as well as a positive impact on self- rated quality of life. Improvements of MetS risk factors in middle- aged and older 2.1 | Study design and subject recruitment adults have been demonstrated to be associated with yoga in- This study was a follow- up to our previous randomized tervention7. One- year yoga training was shown to exert ben- controlled trial in which Chinese participants aged between eficial effect on reducing abdominal obesity and tended to 30 and 80 years who were diagnosed with MetS accord- decrease blood pressure in MetS people.7 Moreover, a short- ing to the diagnostic guidelines of the National Cholesterol term intensive yoga program (90 minutes/day for 15 consec- Education Program (NCEP) Adult Treatment Panel (ATP utive days) has also been demonstrated to cause favorable III) criteria underwent a 1- year yoga intervention program changes in body mass index, waist and hip circumference, in Hong Kong. Individuals with MetS were defined as total cholesterol, postural stability, and handgrip strength.8 having three or more of the following characteristics: (a) Indeed, yoga exercise has been shown to decrease stress, central obesity (waist circumference ≥ 90 cm for Asian reduce depression and anxiety, and increase perceived self- males or ≥ 80 cm for Asian females); (b) elevated blood efficacy in healthy individuals. The reduction in stress has glucose (fasting glucose level ≥ 5.5 mmol/L); (c) elevated been proposed as one of the potential underlying mechanisms blood pressure (systolic pressure ≥ 130 mm Hg or dias- explaining the benefits of yoga exercise.9 Intriguingly, a tolic pressure ≥ 85 mm Hg); (d) elevated plasma triglyc- cross- sectional study comparing the stress hormones between erides (triglyceride level ≥ 1.7 mmol/L); and (e) a low novice and expert yoga practitioners demonstrated that leptin level of high- density lipoprotein cholesterol (HDL- C; level was lowered and the ratio of adiponectin-to- leptin was dou- ≤ 1.03 mmol/L for males or ≤ 1.3 mmol/L for females). bled in experts when compared to novice yoga practitioners.9 Participants were randomly allocated into groups using a An epidemiological link between adiposity and hyperten- computer program. sion has been illustrated. Adipose tissue is a heterogeneous Participants having symptomatic heart or lung disease, organ comprised of subcutaneous and visceral adipose tis- pulmonary illness, severe rheumatoid arthritis or osteoarthri- sue. The incidence of hypertension has been reported to tis, dementia or mental disorder, previous stroke, severe car- be strongly associated with increased visceral adiposity.10 diovascular illness, major orthopedic problems in the lower Compared to subcutaneous adipose tissue, visceral fat is more back, neuromusculo- skeletal illness, and pelvis or lower ex- sensitive to lipolysis and secretes higher amounts of inflam- tremities were excluded. Participants who were on drug ther- matory cytokines such as PAI- 1,11 visfatin,12 and chemerin.13 apy treating metabolic abnormalities, regular tobacco users, In addition to visceral adipokines, subcutaneous adipokines wheelchair users, immobile, with physical conditions not have been correlated with hypertension. Subcutaneous ad- appropriate for yoga exercise were excluded. Additionally, ipose depot secretions of leptin and adiponectin might be participants who exercised at moderate- to- vigorous inten- useful in the prediction of hypertension.14 The progressive sity at least 30 minutes per session regularly (3 or more interaction between proinflammatory and anti-inflammatory days a week) were also excluded. All the experimental pro- adipokines is commonly thought to play a significant role in cedures received human research ethics approval from The the developmental process of systemic metabolic abnormali- Hong Kong Polytechnic University (ethics approval number: ties. Therefore, the understanding of the equilibrium and bal- HSEARS20090820001 and HSEARS20160810001).7 ance of adipokines (ie, pro- vs anti- inflammatory adipokines) In this study, we specifically selected 97 blood samples of in response to lifestyle components such as physical exercise participants (control n = 45, yoga n = 52) who had MetS spe- are critically needed for the new development of regimens to cifically with high- normal blood pressure (systolic pressure combat MetS and other metabolic disorders. ≥ 130 mm Hg or diastolic pressure ≥ 85 mm Hg) from the Yoga reduces MetS risk factors15 as well as inflam- pool of 182 archived blood samples from our previous study. matory adipokines.16,17 Our previous study indicated that The samples from control and yoga intervention group were participants with MetS showed a significant decrease in selected from two time points: Pre (baseline measurement at waist circumference and a decreasing trend in blood pres- the beginning of the study) and Post (the measurement upon sure (P = .067) with moderate effect size
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