A comparative study regarding effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients

Kaustav Nandi; Arunima Chaudhuri; Ayan Goswami; Arnab Guha; Souvik Nandy; Anupam Samanta

doi:10.4103/sjsm.sjsm_54_17

ORIGINAL ARTICLE

Year : 2018 | Volume : 18 | Issue : 1 | Page : 36-41

A comparative study regarding effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients

Kaustav Nandi, Arunima Chaudhuri, Ayan Goswami, Arnab Guha, Souvik Nandy, Anupam Samanta
Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Date of Web Publication

15-Feb-2018

Correspondence Address:
Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjsm.sjsm_54_17

Abstract

Background: Lifestyle modification with exercises such as brisk walking and stress management programs are known useful approaches in the treatment of diabetic individuals.
Aims: This study aims to compare effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients in a population of eastern India.
Materials and Methods: This pilot study was conducted in a time span of 1 year after taking institutional ethical clearance and informed consent of the individuals. Two hundred newly diagnosed diabetes patients were included. One hundred individuals were advised to walk in the morning. One hundred individuals were advised to walk in the evening. Initial laboratory values (Fasting and PP sugar, glycated hemoglobin (HbA1c), lipid profile) and anthropometric measurements (height, weight, body mass index [BMI], waist/hip ratio) were recorded. Life event stress and perceived stress of the individuals were measured by using presumptive life event stress scale and perceived stress scale, respectively. All the parameters were reassessed 3 months after practising the walking regimen.
Results: There were significant changes in both groups before and after the walking regimen, in fasting blood sugar, postprandial blood sugar, HbA1c, serum cholesterol, triglyceride, low-density lipoprotein, very low-density lipoprotein level, and perceived stress scores. No significant change in both groups was observed before and after the walking regimen, in BMI, waist/hip ratio, serum HDL, and presumptive stress score. There was no significant difference in mean values of different parameters, between the two groups before and after the walking regimen.
Conclusions: Walking in the morning and evening may be considered to be equally effective in respect of glycemic control, lipid metabolism, and stress management of diabetic individuals.

Abstract in Arabic

خلفية الدراسة: تعديل نمط الحياة بالتمارين مثل المشي السريع وبرامج إدارة الإجهاد هي المعروف عنها النهج المفيد في علاج الأفراد المصابين بالسكري. الأهداف: وتهدف هذه الدراسة إلى مقارنة تأثيرات العادية مقابل المشي في المساء مقارنة بالمشي في الصباح على الوضع البيوكيميائي والإجهاد الشخصي في تشخيص مرضى السكري المشخص حديثا في عدد سكان شرق الهندو.
المواد والطرق: أجريت هذه الدراسة التجريبية في فترة زمنية مدته سنة بعد أخذ التخليص الأخلاقي المؤسسي والموافقة المستنيرة من الأفراد. تم تضمين مائتي مريض تم تشخيصهم حديثا إصابتهم بمرض السكري. وقد نصح مائة شخص بالسير في الصباح. وقد نصح مائة شخص بالسير في المساء. وسجلت قيم المختبرية الأولية (والسكر الدم اثناء الصيام، الهيموغلوبين الغليكاتي (HbA1c)، تركيز الدهون) والقياسات الأنثروبومترية (الطول والوزن ومؤشر كتلة الجسم، ونسبة الخصر/ الورك). وتم قياس إجهاد الحدث الحياتي والإجهاد المتصور عند الأفراد باستخدام مقياس الإجهاد المفترض للحياة المفترضة ومقياس الإجهاد المتصور، على التوالي. تم إعادة تقييم جميع المعلمات بعد 3 أشهر من ممارسة برنامج المشي.
النتائج: كانت هناك تغيرات كبيرة في كلا المجموعتين قبل وبعد نظام المشي، وسكر الدم في الدم، وسكر الدم بعد الأكل، HbA1c، وكوليسترول الدم، والدهون الثلاثية، والبروتين الدهني منخفض الكثافة، ومستوى البروتين الدهني منخفض الكثافة، ودرجات الإجهاد المتصورة. لم يلاحظ أي تغيير كبير في كلا المجموعتين قبل وبعد نظام المشي، في مؤشر كتلة الجسم، ونسبة الخصر/ الورك، هدل المصل، ودرجة الإجهاد المفترض.
الخلاصة: المشي في الصباح والمساء يمكن اعتباره فعالا على قدم المساواة فيما يتعلق السيطرة على نسبة السكر في الدم، واستقلاب الدهون، وإدارة التوتر من الأفراد المصابين بالسكري.

Keywords: Diabetes, exercise, perceived stress

How to cite this article:
Nandi K, Chaudhuri A, Goswami A, Guha A, Nandy S, Samanta A. A comparative study regarding effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients. Saudi J Sports Med 2018;18:36-41

How to cite this URL:
Nandi K, Chaudhuri A, Goswami A, Guha A, Nandy S, Samanta A. A comparative study regarding effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients. Saudi J Sports Med [serial online] 2018 [cited 2023 Sep 21];18:36-41. Available from: https://www.sjosm.org/text.asp?2018/18/1/36/225301

Introduction

Type 2 diabetes is a chronic disease resulting from a complex inheritance-environment interaction along with other risk factors such as obesity and sedentary lifestyle affecting almost all populations in both developed and developing countries with high rates of diabetes-related morbidity and mortality. The prevalence of type 2 diabetes has been increasing exponentially, and a high prevalence rate has been observed in developing countries and in populations undergoing “westernization” or modernization. Stress is a potential contributor to chronic hyperglycemia. Lifestyle modification with exercises such as brisk walking and stress management programs may be useful approaches in the treatment of diabetic individuals.^{[1],[2],[3],[4],[5],[6]}

Physical activity is an important public health tool used in the treatment and prevention of various physical diseases and in the treatment of some psychiatric diseases. Exercise is beneficial for mental health; it reduces anxiety, depression, and negative mood and improves self-esteem and cognitive functioning. Although the number of reports of the effects of physical activity on mental health is steadily increasing, these studies have not yet identified the mechanisms involved in the benefits and dangers to mental health associated with exercise.^{[7],[8],[9],[10]} Beneficial effect of walking on metabolic control and stress management of diabetic patients is widely known. Information regarding optimum timings (which time of the day) of exercise for being most effective in the treatment management program is lacking. Hence, the present study was conducted to compare effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients in a population of eastern India.

Materials and Methods

This pilot study was conducted in Burdwan Medical College in a time span of 1 year after taking institutional ethical clearance and informed consent of the individuals. Two hundred newly diagnosed diabetes patients attending diabetic clinic of Burdwan Medical College were included. One hundred individuals were advised to walk in the morning. One hundred individuals were advised to walk in the evening. Randomization of the individuals in the two groups was done using an online randomizer.

Inclusion criteria

Newly diagnosed diabetic patients aged above 25 years attending diabetic clinic of Burdwan Medical College and Hospital were included in the study.

Exclusion criteria

Diabetics with renal diseases, liver diseases, and other endocrine abnormalities, smokers, alcoholics, and drug addicts were excluded. Diabetics practising any exercise other than walking or on stress-relieving medication or practising stress management program other than walking or having ischemic heart disease, hypertension, congenital diseases, and individuals on medication that may alter lipid metabolism and autonomic reflexes and pregnant woman were not included.

The individuals were age, gender, and treatment regimen matched and divided into two groups, each group containing 100 individuals; morning walker (MW): individuals were advised to walk in the morning; evening walker (EW): individuals were advised to walk in the evening.

88 males and 12 females in MW group and 85 males and 15 females in EW were included in the present study.

Methods

On the first appointment, particulars of the individuals, personal history, demographic profile, dietary habit, family history, history of past illness, and treatment history of the individuals were recorded. General physical examinations were done, and written consent was taken after proper counseling. Initial laboratory values (Fasting and PP sugar, glycated hemoglobin [HbA1C], lipid profile) and anthropometric measurements (height, weight, body mass index [BMI], waist/hip ratio) were recorded. Life event stress and perceived stress of the individuals were measured by using presumptive life event stress scale (PSLES) and perceived stress scale (PSS), respectively.

Individuals were asked to tally a list of 43 life events based on a relative score. The stress level in the individuals was assessed according to the PSLES. Accordingly, they were categorized into no stress, less/moderate stress, and severe stress. Score stress up to 40: no stress; 41–200 less/moderate stress; >200 severe stress. The PSS of Sheldon Cohen, the most widely used psychological instrument for measuring the perception of stress, was used. It is a measure of the degree to which situations in one's life are appraised to be stressful. Items were designed to find how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress. The questions in the PSS ask about feelings and thoughts during the last month. It comprises 10 items, four of which are reverse scored, measured on a 5-point scale from 0 to 4. PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. Total score ranges from 0 to 40.^{[11],[12],[13]}

Walking regimens were given according to the recommendation of American Diabetic Association that is 150 min/week (distributed over at least 3 days) of moderate to brisk walking with no gaps longer than 2 days.^[8] All the parameters were reassessed 3 months after practising the walking regimen. During the study period, they were followed up as routine checkup at outpatient department and over telephonic conversation. Initially, 260 individuals were included in the study. After the end of the study period, a total of 45 individuals, 21 (male – 9 and female – 12) from the MW group and 24 (male – 14 and female – 10) from the EW did not come back for follow-up. All individuals were reassessed and data were obtained from 100 individuals in each group for analysis purpose.

Statistical analysis

The computer software “Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.)” was used to analyze the data, P< 31.05* was considered as statistically significant and P< 0.01** was considered as statistically highly significant.

Results

In the present study, 200 diabetic adults aged >25 years without any other gross systemic disease were selected. The individuals were age, gender, and treatment regimen matched [Table 1] and divided into two groups, each group containing 100 individuals. One hundred individuals were advised to walk in the morning. One hundred individuals were advised to walk in the evening.

Table 1: Comparison of values of body mass index, waist/hip ratio, fasting and postprandial blood sugar, glycated hemoglobin, serum lipid profile, Cohen perceived stress score, and presumptive life event stress score of the individuals, before the walking regimen

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There were significant changes in both groups before and after the walking regimen, in fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, serum cholesterol, triglyceride, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) level, and perceived stress scores. No significant changes in both groups were observed before and after the walking regimen, in BMI, waist/hip ratio, serum HDL, and presumptive stress score. There was no significant difference in mean values of different parameters, between the two groups before and after the walking regimen [Table 2], [Table 3], [Table 4].

Table 2: Comparison of values of body mass index, waist/hip ratio, fasting and postprandial blood sugar, glycated hemoglobin, serum lipid profile, Cohen perceived stress score, and presumptive life event stress score of the individuals, after the walking regimen

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Table 3: Comparison of values of body mass index, waist/hip ratio, fasting and postprandial blood sugar, glycated hemoglobin, serum lipid profile, Cohen perceived stress score, and presumptive life event stress score of the morning walker group, before and after the walking regimen

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Table 4: Comparison of values of body mass index, waist/hip ratio, fasting and postprandial blood sugar, glycated hemoglobin, serum lipid profile, Cohen perceived stress score11-13 and presumptive life event stress score11-13 of the evening walker group, before and after the walking regimen

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Discussion

Diabetes is a heterogeneous group of disease characterized by a state of chronic hyperglycemia, resulting from diversity of etiology, environmental, and genetic factors acting jointly. Increased stress in life is pushing us toward the increased risk of hypertension, coronary artery disease, and metabolic syndrome including dyslipidemia and diabetes mellitus. Pathophysiological mechanisms linking stress to diabetes have included direct neuroendocrine effects and indirect effects mediated by traditional risk factors.^{[1],[2],[3],[4],[5],[6],[7]}

In the present study, there were significant changes in both groups before and after the walking regimen in FBS, PPBS, HbA1c, serum cholesterol, triglyceride, LDL, VLDL level, and perceived stress scores. No significant changes in both study groups were observed before and after the walking regimen, in BMI, waist/hip ratio, serum HDL, and presumptive stress score. There was no significant difference in mean values of different parameters, between the two groups before and after the walking regimen.

Exercise training programs have emerged as a useful therapeutic regimen for the management of type 2 diabetes mellitus (T2DM). PubMed, Science Direct, Scopus, ISI Web of Knowledge, and Google scholar were searched by Thent et al.^[14] in 2013 using the terms “T2DM,” “exercise,” and/or “physical activity,” and “T2DM with exercise.” Twenty-five studies met the selected criteria. Most of the aerobic exercise-based studies showed a beneficial effect in T2DM. Resistance exercise also proved to have positive effect on T2DM patients. They observed that aerobic exercise is more common in clinical practice compared to resistance exercise in managing T2DM. Treatment of T2DM with exercise training showed promising role in the USA. The present study also shows similar results.

A study in 2017 conducted by Harris et al.^[15] examined the temporal relationship between perceived stress and incident type 2 diabetes in a middle aged cohort of Australian women over 12 years. Women born in 1946–1951 (n = 12, 844) completed surveys for the Australian Longitudinal Study on Women's Health in 1998, 2001, 2004, 2007, and 2010. The total causal effect was estimated using logistic regression and marginal structural modeling. Controlled direct effects were estimated through conditioning in the regression model. A graded association was found between perceived stress and all mediators in the multivariate time lag analyses. A significant association was found between hypertension, as well as physical activity and BMI, and diabetes, but not smoking or diet quality. Moderate/high-stress levels were associated with a 2.3-fold increase in the odds of diabetes 3 years later, for the total estimated effect. Results were only slightly attenuated when the direct and indirect effects of perceived stress on diabetes were partitioned, with the mediators only explaining 10%–20% of the excess variation in diabetes.

Perceived stress was found to be a strong risk factor for type 2 diabetes. The majority of the effect estimate of stress on diabetes risk is not mediated by the traditional risk factors of hypertension, physical activity, smoking, diet quality, and BMI. This gives a new pathway for diabetes prevention trials and clinical practice.^[15] Our findings also support and extend previous research examining the relationship between stress and diabetes.

Williams et al.^[16] showed adiposity had little influence on the relationship between stress and abnormal glucose metabolism. Likewise, Toshihiro et al.^[17] found that obesity did not predict progression to diabetes from impaired fasting glucose and/or impaired glucose tolerance in Japanese workers. We also observed no change in BMI and waist/hip ratio in both groups in the present study.

Multiple risk factors of diabetes, delayed diagnosis until micro- and macrovascular complications arise, life-threatening complications, failure of the current therapies, and financial costs for the treatment of this disease make it necessary to develop new efficient therapy strategies and appropriate prevention measures for the control of type 2 diabetes. Minor changes in lifestyle can greatly reduce chances of getting this disease.

Conclusions

Walking in the morning and evening may be considered to be equally effective in respect of glycemic control, lipid metabolism, and stress management in diabetic individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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