Effect of 12 weeks aquatic and land Exercise training on serum nitric oxide and cardiac risk factors in diabetic women with heart failure

Document Type : Research Paper


1 .Associate professor, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran

2 Assistant professor, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran

3 Professor school of medicine, Tabriz University of Medicine Sciences, Tabriz, Iran

4 department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran


The aim of this study was to investigate effect of 12 weeks of aquatic and land aerobic exercise training on serum nitric oxide and cardiac risk factors in diabetic women with heart failure. Then, In semi experimental research, 40diabetic women with heart failure in 45 to 65 years old range with mean and standard deviation on Basal metabolic rate (BMI) of: 33±2/15 and Fasting blood sugar (FBS) more than 125 mg/dl voluntarily participated in this study and assigned to one of three groups: control (n=16), aquatic (n=16) and land exercise (n=8) groups. Aquatic exercises were carried out three sessions a week for 12 weeks, each session lasting 60 minutes with intensity of 5-8 in RPE Borg classification and land exercises were performed aerobic and resistance exercises with similar intensity. Patients in the control group continued their normal daily living activities. Blood sampling was gathered 48 h before and after training protocol for evaluating dependent variables. The obtained data were analyzed using One-way ANOVA, Kruskal-wallis and post hoc Tukey tests at the significant level α<0/05. The result showed significant increase in ALB (p=0/000) and NO (p=0/006) and significant decrease in FBS (p=0/002) in experimental groups in comparison with control group. There were significant decrease in TG (p=0/005) and LDL (p=0/016) only in aquatic group. The results showed that aerobic exercises especially in water as a safe and effective exercise Method could be helpful in improving complications of diabetic females with heart failures.


1.   Whiting, D.R., et al., IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice, 2011. 94(3): p. 311-321.
2.   Guariguata, L., et al., Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice, 2014. 103(2): p. 137-149.
3.   Nagi, D. and I. Gallen, ABCD position statement on physical activity and exercise in diabetes. Practical Diabetes International, 2010. 27(4): p. 158-163a.
4.   Longo, D.L., et al., Harrison's principles of internal medicine 18E Vol 2 EB. 2012: McGraw Hill Professional.
5.   Yeganeh, M., et al., Central obesity as a reliable predictor for hypertension and dyslipidemia: Tehran Lipid Glucose Study. Iranian Journal of Endocrinology and Metabolism, 2010. 12(3): p. 251-314. [In persian]
6.   Sadeghi, M., et al., A comparison of cardiovascular risk factors and healthy lifestyle of housewives and working women in Iran central regions-Isfahan Healthy Heart Program. Yafteh, 2012. 13: p. 55-64.
7.   Meredith-Jones, K., et al., Upright water-based exercise to improve cardiovascular and metabolic health: a qualitative review. Complementary therapies in medicine, 2011. 19(2): p. 93-103.
8.   Hayat, S.A., et al., Diabetic cardiomyopathy: mechanisms, diagnosis and treatment. Clinical Science, 2004. 107(6): p. 539-557.
9.   Yudkin, J.S., E. Eringa, and C.D. Stehouwer, “Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease. The Lancet, 2005. 365(9473): p. 1817-1820.
10. Bauer, V. and R. Sotníková, Nitric oxide—the endothelium-derived relaxing factor and its role in endothelial functions. General physiology and biophysics, 2010. 29(4): p. 319.
11. Woodman, R.J., D.A. Playford, and G.F. Watts, Basal production of nitric oxide (NO) and non-NO vasodilators in the forearm microcirculation in Type 2 diabetes: Associations with blood pressure and HDL cholesterol. Diabetes research and clinical practice, 2006. 71(1): p. 59-67.
12. Henry, R.M., et al., Type 2 diabetes is associated with impaired endothelium-dependent, flow-mediated dilation, but impaired glucose metabolism is not: The Hoorn Study. Atherosclerosis, 2004. 174(1): p. 49-56.
13. Hill, J.O. and H.R. Wyatt, Role of physical activity in preventing and treating obesity. Journal of Applied Physiology, 2005. 99(2): p. 765-770.
14. Sigal, R.J., et al., Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Annals of internal medicine, 2007. 147(6): p. 357-369.
15. Delevatti, R.S., et al., Glycemic reductions following water-and land-based exercise in patients with type 2 diabetes mellitus. Complementary therapies in clinical practice, 2016. 24: p. 73-77.
16. Åsa, C., et al., Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evidence-based complementary and alternative medicine, 2012. 2012.
17. Meyer, K. and M.-C. Leblanc, Aquatic therapies in patients with compromised left ventricular function and heart failure. Clinical & Investigative Medicine, 2008. 31(2): p. 90-97.
18. Albright, A., et al., American College of Sports Medicine position stand. Exercise and type 2 diabetes. Medicine and science in sports and exercise, 2000. 32(7): p. 1345-1360.
19. Jones, L.M., K. Meredith-Jones, and M. Legge, The effect of water-based exercise on glucose and insulin response in overweight women: a pilot study. Journal of Women's Health, 2009. 18(10): p. 1653-1659.
20. Volaklis, K.A., A.T. Spassis, and S.P. Tokmakidis, Land versus water exercise in patients with coronary artery disease: effects on body composition, blood lipids, and physical fitness. American heart journal, 2007. 154(3): p. 560. e1-560. e6.
21. Colado, J.C., et al., Effects of aquatic resistance training on health and fitness in postmenopausal women. European journal of applied physiology, 2009. 106(1): p. 113-122.
22. McNamara, R.J., et al., Water-based exercise in COPD with physical comorbidities: a randomised controlled trial. European Respiratory Journal, 2013. 41(6): p. 1284-1291.
23. Jorge, M.L.M.P., et al., The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metabolism, 2011. 60(9): p. 1244-1252.
24. Santos, J., et al., Skeletal muscle pathways of contraction-enhanced glucose uptake. International journal of sports medicine, 2008. 29(10): p. 785-794.
25. Rutter, G.A., G. da Silva Xavier, and I. Leclerc, Roles of 5′-AMP-activated protein kinase (AMPK) in mammalian glucose homoeostasis. Biochemical Journal, 2003. 375(1): p. 1-16.
26. Zoppini, G., et al., Effects of moderate-intensity exercise training on plasma biomarkers of inflammation and endothelial dysfunction in older patients with type 2 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 2006. 16(8): p. 543-549.
27. Adams, V., et al., Impact of regular physical activity on the NAD (P) H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation, 2005. 111(5): p. 555-562.
28. Maiorana, A., et al., Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes research and clinical practice, 2002. 56(2): p. 115-123.