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Background: Diabetic nephropathy (DN) is a prevalent microvascular diabetic complication all over the world. Objective: This study was designed to measure oxidative stress, systemic inflammation and kidney function response to exercise training in patients with type 2 diabetic (T2DM) nephropathy. Material and Methods: Eighty obese T2DM patients ( 50 males and 30 females), their body mass index (BMI) mean was 33.85±3.43 Kg/m2 and the mean of diabetes chronicity was 12.53±2.64 year participated in the present study and enrolled two groups; group I: received aerobic exercise training and group II: received no training intervention. Results: The mean values of creatinine, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) were significantly decreased, while the mean values of interleukin-10 (IL-10), glutathione peroxidase (GPx) and glutathione (GSH) were significantly increased in group (A) after the aerobic exercise training, however the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study (P

Background: Type 2 diabetes mellitus (T2DM) considered as one of the cardiovascular disorders (CVD) principle risk fac- tor as diabetes is associated with abnormal levels of endothelial function, inflammatory and adipocytokines. Objective: The aim of this study was to measure the impact of weight reducing on inflammatory cytokines, adipocytokines and endothelial function biomarkers among obese T2DM patients. Methods: One–hundred T2DM patients enrolled in the present study; the age range was 35-55 year. Participants shared in this study were enrolled in group (A) received diet control and aerobic exercise on treadmill, while, group (B) had no inter- vention for 3 months. Results: The mean values of body mass index (BMI), tumor necrosis factor –alpha (TNF-α), interleukin-6 (IL-6), leptin, inter-cellular adhesion molecule (ICAM-1) ,vascular cell adhesion molecule (VCAM-1), E-selectin and plasminogen activator inhibitor-1 activity (PAI-1 activity) were significantly decreased and adiponectin was increased significantly in the training group, however the results of the control group were not significant. Also, there were significant differences between both groups at the end of the study. Conclusion: Weight reducing program modulates inflammatory cytokines, adipocytokines and endothelial function bio- markers among obese T2DM patients. Keywords: Diabetes; endothelial dysfunction biomarkers; cytokines; adipocytokines; weight reduction.

Background: Chronic primary insomnia is characterized by long-term difficulties in maintaining and initiating sleep, too early waking up, poor mood, fatigue, impaired concentration and poor quality of life. Exercise training is recommended to prevent and alleviate sleep disorders. Objective: The aim of the study was to investigate the influence of aerobic exercise training on quality of sleep, psycho- logical wellbeing and immune system among subjects with chronic primary insomnia. Material and methods: Eighty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 35-56 years. All participants were randomly assigned to supervised aerobic exercise intervention group (group A, n=40) or control group (group B, n=40). Polysomnographic recordings for sleep quality assessment, Beck Depression Inventory (BDI), Profile of Mood States(POMS), Rosenberg Self-Esteem Scale (RSES), number of CD3+,CD4+,CD8+ T cells count and CD4/CD8 ratio were measured before and at the end of the study after six months. Results: There was a significant increase in the total sleep duration, sleep efficiency and sleep onset latency in group(A) after six months of aerobic exercise training, while, wake time after sleep onset and rapid eye movement (REM) latency significantly reduced after six months of aerobic training compared with values obtained prior to aerobic exercise training. Also, the mean values of BDI, POMS, CD3 count, CD4 count and CD8 count decreased significantly and the mean value of RSES significantly increased in group (A) after the aerobic exercise training, while the results of the control group were not significant. Moreover, there were significant differences between both groups at the end of the study. Conclusion: Exercise training can be considered as a non-pharmacological modalty for modifying sleep quality, psycholog- ical wellbeing and immune system among subjects with chronic primary insomnia. Keywords: Aerobic exercise; chronic primary insomnia; immune function; sleep quality; psychological wellbeing.

Background: Chronic primary insomnia is a prevalent sleep disorder that is associated with adverse effects on health out- comes. Exercise is often considered a non-pharmacological approach that could have beneficial effects on sleep. Objective: The aim of the study was to compare the impact of aerobic and resistance exercise training on quality of sleep and inflammatory markers among subjects with chronic primary insomnia. Material and Methods: Sixty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 31-52 years. All participants were randomly assigned to aerobic exercise intervention group (group A, n=35) or resistance exercise intervention group (group B, n=35). Polysomnographic recordings for sleep quality assessment, IL-6, IL-10 and TNF-α were measured before and at the end of the study after six months. Results: There was a significant increase in the total sleep duration, sleep efficiency, sleep onset latency and IL-10 in group(A) and group (B) in addition to significant reduction in awake time after sleep onset, REM latency, IL-6 and TNF-α after 6 months of aerbic and resistance exercise training. However, there were significant differences between both groups at the end of the study. Conclusion: Aerobic exercise training is more appropriately than resistance exercise training in modulation of inflammatory and sleep quality among subjects with chronic primary insomnia. Keywords: Aerobic exercise; chronic primary insomnia; inflammatory cytokines; resistance exercise; sleep quality.

Background: Chronic primary insomnia is a prevalent sleep disorder that is associated with adverse effects on health out- comes. Sleep disturbance is usually associated with abnormal level of systemic inflammation biomarkers. Objective: The aim of this study was to detect changes in sleep quality and inflammatory markers following weight loss among subjects with chronic primary insomnia. Material and Methods: Eighty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 32-51 year were randomly assigned to life style intervention group (group A, n=40) or control group (group B, n=40). Polysomnographic recordings for sleep quality assessment, IL-6, IL-10 and TNF-α were measured before and at the end of the study after six months. Results: There was a significant increase in the total sleep duration, sleep efficiency, sleep onset latency and IL-10 in addi- tion to significant reduction in awake time after sleep onset, REM latency, IL-6 and TNF-α after 6 months of in group(A) as a result of weight loss program; while the results of the control group (group B) were not significant. Also, there were significant differences between both groups at the end of the study. Conclusion: Life style intervention modulates systemic inflammatory parameters and sleep quality among subjects with chronic primary insomnia. Keywords: Chronic primary insomnia; inflammatory cytokines; life style intervention; sleep quality.

Background: Obstructive sleep apnea (OSA) is the most common sleep disorder in clinical practice. Its growing worldwide prevalence may be due to the rising incidence of obesity in the public. OSA has been increasingly recognized as a major public health issue, as it has a significant influence on the incidence and prognosis of cardiovascular diseases. Although, these abnormalities could be modulated with weight reduction, there is limitation in clinical studies have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and cytokines for obesity associated with OSA. Objective: This study was designed to detect the effects of weight loss on the inflammatory cytokines and adhesive molecules in obese patients with obstructive sleep apnea. Methods: Seventy obese patients with moderate to severe OSA (the apnea-hypopnea index (AHI)>15 events/hour), their age ranged from 36- 50 years and their body mass index ranged from 26-31kg/m2 were equally assigned into two groups: the weight reduction group received aerobic exercises, diet regimen, where the control group received no intervention for 12 weeks. Results: The mean values of body mass index (BMI), apnea-hypopnea index (AHI), tumor necrosis factor –alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), inter-cellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1) and E-selectin were significantly decreased in the training group, however the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study. Conclusion: Weight loss ameliorates inflammatory cytokines and adhesive molecules among obese patients with obstructive sleep apnea.

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease associated with increased the risk of fracture due to altered bone micro architecture and/or poor quality as key factors. Bone remodeling appears to be impaired among patients with T2DM as both markers of bone formation and markers of bone resorption are decreased when compared to healthy subjects. Objective: This study aimed to detect if weight reduction modulates adipokines and markers of bone turnover among T2DM patients. Material and Methods: Eighty obese patients with T2DM (46 men and 34 women), their age ranged from 40-53 years and their body mass index ranged from 30-36 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises, diet regimen, where the control group received medical treatment only for 6 months. Results: The mean values of body mass index (BMI), leptin, resistin, visfatin levels significantly decreased, however the mean values of adiponectin, bone alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of type I collagen (NTX) levels significantly increased in the training group. While, the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study. Conclusion: Weight loss ameliorates adipocytokines and bone turnover markers among obese patients with type 2 diabetes mellitus.

Background: Activation of immunological and systemic inflammation markers are common in obesity and asthma. Objective: The target of this study was to assess impact of weight reduction on immunological and systemic inflammation markers in obese asthma patients. Material and methods: Eighty asthmatic patients of both sex; their age and body mass index (BMI) mean were 38.72 ± 7.14 year and 32.65 ± 3.18 Kg/m2 respectively. Exclusion criteria included smokers, infections, vaccinations, cancer, surgery, immune system disorders and medications that may influence immune system function as anti-inflammatory medications, analgesics and anti-depressant. All subjects were randomly enrolled in weight reduction group (group A) or control group (group B). Results: The main findings in the present study indicated that weight reducing program in group (A) was associated with significant reduction in the mean values of IL6, TNF-α, and IL8 in addition to significant increase in the mean values of CD4 and CD8 cell count . However, findings of group (B) showed no significant changes. Moreover, Comparison between both groups at the end of the study revealed significant differences. Conclusion: Weight reduction improved immunological and systemic inflammation markers in obese asthma patients. Keywords: Bronchial asthma; cytokines; obesity; immune system; weight reduction.

Background: Aging is the major risk factor for the development of cardiovascular diseases as aging increases plasma levels of pro-inflammatory mediators and endothelial dysfunction. Physical exercise is a potential strategy for improving the endothelial dysfunction and chronic inflammation that accompanies aging. However, there is a need to differentiate between aerobic and resistance exercise training regarding endothelial activation markers and systemic inflammation among elderly population. Objective: The aim of this study was to compare the impact of six months of aerobic versus resisted exercise training on inflammatory cytokines and endothelial activation markers among elderly. Material and methods: Eighty previously sedentary elderly subjects participated in this study, their age ranged from 61-66 years. All subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=40) or resistance exercise group (group B, n=40). Results: The mean value of interleukin-10 (IL-10) was significantly increased, where the mean value of inter-cellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), E-selectin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were significantly decreased in group (A) and group (B). In addition, there were significant differences in the mean levels of the investigated parameters between group (A) and group (B) at the end of the study. Conclusion: The current study provides evidence that aerobic exercise is more appropriate in modulate entering altered endothelial activation and inflammatory markers than resisted exercise among elderly population. Keywords: Endothelial activation markers; inflammatory cytokines; aerobic exercise; resistance exercise; aging.

Background: Recently, about 2.35% of the world populations are estimated to be chronically infected with hepatitis C virus (HCV). Previous cohort studies indicated that obesity increases risk of hepatic steatosis and fibrosis in non-diabetic patients with chronic hepatitis C infection due to diminished response to anti-viral therapy and as a result obesity is considered as an important factor in the progression of chronic HCV. However, there is a strong association between BMI and the human immune system among HCV patients. Objective: This study aimed to examine effects of weight reduction program on selected immune parameters among HCV Saudi patients. Material and methods: One-hundred obese Saudi patients with chronic HCV infection participated in this study, their age ranged from 50- 58 years and their body mass index (BMI) ranged from 30-35 kg/m2. All Subjects were included in two groups: The first group received weight reduction program in the form of treadmill aerobic exercises in addition to diet control whereas, the second group received no therapeutic intervention. Parameters of CD3, CD4 and CD8 were quantified; Leukocyte, differential counts and BMI were measured before and after 3 months, at the end of the study. Results: The mean values of BMI, white blood cells, total neutrophil count, monocytes, CD3, CD4 and CD8 were significantly decreased in the training group as a result of weight loss program; however the results of the control group were not significant. Also, there were significant differences between both groups at the end of the study. Conclusion: Weight loss modulates immune system parameters of patients with HCV. Keywords: Hepatitis C virus, obesity, immune system, weight reduction.

Background: Sleep disturbance is a major problem for older adults which can be exacerbated by increased inflammation as aging is associated with increased circulating pro-inflammatory and lower anti-inflammatory cytokines. There is a need to develop alternative medicine techniques to help improve sleep quality in the elderly. Objective: To investigate the effects of aerobic exercise training on the sleep quality and inflammatory cytokines in elderly subjects. Material and methods: Forty previously sedentary elderly subjects participated in this study, their age ranged from 61- 67 years. All subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=25) or control group (group B, n=25). Polysomnographic recordings for sleep quality assessment, interleukin- 6 (IL-6), tumor necrosis factor- alpha (TNF-α) and interleukin-10 (IL-10) were measured before and after 6 months at the end of the study. Results: There was a significant increase in total sleep duration, sleep efficiency and sleep onset latency in group(A) after 6 months of aerobic exercise training, while, wake time after sleep onset and rapid eye movement (REM) latency significantly reduced after 6 months of aerobic training compared with values obtained prior to aerobic exercise training. Also, the mean values of TNF- α and IL-6 decreased significantly and the mean value of IL-10 significantly increased in group (A) after the aerobic exercise training, however the results of the control group were not significant. Moreover, there were significant differences between both groups at the end of the study. Conclusion: Exercise training can be considered as a non-pharmacological modality for modifying sleep quality and inflammation among elderly. Keywords: Sleep quality, inflammatory cytokines, aerobic exercise, aging.

Background: Type 2 diabetes mellitus is usually related to vascular problems and is associated with impairment in endothelial function characterized by impaired endothelial-dependent vasodilation and increased platelet adhesion. There is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and adipokines dysregulation for obesity associated with type 2 diabetes mellitus. Objective: This study was designed to detect the effects of weight loss on insulin resistance, adhesive molecules and adipokines dysregulation in obese type 2 diabetic patients. Methods: Eighty obese patients with type 2 diabetes mellitus, their age ranged from 35-55 years and their body mass index ranged from 31-37 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises in addition to diet regimen, where the control group received medical treatment only for 12 weeks. Results: There was a 24.04%, 19.33%, 22.78% ,12.28%, 9.35%, 22.53% & 10.12 % reduction in mean values of Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR), Leptin, Adiponectin, Resistin, intercellular cell adhesion molecule -1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin & body mass index (BMI) respectively in addition to 26.20% & 24.58% increase in the mean values of adiponectin & the quantitative insulin-sensitivity check index (QUICKI) respectively in group (A) at the end of the study. The mean values of leptin, resistin, insulin, HOMA-IR, ICAM-1, VCAM-1, E-selectin & BMI were significantly decreased in addition to significant increase in the mean values of adiponectin & QUICKI in group (A) those that received aerobic exercise training in addition to diet regimen. While the results of group (B) those that received no treatment intervention were not significant. In addition, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment (P

Background:Pulmonary difficulties is the most common cause of morbidity and mortality following spinal cord injury, which is the main cause of chronic respiratory failure in young adults.Objective:This study aimed to investigate the effect of resistive respiratory muscle training on blood gases and pulmonary function of patients with cervical spinal cord injury.Methods:Thirty six patients with complete spinal cord injury at level from C5 to C8 of both sexes (23 males and 9 females), their age ranged from 23-41 years (30.51±6.82 year) were selected from ICU of Cairo University Hospital participated in this study. Their height ranged between 149-185cm. Participants equally enrolled to either training group (group A) or control group (group B). The respiratory muscle resisted training program was started for group (A) after the clinical stability of patient condition with a threshold positive expiratory pressure device using a three-way valve system via flanged mouthpiece. The patient performed six work sets, five minutes in duration, with a rest period in between for three minutes. All patients received a 45 minutes training/day, five days/ week for six weeks. The arterial blood gases and pulmonary function test are measured before and after exercise program.Results:The mean value of heart rate (HR), respiratory rate (RR), partial pressure of arterial carbon dioxide (PaCO2) and PH revealed significant reduction, where forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and partial pressure of arterial oxygen (PaO2) revealed significant increase in group (A) at the end of the study. However, changes in group (B) were not significant. Moreover, there were significant differences between both groups at the end of the study (P

Background & objective: Sickle cell anemia (SCA) is well recognized as a chronic inflammatory disease. Despite progress in therapy, SCA remains a cause of significant morbidity and mortality. The relationship between exercise and immune function has been of great interest to the scientific community and the lay public. The aim of this study was to measure the impact of aerobic exercise training on the immunologic parameters and inflammatory cytokines of patients with sickle cell anemia (SCA) in asymptomatic steady state. Material and methods: Sixty asymptomatic sickle cell anemia patients were involved in this study, their age ranged from 25- 40 years and were assigned to two sub-groups; group (A) received aerobic exercise training for 12 weeks, however group (B) received no training intervention for 12 weeks. Parameters of CD3, CD4 and CD8 were quantified, Leukocyte, differential counts, IL-6 and TNF-α were measured before and after 12 weeks, at the end of the study. Results: The mean values of CD3, CD4 and CD8, leukocyte, monocytes counts, IL-6 and TNF-α were significantly decreased in group (A), while group (B) showed non-significant changes in these parameters. Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion: The current study provides evidence that aerobic exercise training improves inflammatory markers and immune system in patients with sickle cell anemia (SCA) in asymptomatic steady state. Keywords: Cytokines, immune parameters, aerobic exercise, sickle cell disease, stable state.

Background: Aging is characterized with immunosenescence associated with a hyper-inflammatory state, characterized by elevated circulating levels of pro-inflammatory mediators. Physical exercise is a potential strategy for improving the immune system dysfunction and chronic inflammation that accompanies aging. However, there is a need to differentiate between aerobic and resistance exercise training regarding human immune system and systemic inflammation among the elderly Saudi population. Objective: The aim of this study was to compare the impact of 6 months of aerobic versus resisted exercise training on inflammatory cytokines and immune system response among elderly. Material and methods: Sixty previously sedentary elderly subjects participated in this study, their age ranged from 61- 66 years. All Subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=40) or resistance exercise group (group B, n=40). Number of CD3+,CD4+,CD8+ T cells count and CD4/CD8 ratio were quantified, IL-6, TNF-α and IL10 were measured before and after 6 months, at the end of the study. Results: The mean values of CD3+, CD4+ and CD8+ T cells count and IL-10 were significantly increased, whereas the mean values of CD4/CD8 ratio,IL-6 and TNF-α were significantly decreased in group (A) and group (B). Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion: The current study provides evidence that aerobic exercise is more appropriate in modulating the immune system and inflammatory markers among the elderly population. Keywords: Immune function, inflammatory cytokines, aerobic exercise, resistance exercise, aging.

Introduction:Background: Obesity is a major risk factor for developing cardiovascular disorders due to increased platelets count and platelets activation. Objective: The aim of this study was to measure the influence of weight loss on the coagulation and fibrinolysis parameters among obese patients.Material and Methods:One hundred obese subjects of both genders (mean age 46.72± 3.13 year) selected from the Internal Medicine Department at King Abdul Aziz University Teaching Hospital, their body mass index (BMI) ranged from 32 to 36 Kg/m2. Participants enrolled randomly into two study groups; the first group (A) received aerobic exercises and diet regimen for three months, while the second group (B) received no exercise training or diet regimen for three months.Results:Mean values of von Willbrand factor antigen (vWF-Ag), fibrinogen, plasminogen activator inhibitor-1 antigen (PAI-1:Ag) and plasminogen activator inhibitor-1 activity (PAI-1:Ac), tumor necrotic factor-alpha (TNF-α), Interleukin – 6 (IL-6) and body mass index (BMI), while the mean values of partial thromboplastin time (PTT), prothrombin time (PT), tissue plasminogen activator antigen (tPA:Ag) and tissue plasminogen activator activity (tPA:Ac) increased significantly after 3 months in group (A) as a result of weight reduction program. However, the mean values of all investigated parameters of group (B) had no significant changes. Moreover, comparison between both groups had statistical significant differences in all investigated parameters at the end of the study (P

Introduction:Systemic inflammation and activated immune system response are common features in obese patients with non-insulin dependent diabetes mellitus (NIDDM) as obesity-induced NIDDM represents a burden for healthcare systems worldwide. However, there is a strong association between BMI and the human immune system and systemic inflammation among obese patients with NIDDM.Material and Methods:Eighty obese patients with NIDDM participated in this study, their age ranged from 41-52 years and their BMI ranged from 31-36 kg/m2. All Subjects were included in two groups: The first group received life style modification in the form of treadmill aerobic exercises in addition to diet control where, the second group received no therapeutic intervention. Parameters of CD4 and CD8 cells count were quantified, IL-6, TNF-α, leptin and body mass index (BMI) were measured before and after 3 months at the end of the study.Results:The mean values of CD4 and CD8 cells count were significantly increased, where mean values of TNF-α, IL-6, IL-8 and body mass index (BMI) were significantly decreased in group (A). While group (B) showed non-significant changes in these parameters. Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study.Conclusions:Within the limit of this study, life style modification modulates systemic inflammation and immunological parameters among obese patients with NIDDM.Objecttive:This study aimed to examine effects of weight reducing program on selected immune and systemic inflammation parameters among obese patients with NIDDM.

Background: Alzheimer’s disease has a destructive drawbacks on the patient and his/her entire family as this disease badly affects the behavior, cognition and abilities to do activities of daily living (ADL). The physical and mental benefits of exercise are widely known but seldom available to persons suffering from Alzheimer’s disease. Objective: The aim of this study was to measure quality of life, systemic inflammation and psychological well-being response to aerobic exercises in Alzheimer’s. Methods: Forty Alzheimer elderly subjects were enrolled in two groups; the first group received treadmill aerobic exercise, while the second group was considered as a control group and received no training intervention for two months. Assessment of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), Rosenberg Self-Esteem Scale (RSES),Beck Depression Inventory (BDI), Profile of Mood States(POMS) and SF-36 health quality of life (SF-36 HRQL) were taken before and at the end of the study. Results: There was a 25.2%, 19.4%, 23.5%, 21.3%, 17.7% , 11.7%, 12.5% and 10.1 % reduction in mean values of TNF-α, IL-6, BDI, POMS, health transition SF-36 subscale, bodily pain SF-36 subscale, role functioning: emotional SF-36 subscale and mental health SF-36 subscale respectively in addition to 15.7%, 13.1%, 12.6%, 11.1%, 13.2% and 11.2 % increase in mean values of RSES, physical functioning SF-36 subscale, role functioning:physical SF-36 subscale, general health SF-36 subscale, Vitality SF-36 subscale and Social functioning SF-36 subscale respectively in group (A) received aerobic exercise training, so that there was a significant reduction in the mean values of TNF-α, IL-6, BDI & POMS and increase in the mean values of SF-36 HRQL subscale scores, RSES in group (A) as a result of aerobic exercise training, while the results of group (B) who received no training intervention were not significant. Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study (P

Introduction:The risk of endothelial dysfunction and insulin resistance is higher in type 2 diabetes mellitus (T2DM) which could be modulated with exercise training. However, to our knowledge, there is no clinical studies have addressed which exercise specific type is superior in modulating biomarkers of endothelial dysfunction and insulin resistance for T2DM.This study aimed to determine the differences in response of biomarkers of endothelial dysfunction and insulin resistance to aerobic versus resistance exercises in type 2 diabetic patients.Material and Methods:Eighty obese type 2 diabetic patients participated in this study and were included into two groups, group (A) received aerobic exercises; where group (B) received resistance exercises for 12 months.Results:The mean values of Inter-Cellular Adhesion Molecule (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1), tissue plasminogen activator (tPA), E-selectin, glycosylated hemoglobin (HBA1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) were significantly decreased in both groups at the end of the study. However, the mean values of ICAM-1, VCAM-1 and t-PA antigen were more significantly reduced in group (A), while the mean values of HBA1c and HOMA-IR were more significantly reduced in group (B) and there were significant differences between both groups at the end of the study.Conclusions:Resistance exercise appears to be more beneficial than aerobic exercise for improving insulin resistance in T2DM. Also, aerobic exercise appears to be more beneficial than resistance exercise for improving endothelial function in T2DM.

Introduction:Recent studies suggested that Hepatitis C Virus (HCV) patients may suffer from insulin resistance (IR), lipid profile abnormalities and poor virological response to the antiviral treatment. The beneficial effects of aerobic exercise have been a matter of controversy in the field of HCV management.This study aimed to measure the impact of aerobic exercise training on insulin resistance, lipid profile abnormalities and virological response in type 2 diabetic patients with chronic hepatitis C.Material and Methods:Eighty non-hypertensive, non-cirrhotic chronic HCV infection Saudi patients with high Triglycerides (TG), Total cholesterol (TC) and Low Density Lipoprotein Cholesterol (LDL-c) & non-insulin dependent diabetic with insulin resistance. Patients were divided in to two equal groups. The first group received aerobic exercise training, three sessions per week for three months in addition to their antiviral treatment. The second group (B) received only their antiviral treatment.Results:The mean values of Homeostasis Model Assessment-Insulin Resistance- index (HOMA-IR), TC, LDL-c, TG, virologic response and Body Mass Index (BMI) were significantly decreased in group (A), where the mean value of High Density Lipoprotein Cholesterol (HDL-c) was significantly increased, while there were no significant changes in group (B) Also; there was a significant difference between both groups at the end of the study.Conclusions:Treadmill walking exercise training is an effective treatment policy to improve insulin resistance, lipid profile abnormalities and virological response in type 2 diabetic patients with chronic hepatitis C.

Obesity among elderly is an important health-related problem worldwide, to date there is controversy regarding the adverse impact of weight loss among elderly women.

Background: Postoperative respiratory complications such as hypoxemia and atelectasis remain important causes of mortality after CABG. Objective: The aim of this study was to compare the changes in arterial blood gases after the use of incentive spirometry (IS) with continuous positive airway pressure (CPAP) during intensive care unit period, after coronary artery bypass graft (CABG) also to provide an idea about which of them is more effective method following coronary artery bypass surgery in intensive care unit. Methods: 30 volunteer patients’ (22 males and 8 females) who had coronary artery bypass surgery participated in this study and they were randomly selected from surgical department at intensive care unit (ICU) in National Heart Institute, Egypt, their ages ranged from 45 to 55 years. Participants were randomly assigned between two equal groups. Group 1 received incentive spirometry breathing training in addition to routine chest physiotherapy following CABG, while Group 2 received CPAP in addition to routine chest physiotherapy program following CABG. Results: The results obtained in this study indicated that, there was statistical significant increase PaO2 and decrease in PaCO2 after two hours of using incentive spirometry, which indicated long term effect of incentive spirometry. While there was no statistical significant improvement in arterial blood gases after two hours of using CPAP which indicated short term effect of CPAP (p

Background: Chronic obstructive pulmonary disease (COPD) is a main risk for morbidity, associated with alterations in systemic inflammation. Recent studies proved that morbidity and mortality of COPD is related to systemic inflammation as it contributes to the pathogenesis of atherosclerosis and cardiovascular disease. However, increase of inflammatory cytokines adversely affects quality of life, alteration in ventilatory and skeletal muscles functions. Moreover, exercise training has many beneficial effects in correction of the adverse effects of COPD. Objective: This study aimed to compare the response of inflammatory cytokines of COPD to aerobic versus resisted exercises. Materials and methods: One hundred COPD diseased patients participated in this study and were randomly included in two groups; the first group received aerobic exercise, whereas the second group received resisted exercise training for 12 weeks. Results: The mean values of TNF-α, Il-2, IL-4, IL-6 and CRP were significantly decreased in both groups. Also; there was a significant difference between both groups at the end of the study with more reduction in patients who received aerobic exercise training. Conclusion: Aerobic exercise is more appropriate than resisted exercise training in modulating inflammatory cytokines level in patients with chronic obstructive pulmonary disease. Keywords: Aerobic exercise, chronic obstructive pulmonary disease, inflammatory cytokines, resisted exercises

Background:Chronic obstructive pulmonary disease (COPD) appears to be associated with low bone mineral density (BMD) due to long-term use of corticosteroids as a result patients with COPD are at risk for osteoporosis-related fractures and worsening pulmonary function.Objective:The present study aimed to measure the effects of treadmill walking exercises on bone mineral status in patients with COPD.Methods:Sixty patients with moderate COPD of both sexes, their age ranged from 45 to 58 years. Subjects were divided into two equal groups: training group (group A) received aerobic exercise training on treadmill for six months, where the second group (B) was considered as a control group who received no exercise training. The program consisted of three sessions per week for six months.Results:The results of this study indicated a significant increase in BMD of the lumbar spine & the radius and serum calcium & significant reduction in parathyroid hormone in group (A), while these changes were not significant in group (B).Also; there was a significant difference between both groups at the end of the study.Conclusion:Treadmill walking exercise training is an effective treatment policy to improve bone mineral status in patients with COPD.

Background: Although postmenopausal associated disorders are important public health problems worldwide, to date limited studies evaluated the endothelial function and systemic inflammation response to weight loss in obese postmenopausal women. Objective: This study was done to evaluate the endothelial function and systemic inflammation response to weight loss in obese postmenopausal Saudi women. Material and methods: Eighty postmenopausal obese Saudi women (mean age 52.64±6.13 year) participated in two groups: Group (A) received aerobic exercise on treadmill and diet whereas, group (B) received no intervention. Markers of inflammation and endothelial function were measured before and after 3 months at the end of the study. Results: The values of body mass index(BMI), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), inter-cellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1) and plasminogen activator inhibitor-1 activity (PAI-1:Ac) were significantly decreased in group (A), while changes were not significant in group (B). Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion: Weight loss ameliorates inflammatory cytokines and markers of endothelial function in obese postmenopausal Saudi women. Keywords: Menopause, cytokines, endothelial function, exercise, diet

Background: Globally, chronic B viral hepatitis (HBV) is a major health problem. Obesity is a common problem among patients with HBV. Several studies have reported that obesity is an important risk factor that alters immune system response in individuals with no underlying cause of liver disease. However, there is a strong association between BMI and the human immune system among HBV patients. Objective: This study was to examine the correlation between body mass index, serum alanine aminotransferase activity (ALT) and immunologic response in obese hepatitis B patients. Material and methods: One hundred fifty male patients with chronic hepatitis B virus, their age ranged from 30 to 45 (38.64 ± 7.12) years and their BMI ranged from 30-35 kg/m 2 . All Subjects were included in two groups: The first group received weight reduction program in the form of treadmill aerobic exercises in addition to diet control whereas the second group received no therapeutic intervention. Parameters of serum alanine aminotransferase (ALT), CD3, CD4 and CD8 were quantified; Leukocyte, differential counts and body mass index (BMI) were measured before and after 3 months at the end of the study. Results: There was a 24.7%, 36.8%, 30.8%, 40.7%, 28.6%, 25.9%, 33.3% and 14.3 % reduction in mean values of alanine aminotransferase (ALT), white blood cells, total neutrophil count, monocytes, CD3, CD4 ,CD8 and BMI respectively in group (A) at the end of the study. In addition, there were significant differences between mean levels of the investigated parameters in groups. Conclusion: Based on our findings, weight loss modulates serum alanine aminotransferase and immune system parameters of patients with hepatitis B virus infection. Keywords: Hepatitis B virus, obesity, immune system, weight reduction

Background : Non-insulin dependent diabetic patients frequently suffer from fatigue symptoms that result from chronic systemic inflammation. Aerobic exercise was proved to modulate systemic inflammation. Objective : This study was an attempt to measure the impact of aerobic exercises on fatigue symptoms related to systemic inflammation in obese patients with type 2 diabetes. Methods : Eighty obese patients with type 2 diabetes participated in the present study, their age ranged from 40- 58 years and their BMI ranged from 31-36 kg/m 2 and were assigned to two subgroups; group (A) received aerobic exercise training for 12 weeks and group (B) received no exercise training for 3 months. Measurements of fatigue symptoms and markers of systemic inflammation were assessed before and at the end of the study for all participants in both groups. Results : The mean values of inflammatory markers (IL-6 and TNF-α) and Multidimensional Fatigue Inventory (MFI) was significantly decreased in group (A), while changes were not significant in group (B). Moreover, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. Conclusion : Treadmill walking exercise training is an effective treatment policy to improve symptoms of fatigue related to inflammatory cytokines in obese patients with type 2 diabetes. Keywords : Aerobic exercise, inflammatory cytokines, obesity, Type 2 diabetes, fatigue syndrome.

Aim: Alzheimer’s disease is one of the leading cause of all deaths worldwide , it contributes to a reduction in overall function and independent living and there is evidence that exercise can have an impact on the size, strength, and aerobic capacity of skeletal muscle in older people. This study was designed to detect changes in exercise tolerance and quality of life in Alzheimer's after aerobic exercise training in the form of walking and upper limbs exercises with the cycle ergometer. Method: Thirty patients with mild Alzheimer, their age ranged between 65 to 72 years and were included into 2 equal groups; group (A) received aerobic walking exercise training and upper limbs exercises with the cycle ergometer at a frequency of 3 sessions per week for two months. The second group (B) received no exercise training. Measurements of six minute walking test, hand grip strength and questionnaire of the quality of life (QOL) were obtained for both groups before and after the exercise program. Result: There was a significant increase in six minute walking test, hand grip strength and questionnaire of QOL of group (A), while the results of group (B) were not significant. There was a significant dif ference between both groups. Conclusion: aerobic exercise training program in the form of walking exercise and upper limbs exercises with the cycle ergometer for patients with Alzheimer's to improve their exercise tolerance and quality of life.

Diabetic patients are particularly burdened by foot ulcer as about 2.5% of patients with diabetes will develop a foot ulcer each year leads to lower extremity amputation by 15–40 times in diabetics greater than the rate in patients without diabetes mellitus. The aim of this study was to determine which therapeutic method out from hyperbaric oxygen therapy (HBO); laser and ultrasound, in addition to medical treatment obtain the best improvement in healing rate of foot ulcers in diabetic patients. Forty- five non-insulin dependent diabetic patients of both sexes complicated with foot ulcer grade II. Their age ranged from 35 to 50 years. were included into 3 equal groups ; Group (A) received laser therapy, group (B) received HBO and group (C) received the pulsed ultrasound therapy in addition to medical treatment. Measurements of ulcer surface area and volume for all patients in the three groups were done before treatment and after two months at the treatment program. There was a statistically significant difference between mean levels of the investigated parameters in laser therapy group and HBO group and HBO group & pulsed ultrasound therapy group after treatment. Where there was no significant difference between laser therapy group & pulsed ultrasound therapy group (p>0.05). It is recommended to use HBO in addition to medical treatment to accelerate healing rate of foot ulcers in diabetic patients.

Background: Diabetes mellitus has been shown in many studies to be associated with reduced bone mass and an increased risk of fracture. Currently, our understanding of how to use exercise effectively in diabetic patients in prevention of osteoporosis is incomplete and has prompted our interest to identify the type of effective osteogenic exercise. Objective : The aim of this study was to compare the changes in handgrip strength and bone metabolism after 6 months between aerobic and resistance exercise training in non-insulin dependent diabetic patients in Jeddah area. Materials and methods : One hundred non-insulin dependent diabetic male patients participated in this study and were divided into two equal groups; the first group (A) received aerobic exercise training, where the second group (B) received resistance exercise training. The program consisted of three sessions per week for six months. Results : The mean values of serum calcium and Hand grip strength were significantly increased, while the mean values of parathyroid hormone were significantly decreased in both groups .Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion : Aerobic exercise training on treadmill is appropriate to improve markers of bone metabolism and hand grip strength in non-insulin dependent diabetic patients. Keywords : Aerobic exercise, resistance exercise, bone mineral density, non-insulin dependent diabetes.

Background : Chronic hepatitis C (CHC) is a medical condition that has broad implications for a person’s physical and psychological health. Objective : The aim of this study was to detect changes in liver enzymes and psychological well-being in response to aerobic exercise training in patients with CHC. Material and Methods : Fifty CHC patients were included in two equal groups. The first group (A) received aerobic exercise training in addition to their regular medical treatment. The second group (B) received no training and only has their regular medical treatment. The program consisted of three sessions per week for three months. Results : There was a significant decrease in mean values of Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma – Glutamyltransferase (GGT) , Beck Depression Inventory (BDI ) & Profile of Mood States(POMS) and increase in Rosenberg Self-Esteem Scale (RSES) in group (A) after treatments, but the changes in group (B) were not significant. Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. Conclusion : Aerobic exercise training improves hepatic enzymes and psychological well-being in patients with chronic hepatitis C. Key words : liver enzymes; psychological well-being; aerobic exercise; chronic hepatitis C.

Background : Non-alcoholic steatohepatitis is a growing public health problem with no approved therapy; as cytokines and other pro-inflammatory mediators may each play a role in transition of steatosis to NASH which is projected to be the leading cause of liver transplantation in the United States by 2020. Objective : The aim of this study was to compare the impact of aerobic versus resisted exercise training on inflammatory cytokines and markers of liver function in patients with nonalcoholic steatohepatitis. Material and Methods : Fifty patients with NASH were included in the study and divided into two subgroups. Participants were included into 2 equal groups; the first group (A) received aerobic exercise training. The second group (B) received resisted exercise training three times a week for 3 months. Results : The mean values of TNF- α, IL6, IL8, ALT and AST were significantly decreased in group (A) and group (B).Also; there was a significant difference between both groups after treatment. Conclusion : Aerobic exercise training modulates inflammatory cytokine levels and markers of liver function in patients with nonalcoholic steatohepatitis. Keywords : Aerobic Exercise; Resisted Exercises; Inflammatory Cytokine; markers of liver function; Non-alcoholicsteatohepatitis.

Background: Patients with hemophilia A have low bone density than healthy controls. It is now widely recognized that physical activity and sports are beneficial for patients with hemophilia. Objective: The aim of this study was to compare the effects of mild and moderate intensity treadmill walking exercises on markers of bone metabolism and hand grip strength in male patients with moderate hemophilia A. Material and Methods: Fifty male patients with moderate hemophilia, their age ranged from 25 to 45 years. The subjects were randomly assigned into 2 equal groups; the first group (A) received moderate intensity aerobic exercise training. The second group (B) received mild intensity aerobic exercise training. Results: There was a 32.1% and 24.8% increase in mean values of Serum Calcium and Hand grip strength respectively and 22.7 % reduction in mean values of parathyroid hormone in moderate exercise training group (A). While, There was a 15.1 % and 15 % increase in mean values of Serum Calcium and Hand grip strength respectively and 10.3 % reduction in mean values of parathyroid hormone in mild exercise training group(B). The mean values of Serum Calcium and Hand grip strength were significantly increased, while the mean values of parathyroid hormone were significantly decreased in both groups .Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion: Moderate intensity aerobic exercise training on treadmill is appropriate to improve markers of bone metabolism and hand grip strength in male patients with hemophilia A.Keywords: Aerobic exercise, Markers of Bone Metabolism, Hand Grip Strength, HemophiliaAfrican Health sciences Vol 14 No. 1 March 2014

Background : Type 2 diabetes mellitus is associated with abnormal markers of inflammatory cytokines and oxidative stress markers. Although, these abnormalities could be modulated with weight reduction; there is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of inflammatory cytokines and oxidative stress for obesity associated with type 2 diabetes mellitus. Objective : This study was designed to detect the effects of weight loss on the inflammatory cytokines, oxidative stress markers in obese type 2 diabetic patients. Material and Methods : Eighty obese patients with type 2 diabetes mellitus, their age ranged from 35-57 years and their body mass index ranged from 31-35 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises, diet regimen, where as the control group received medical treatment only for 12 weeks. Results : The mean values of body mass index (BMI), tumor necrosis factor–alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (sCRP), conjugated dienes (CD) and malondialdehyde (MDA) were significantly decreased, while the mean values of glutathione peroxidase (GPx), superoxide dismutase (SOD) and glutathione (GSH) were significantly increased in patients of group (A), while changes were not significant in group (B). Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. Conclusion : Weight loss ameliorates inflammatory cytokines and oxidative stress markers in obese type 2 diabetic patients. Keywords : Type 2 diabetes, weight reduction, oxidative stress, cytokines, obesity.

Background : Obesity and asthma are an important public health problem in Saudi Arabia. An increasing body of data supports the hypothesis that obesity is a risk factor for asthma. Asthma appears to be associated with low bone mineral density (BMD) due to long-term use of corticosteroids. Studies recently showed that weight bearing exercise training can increase mineral bone density, reduce weight and improve metabolic control. Objective : The present study aimed to measure the effects of treadmill walking exercises on bone mineral status and inflammatory cytokines in obese asthmatic patients treated with long term intake of corticosteroids. Methods : Eighty obese asthmatic patients of both sexes, their age ranged from 41 to 53 years. Subjects were divided into two equal groups: training group (group A) received aerobic exercise training on treadmill for six months in addition to the medical treatment where, the control group (group B) received only the medical treatment. Results: The results of this study indicated a significant increase in BMD of the lumbar spine & the radius, serum calcium and high density lipoprotein cholesterol (HDL-c) & significant reduction in parathyroid hormone, leptin, tumor necrosis factor– alpha(TNF-α), interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), low density lipoprotein cholesterol (LDL-c), triglycerides (TG) and body mass index (BMI) in group (A), while these changes were not significant in group (B).Also; there was a significant difference between both groups at the end of the study. Conclusion : Treadmill walking exercise training is an effective treatment policy to improve bone mineral status and modulates inflammatory cytokines and blood lipids profile in obese asthmatic patients with long term intake of corticosteroids. Keywords : Bone mineral density, bronchial asthma, exercises, inflammatory cytokines, inhaled corticosteroids, obesity. Due to errors in the previous PDF especially in the 'Cite as' authors names, the PDF fulltext has been reloaded. This information is now correc t.

Non-alcoholic fatty liver disease (NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosis to inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.

Background: Although post-menopausal obesity is an important public national health problem in Saudi Arabia, to date no study has evaluated the effects of weight reduction on biochemical & clinical parameters and quality of Life for obese Saudi post-menopausal women. Objective: The aim of this study was examine the effects of aerobic versus resisted exercise training effects upon systemic inflammation biomarkers and quality of life for obese post-menopausal Saudi women. Material and Methods: One hundred Saudi post-menopausal obese women participated in this study, their age ranged from 50-58 years and their body mass index (BMI) ranged from 30-35 kg/m2. All participants were divided into two equal groups: The first group received aerobic exercise training on treadmill where, the second group received resisted exercise training. Health-related quality of life (SF-36 HRQL), tumor necrosis factor– alpha(TNF-α), Interleukin-2(IL-2), Interleukin-4 (IL-4), Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured before and after 3 months at the end of the study. Results: The mean values of SF-36 HRQL subscale scores were significantly increased, while the mean value of TNF-α, Il-2, IL-4, IL-6,CRP and BMI were significantly decreased in both groups after treatments. There were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment with more changes in patients received aerobic exercise training. Conclusion: The current study provides evidence that aerobic exercise is more appropriate than resisted exercise training in modulating inflammatory cytokines and quality of life among obese post-menopausal women.Keywords: Aerobic exercise; resisted exercises; inflammatory cytokine; quality of life; obesity; menopause.