Efficacy of Pilates exercises and supplementation with Camellia sinensis extract in body composition of female patients diagnosed with metabolic syndrome:a randomized,double-blind,placebo-controlled clinical trial

1 Institute for Geriatrics and Gerontology of the Pontifical Catholic University of Rio Grande do Sul,Porto Alegre,RS,Brazil

2 Federal University of Rio Grande do Sul,Porto Alegre,RS,Brazil

3 Pontifical Catholic University of Rio Grande do Sul,Porto Alegre,RS,Brazil

Abstract

Key words:body composition; Camellia sinensis; cardiometabolic risk factor; diet; dietary; metabolic syndrome; physical exercises; Pilates exercises; randomized controlled trial

INTRODUCTION

Metabolic syndrome (MetS) is a complex multifactorial disorder determined by a plethora of cardiometabolic risk factors,increasing the morbidity and mortality rates of cardiovascular diseases.1-4The major cardiometabolic risks for MetS are abdominal obesity,hypertension,diabetes,and dyslipidemia which,in isolation or combination,have a strong impact on health and quality of life.5MetS is associated with a higher prevalence (22% to 69%) among postmenopausal women,depending on the diagnostic criteria used.This is closely related to low levels of estrogen,which is deemed to be a protective factor of the cardiovascular system in premenopausal women.6Reduction in the levels of this hormone may trigger metabolic changes and increase visceral fat deposition and oxidative stress,thereby resulting in endothelial dysfunction,reduction of parasympathetic tonus,and increase in renin-angiotensin system activity.7

Scientific evidence has demonstrated that a sedentary lifestyle in conjunction with dietary excesses and poor diet quality,in addition to genetic predisposition,are important etiologic factors,perhaps playing a decisive role in the global incidence and higher prevalence of MetS.8-11A previous study on lifestyle modification,including balanced and healthy diet and regular physical exercise practice,has yielded excellent results for weight loss and control of MetS.12It has been shown that a sedentary lifestyle is one of the main risk factors for developing metabolic disorders and cardiovascular diseases,in addition to severely reducing muscle strength and muscle mass,especially among postmenopausal women.13Therefore,regular physical exercise practice combined with a diet rich in bioactive compounds is of great importance,not only as adjuvant therapy,but also as a way to prevent components of the MetS and the increase in cardiovascular risk.Another study has revealed that both physical exercises and dietary bioactive compounds can maintain the oxidative process within physiological limits,thus controlling injury to macromolecules,which often lead to irreparable systemic damage.14Accordingly,Pilates exercises have attracted a large band of followers in several countries,with special emphasis on postural correction and on strengthening back and abdominal muscles,thereby mitigating or preventing risk factors for cardiovascular diseases and metabolic diseases.14One of the mainstays of the Pilates method is the use of respiratory maneuvers that require a constant energy expenditure in all movements,avoiding excessive cardiac stress,thus improving hemodynamic parameters.15Moreover,a study on the Pilates method has demonstrated its efficacy in improving body composition among postmenopausal women.16However,Pilates exercises should be combined with the consumption of functional foods rich in bioactive compounds,such as green tea,obtained fromCamellia sinensis,for the prevention and treatment of MetS and its components.17Camellia sinensishas a high flavonoid (catechin) content,which produces a thermogenic effect and oxidizes body fat,leading to weight loss and reduction of abdominal obesity,thus being regarded as a powerful adjunct in the prevention of health problems caused by MetS components.18,19Green tea also contains carotenoids,tocopherol,ascorbic acid,and minerals (Zn,Ca,K,and Mn),which enhance its antioxidant potential.Green tea polyphenols havein vitroantioxidant activity that neutralizes reactive oxygen species and reactive nitrogen species.20They can also chelate metals (e.g.,iron),precluding its participation in free radical-generating reactions such as the Fenton and Haber-Weiss ones,which are extremely harmful to lipids,proteins,and DNA.

The aim of the present study was to check the efficacy of Pilates exercises and supplementation withCamellia sinensisextract (CSE) (green tea) in the body composition of postmenopausal women.

PARTICIPANTS AND METHODS

Study design

A randomized,double-blind,placebo-controlled clinical trial.

Participants

The study population comprised postmenopausal women from Porto Alegre,state capital of Rio Grande do Sul,southern Brazil,who had at least two MetS components and no cardiovascular event until the beginning of the study.Estimated sample size was initially 60 women,but 50 volunteers were eventually included.The trial was reported in line with the CONsolidated Standards Of Reporting Trials (CONSORT) 2010 guidelines21(Figure1) and performed in accordance with theDeclaration of Helsinki.This study protocol was approved by the Institutional Ethics Committee of Pontifical Catholic University.All participants provided the written informed consent.

The study recruited 50 volunteers,with a mean age of 61.3 ± 6.6 years (range from 51 to 77 years),who met the diagnostic criteria for MetS.1All participants were randomly assigned to four groups:(1) Pilates + CSE (n= 14); (2) Pilates + Placebo (n= 11); (3) CSE (n= 11); and (4) Placebo (n= 14) using a box from which the numbers corresponding to each participant (simple randomization method).

Mean age (years) did not differ among the groups:60.5 ± 6.2 for the Pilates + CSE group,62.6 ± 6.7 for the Pilates + Placebo group,59.1 ± 4.7 for the CSE group,and 62.9 ± 8.0 for the Placebo group (P= 0.462).

Intervention

Both the placebo and CSE capsules were the same size,contained the same amount of substances (500 mg),and were administered once a day for 24 weeks.

Pilates exercises were performed in 25 women in the Pilates + CSE (n= 14) and Pilates + Placebo (n= 11) groups.Intervention consisted of 60-minute sessions for 24 weeks,twice a week.The exercises were carried out on the following equipment:Reformer,Cadillac,Wall Unit,Ladder Barrel,and Chair.Basic-level mat exercises were also performed.All exercises were done in a progressive and easy-to-follow (didactic) manner,in compliance with the fundamental principles of the Pilates method.

Body composition measurement

Bio Tetrapolar Sanny,a four-electrode system placed on the skin surface,was used to record body fat (expressed both in kg and percentage),lean mass (expressed both in kg and percentage),whole-body mass,and total body water.All assessed participants were dressed in swimsuit,and all measurements were made in the supine position.Weight was checked using a calibrated anthropometric scale with a 150-kg capacity and 100-g increments.Minimum abdominal circumference or waist circumference was measured at the iliac crest level; and those with a circumference greater than 80 cm were considered to have central obesity.

Statistical analysis

The data were analyzed by IBM SPSS statistical package (version 21.0; IBM,Armonk,NY,USA).The continuous variables were described as the mean and SD/SE.One-way analysis of variance was used along with Tukey’spost hoctest for comparison of the means.Analysis of covariance was used with Bonferroni correction to adjust any differences from baseline values.Within-group comparisons were made by Student’st-test for paired samples.The significance level was set at 5% (P＜ 0.05).

RESULTS

As shown in Table1,the means for lean mass (kg) in the Pilates + CSE and Pilates + Placebo groups were significantly higher than those in the CSE and Placebo groups (P＜ 0.05).Percentage lean mass was significantly higher in the Pilates + CSE group than in the CSE + Placebo group (P＜ 0.05).Percentage lean mass of the Pilates + Placebo group was significantly higher only when compared with the Placebo group (P＜ 0.05).Percentage fat mass was significantly lower in the Pilates + CSE group than in the CSE and Placebo groups (P＜ 0.05).Percentage fat mass was significantly lower in the Pilates + Placebo group than in the Placebo group (P＜ 0.05).

Table2 shows the comparisons for the intra-group variables.There was a sharp reduction in fat mass and percentage fat mass in the Pilates + CSE group (P＜ 0.05),in addition to a significant increase in lean mass and percentage lean mass(P＜ 0.05).The Pilates + Placebo group showed a significant reduction of fat mass and percentage fat mass (P＜ 0.05) and a significant increase in lean mass and percentage lean mass (P＜ 0.05).Whole-body mass was significantly reduced in the CSE group (P＜ 0.05).

Table1:Inter-group comparison of body composition after intervention

Table2:Intra-group comparison of body composition

Figure1:Trial flow chart.

DISCUSSION

The results obtained herein indicate that Pilates exercises and supplementation with CSE are efficient in improving body composition,reducing percentage fat mass and fat mass and increasing percentage lean mass and lean mass.

Author contributions

All authors contributed to the study design,paper writing and data analysis and approved the final version of the paper.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Financial support

None.

Institutional review board statement

This study protocol was approved by the Institutional Ethics Committee of Pontifical Catholic University,and performed in accordance with theDeclaration of Helsinki.

Declaration of participant consent

The authors certify that they have obtained all appropriate participant consent forms.In the forms the participants have given their consent for their images and other clinical information to be reported in the journal.The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity.

Reporting statement

This study followed the CONsolidated Standards Of Reporting Trials (CONSORT) guidelines.

Biostatistics statement

The statistical methods of this study were reviewed by the biostatistician of the Pontifical Catholic University of Rio Grande do Sul in Brazil.

Copyright license agreement

The Copyright License Agreement has been signed by all authors before publication.

Data sharing statement

Individual participant data will not be available.However,the study protocol and informed consent form will be made available beginning 3 months and ending 5 years following article publication.In order to gain access,data requestors will need to sign a data access agreement.Proposals should be directed to silvanajunges@gmail.com.

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Peer review

Externally peer reviewed.

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