The investigation of relation between Anxiety and Syndrome Metabolic profiles after 12 Months Aerobic Exercise whit Moderate Intensity in 50-65 Years Old Women with Syndrome Metabolic

Background and purpose The aim of this research was to investigate the effect of twelve Month aerobic exercise whit moderate intensity on anxiety in 50-65 years old women with syndrome metabolic and relation between anxiety and Syndrome Metabolic profiles. Materials and methods 24 women with syndrome Metabolic participated voluntarily in this investigation and divided in two-group MetS exercise (ME), MetS control (MC). ME group participated in an aerobic exercise training (AT) program (12 Month), three session per week, each session contained three performing parts and two rest part. Also, Beck anxiety questionnaire and blood samples were conducted before and after training for evaluating levels of anxiety. Data were analyzed using Pried-sample T-Test, Independent samples T-Test, and Pearson correlation. Results anxiety after 12-month aerobic exercise significantly decreased (P˂0.05), and there was a significant relation between improvement of syndrome metabolic and decreasing of anexiety. Conclusion These findings indicate that 12-month aerobic exercises induce to decrease anxiety and ameliorate syndrome metabolic. Moreover, we can say ameliorating in Syndrome Metabolic profiles maybe related to decreasing in anxiety levels.


Background
Aging is an inevitable reality and increasing the elderly population around the world is a matter of attention and it is very important that the World Health Organization has estimated the total number of seniors in 2006 for about 700 millions in the next 40 years and this number will be 2 times in Iran, as well as the population of 60 will be around 10 million years until the year 2020 and 2050 to more than 26 million people (2). Increasing age is associated with increasing the risk of metabolic syndrome (3). Due to change in life style, the prevalence of metabolic syndrome in today's society has increased (4). Metabolic syndrome can have a negative effect on physical performance, mental state, personal, familial and social relationships, and general health and feeling of well-being of patients. Metabolic syndrome was defined according to the criteria of the NCEP/ATP III to include individuals with any three or more of the following five components:(1) Waist circumference > 94 cm; (2) high TG ≥ 150 mg/dl; (3) low HDL-C < 40 mg/dl; (4) high blood pressure (systolic BP ≥ 130 mm Hg or diastolic BP ≥ 85 mm Hg or treatment of hypertension, and (5) high FBG ≥ 6.1 mmol/L (4, 5) Stress caused by social issues and the absence of a family member leads to increase in anxiety and worry in the person (6). Chronic anxiety and the stress caused by the society cause bulimia and the cause of metabolic syndrome (7). Diseases are the cause of increasing stress and cause anxiety. The results of some fundamental research such as Carroll et al. (2009),and Kai et al. (2015 refers to the positive relationship between anxiety and metabolic syndrome (8,9). In another study, there has been a relationship between anxiety and metabolic syndrome indexes. In particular, they noted a strong relationship between the size of waist cercomfrences, triglyceride and blood pressure (10). While Takeuchi et al. (2009) refers to the presence of a positive and meaningful (significantly) relationship between depression and metabolic syndrome and lack of meaningful (significantly) relationship with metabolic syndrome (11). The research of Vogelzangs et al. (2007) noted that anxiety in old men was significantly related to metabolic syndrome, which was not significant in women, and the cause of lack of meaningful (significantly) relationship was related to the impact of the stress which caused by the society which women experience this problem less than men. The question is suggested whether social stress is associated with metabolic syndrome or other variables in that role (12). We will review the research history that has examined the impact of exercise on anxiety reduction. Kargarfard et al.  (15). Given that the previous research has examined the impact of exercise training on anxiety in people with different diseases and so far, there was no research that examined the effect of exercise on anxiety in patients with metabolic syndrome and since the prevalence of metabolic syndrome is much more than other fears. It is a high importance for the research to eliminate the physical and mental problems of these patients.
The aim of this study was to investigate the relationship between metabolic syndrome indices and anxiety of 50-65 year old patients with metabolic syndrome after 12 months of aerobic exercise.
Considering that, the origin of stress and anxiety of this participant is a lack of spouse of the martyrs inevitably has been involved with social issues. the martyr's widows have been involved with social issues. According to the results mentioned fundamental research can be said of this process, affecting their stress and anxiety disorder is metabolic syndrome. The question is, in the mind of the researcher, does the choice of exercise reduce the level of anxiety in martyrs' wive and what is the relationship of anxiety with the indicators of metabolic syndrome after 12 months of aerobic exercise?
Many studies have examined the effect of aerobic exercise on metabolic syndrome. But so far, research investigating the association of anxiety with metabolic syndrome indices after 12 months of aerobic exercise in women who have lost their spouses for more than 30 years has not been investigated.

Methods Participants
The same-experimental method was applied and the research design consisted of pre-test and posttest with a control group and an experimental group. Forty-four females with metabolic syndrome ages aged 60-65 years participated in this research after giving written informed consent. This research was conducted according to the guidelines laid down in the Declaration of Helsinki and was approved by the ethics committees of Semnan University of Medical Sciences and Health Services (IR.SEMUMS.REC.1396.107). It should be noted that four subjects were excluded from the study due to absence of regular exercise and two control subjects due to absence of post-test. Finally, 24 subjects were included in the statistical analysis. The exclusion criteria for absenteeism were more than three sessions out of twelve sessions.

Metabolic Syndrome Definition
Metabolic syndrome was defined according to the criteria of the NCEP/ATP III to include individuals with any three or more of the following five components: (1) Waist circumference > 94 cm; (2) high TG ≥ 150 mg/dl; (3) low HDL-C < 40 mg/dl; (4) high blood pressure (systolic BP ≥ 130 mm Hg or diastolic BP ≥ 85 mm Hg or treatment of hypertension, and (5) high FBG ≥ 6.1 mmol/L (5).

Exercise protocol
Each subject walked or ran at 65-75% heart rate reserve (HRR) on a treadmill for 3 ⋅ 12-17 min. Over the 12-months treatment, each week, one minute was added to each set, beginning with 8 minutes, so that the duration of each training set at the 12 week was 19 minutes. After the 12 weeks, the training set times did not change. Each session consisted of three sets of consecutive sessions with a 5-minute rest interval between the sets. Heart Rate was monitored during the test using heart rate monitoring devices (Polar M400; Finland).

Measurement of biochemical parameters
Fasting venous blood samples were taken from the antecubital vein 24 hours before (Fasting blood samples were taken at 9am) and after exercise (It should be noted, however, that in order to eliminate the acute effects of exercise such as delayed fatigue and possible minor damage to muscle structure on blood variables, post-test blood sampling was performed four days after the last training session) (17,18).
For measuring serum blood markers, the samples were allowed to clot for 30 min at room temperature and then centrifuged at 3000 rpm for 10 min at 4 °C. Obtained serums were dispensed into micro tubes and stored at − 80 °C until the measurement of blood parameters. For measuring plasma blood markers, blood samples collected into tubes containing ethylene diamine tetra acetic acid (EDTA) were immediately centrifuged and stored at − 80 °C until the assay.
Blood glucose levels were measured by glucose oxidase method and fat levels were measured by standard enzymatic method using Kobas Mira model biochemical autoanalysis device.

How to calculate body fat percentage
The body fat percentage of the subjects was calculated using the German-made OMRON BF500 body composition.
How to calculate caloric intake Subjects were recorded daily food intake on the note sheet and food consumed at breakfast, snack, lunch and dinner was calculated by N4 software.

Statistical analysis
Data were presented as mean ± SD. The Kolmogorov-Smirnov test was used to check for normality of distribution of all blood parameters. The distribution of these parameters did not differ significantly from normal. Independent t-test and dependent t-test were used to evaluate changes. Pearson correlation test was used to examine the relationship between the dependent variables (P˂0.05). Statistical significance was set at P < 0.05. Data analysis was performed using SPSS version18 software.

Results
In Table 1, the intra-group comparison of metabolic syndrome Index, weight, fat percentage, BMI and anxiety of EM and CM groups were noted. The results of paired T-test showed a significant effect of 12 months aerobic exercise on reducing blood pressure, triglyceride, waist circumference, BMI, weight, body fat percentage and anxiety (Table 1). The subjects of my group participated in 12 months of exercise with adherence to 91% in the study.
According to both groups, in terms of total calorie intake, calorie intake of protein, carbohydrate and fat, fat percentage and body mass index were homogeneous, although no significant difference was observed in independent T-test results, so we did not consider any of the variables as a confounding variable ( Table 2). The results of independent T-Test showed that there is a significant difference in the level of anxiety in the trained group compared to the control group, which is statistically significant.There is a significant correlation between anxiety/blood pressure, waist circumference and glucose (Table 4). Table 4 ) Considering that there is still no precise mechanism regarding the effects of exercise in improving anxiety, it is likely that the cause of anxiety reduction in the impact of exercise on the development of overall health and fitness and increasing social relationships of individuals (13,15,(20)(21)(22). approved this study.

Consent for publication
All participants were aware during the informed consent process that the results of this study may be published.

Competing interests
The authors declare that they have no competing interests.
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Contributions
The study was designed by OA; data were collected and analyzed by OA; data interpretation and manuscript preparation were undertaken by OA.