Changes in Lipid Profile and C-Reactive Protein in Response to High Interval Intensity Training in Physically Active and Inactive Women

authors:

avatar Asiye Seyyed ORCID 1 , * , avatar Hadis Ghajari 2

Department of Sport Physiology, Behbehan Branch, Islamic Azad University, Behbahan, Iran
Department of Sport Physiology, Noorabad Branch, Islamic Azad University, Noorabad, Iran
Annals of Military and Health Sciences Research: Vol.17, issue 4; e97274
published online: January 25, 2020
article type: Research Article
received: August 17, 2019
revised: January 4, 2020
accepted: January 6, 2020
DOI: https://doi.org/10.5812/amh.97274

how to cite: Seyyed A, Ghajari H. Changes in Lipid Profile and C-Reactive Protein in Response to High Interval Intensity Training in Physically Active and Inactive Women. Ann Mil Health Sci Res. 2019;17(4):e97274. https://doi.org/10.5812/amh.97274.

Abstract

Background:

High-intensity interval (HIIT) is a contributing factor to cardiovascular disease.

Objectives:

This study aimed to examine the effect of HIIT on lipid profile and C-reactive protein (CRP) in physically active (PhA) and physically inactive (PhI) women.

Methods:

Forty volunteer female students (20 PhA and 20 PhI) were selected and divided into 10-person groups of PhA (control and HIIT) and PhI (control and HIIT). During six weeks, the HIIT groups performed HIITs three sessions per week. Lipid profile and CRP levels of plasma were measured in the pretest and posttest.

Results:

We showed LDL, VLDL, and cholesterol were lower and HDL levels were higher in the PhA HIIT and PhI HIIT groups than in the PhA control group (P ≤ 0.05). Changes in CRP and TG levels were not significant in the PhA HIIT, PhI HIIT, and PhA control groups (P ≥ 0.05). Moreover, LDL, VLDL, and TG levels were lower and the HDL levels were higher in the PhI HIIT group than in the PhI control group (P ≤ 0.05). However, changes in CRP levels were not significant in the PhI HIIT group and PhI control group (P ≥ 0.05).

Conclusions:

It seems that HIIT can improve the lipid profile of PhA and PhI women, but further studies are necessary in this regard.

1. Background

The sedentary lifestyle in adults is associated with overweight and obesity, and recognized as the fifth leading cause of death in the world. It increases the risk of diseases such as hypertension, metabolic syndrome, and cardiovascular disease (1). In inactive people, obesity and weight gain are strongly associated with changes in the lipid profile and insulin resistance as the risk factors of cardiovascular disease (2). Studies show that the main causes of atherosclerosis and heart disease include increasing C-reactive protein (CRP) as an inflammatory marker (3), very low-density lipoprotein (VLDL), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) along with decreasing a potent marker called high-density lipoprotein (HDL-C) (4). Also, it seems that entering a college, because of the sensitivity of this important period of life, can cause a major change in the mental and physical lifestyle of girls, which can be linked to weight gain, obesity, and increased risk of cardiovascular disease (5). Studies have shown that physical activity is effective in lowering blood lipids, reducing inflammatory factors, and improving the immune system (1, 4, 6, 7). Based on studies, regular, long-term moderate and low-intensity endurance training has beneficial effects on reducing inflammation, decreasing insulin resistance, and improving aerobic metabolism (8).

In recent years, researchers in the field of sports science have become more interested in research into the cardiovascular effects of high-intensity interval training (HIIT) (6). However, contradictory results have been reported on the intensity and the type of training. For example, continuous and interval training had a significant effect on fibrinogen and CRP in healthy obese women (9). Moreover, HIIT training had a significant effect on the reduction of decreased LDL, TC, increasing HDL, and decreasing hs-CRP in sedentary healthy overweight/obese youth (10). In addition, HIIT and continuous training decreased LDL, TC, increasing HDL, and decreasing hs-CRP serum levels, but the effects were not significant on TG and VLDL (11). On the other hand, HIIT and continuous training did not have a significant effect on reducing CRP serum levels in obese children (12) and HIIT increased intracellular adhesion molecules (13).

2. Objectives

Given that the motivation for physical activity has diminished due to the occupation and modernization of societies and the growing prevalence of obesity can increase the risk of cardiovascular disease, especially in young women, finding a suitable method that can be the most appropriate way to prevent these diseases in the shortest possible time seems indispensable. Accordingly, this study aimed to investigate the C-reactive protein and lipid-lowering effect of HIIT training in physically active (PhA) and physically inactive (PhI) women.

3. Methods

This was a quasi-experimental study. Forty volunteer female college students of Islamic Azad University of Behbahan (mean age 22 years and 10 months, mean height 160 cm, and mean weight 57.9 kg) were selected based on availability. They were briefed on the purpose of research after completing a consent form. It is noteworthy that before the grouping of subjects, they completed the physical health questionnaire and the International Physical Activity Questionnaire (IPAQ), reliability of which had been measured by researchers in Iran with a correlation coefficient of 0.86. The inclusion criteria for all subjects were no history of cardiovascular disease, no smoking, not having at least six months of regular exercise, and the ability to perform the training. Based on the IPAQ, the subjects were categorized into three levels (sedentary, adequate mobility, and high mobility). Students with physical activity levels of less than 600 METs-min/week were classified as low physical activity group (inactive) and between 600 and 3000 and higher as appropriate physical activity group (active group). It is noteworthy that this questionnaire was designed according to a study by BashiriMoosavi et al. (14).

The subjects included 20 PhI students (control and HIIT groups) with no athletic experience at least in the last two years and 20 PhA students (control and HIIT groups). Afterward, before the start of training in the pretest and 48 hours after the last training session in the posttest, blood samples (6 cc) were gathered from the left brachial vein of each subject at 8:00 to 9:00 a.m. During six weeks, three sessions per week, the HIIT groups performed HIITs CRP (Iranian Biotechnic kit) measured by Hitachi 911 device with enzymatic photometry and lipid profiles measured by Pars Azmoon kit.

During six weeks, the HIIT groups performed the training for three sessions per week over a distance of 20 m (indicated by cones) (Figure 1). Indeed, each subject first ran from cone 1 to cone 2 (path A) and then backed to cone number 3 (path B) and eventually to cone number 1 (path C). Each subject did this process for 30 seconds and then rested for 30 seconds. For training overload, 30-second intervals were increased in the first and second weeks (four intervals), third and fourth weeks (six intervals), fifth and sixth weeks (six intervals). Subjects were instructed to warm up and cool down for 5 minutes before and after training. The training protocol of the present study was designed based on a 40 m shuttle run test with maximum speed running. Training intensity was above 90% of the maximum heart rate (HRmax) at all stages. It should be noted that the “220-age” formula was used to calculate the HRmax (15). The Kolmogorov-Smirnov test was used for assessing the normal distribution of data. The one-way analysis of variance (ANOVA) with Tukey’s post hoc test was used for statistical analysis of data (P ≤ 0.05).

Schematic plan of the high-intensity interval training protocol
Schematic plan of the high-intensity interval training protocol
Figure 1.

Schematic plan of the high-intensity interval training protocol

4. Results

The results of the paired sample t-test showed that body mass index (BMI), CRP, LDL, and TG were not significantly different between the post-intervention and pre-intervention in the PhA control group (P ≥ 0.05). However, VLDL and cholesterol were significantly higher in the post-intervention than in the pre-intervention in the PhA control group (P ≤ 0.05) and HDL (P = 0.002) was significantly lower in the post-intervention than in the pre-intervention (Figures 2 - 8). In the PhA HIIT group, BMI, TG, cholesterol, and CRP did not significantly change from the pre-intervention to post-intervention (P ≥ 0.05); however, LDL and VLDL were significantly lower in the post-intervention than in the pre-intervention (P ≤ 0.05) and HDL was significantly higher in the post-intervention than in the pre-intervention (P = 0.002). In addition, BMI, LDL, VLDL, and CRP were not significantly different between the post-intervention and pre-intervention in the PhI control group (P ≥ 0.05), but HDL (P = 0.01) was significantly lower in the post-intervention than in the pre-intervention. In the PhI control group, TG and cholesterol were significantly higher in the post-intervention than in the pre-intervention (P ≤ 0.05). In the PhI HIIT group, BMI and CRP were not different between the post-intervention and pre-intervention (P ≥ 0.05); however, LDL, VLDL, TG, and cholesterol were significantly lower in the post-intervention than in the pre-intervention (P ≤ 0.05). Also, HDL in the PhI HIIT group was significantly higher in the post-intervention than in the pre-intervention (P = 0.03).

The results of the one-way ANOVA test indicated no significant difference in BMI (Figure 2) and CRP (Figure 3) between the research groups (P ≥ 0.05). However, there were significant differences in LDL, VLDL, TG, cholesterol, and HDL between the research groups (P ≤ 0.05). The results of Tukey’s post hoc test showed that LDL was significantly lower in the PhA HIIT (P = 0.002) and PhI HIIT groups (P = 0.03) than in the PhA control group. In the PhA HIIT (P = 0.001) and PhI HIIT (P = 0.01) groups, the LDL levels were significantly lower than that of the PhI control group (Figure 4).

Moreover, VLDL was significantly lower in the PhA HIIT (P = 0.02) and PhI HIIT (P = 0.02) groups than in the PhA control group. The VLDL levels were significantly lower in the PhI HIIT group than in the PhI control group (P = 0.02) (Figure 5). The HDL levels were significantly higher in the PhA HIIT (P = 0.001) and PhI HIIT (P = 0.001) groups than in the PhA control group. The HDL levels were significantly higher in the PhA HIIT (P = 0.001) and PhI HIIT (P = 0.001) groups than in the PhI control group (Figure 6). The TG level in the PhI HIIT group was significantly higher than in the PhA control group (P = 0.01) and lower than in the PhI control group (P = 0.009) (Figure 7). The cholesterol levels were significantly lower in the PhA HIIT group than in the PhA control group (P = 0.001) and PhI control group (P = 0.005) and they were significantly lower in the PhI HIIT group than in the PhA control group (P = 0.02) (Figure 8).

Changes in body mass index in the pre and post-intervention
Changes in body mass index in the pre and post-intervention
Figure 2.

Changes in body mass index in the pre and post-intervention

Changes in C-reactive protein in the pre and post-intervention
Changes in C-reactive protein in the pre and post-intervention
Figure 3.

Changes in C-reactive protein in the pre and post-intervention

Changes in low-density lipoprotein in the pre and post-intervention. *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhA control group.
Changes in low-density lipoprotein in the pre and post-intervention. *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhA control group.
Figure 4.

Changes in low-density lipoprotein in the pre and post-intervention. *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhA control group.

Changes in very-low-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhI control group.
Changes in very-low-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhI control group.
Figure 5.

Changes in very-low-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; ¥, lower than the PhI control group; £, lower than the PhI control group.

Changes in high-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, higher than the PhI control group.
Changes in high-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, higher than the PhI control group.
Figure 6.

Changes in high-density lipoprotein in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, higher than the PhI control group.

Changes in triglyceride levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhI control group.
Changes in triglyceride levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhI control group.
Figure 7.

Changes in triglyceride levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhI control group.

Changes in cholesterol levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhA control group; ¥, lower than the PhI control group.
Changes in cholesterol levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhA control group; ¥, lower than the PhI control group.
Figure 8.

Changes in cholesterol levels in the pre and post-intervention. #, higher than the pre-intervention; *, lower than the pre-intervention; £, lower than the PhA control group; ¥, lower than the PhI control group.

5. Discussion

The levels of LDL, VLDL, and cholesterol were significantly lower and the HDL levels were significantly higher in the PhA HIIT and PhI HIIT groups than in the PhA control group. Nevertheless, changes in CRP and TG levels were not significant in the PhA HIIT, PhI HIIT, and PhA control groups. Low physical activity has been known to increase the risk of various diseases such as atherosclerosis, diabetes, hypertension, and so on (15). Most studies showed the effect of long-term and aerobic exercise on weight loss and lipid profile improvement in obese and inactive individuals (4, 8, 16).

There are contradictory results regarding the effect of HIIT on the lipid profile. For example, HIIT significantly reduced the percentage of lipid, cholesterol, and LDL and increased HDL levels in a study (17). This study was consistent with the present study regarding the reduced LDL and cholesterol levels and inconsistent regarding the HDL variations. The similarity of the training period and the inactivity of both populations appear to be the reasons for the consistency of the results. Also, since BMI was not significantly different between different groups in the present study, some of the results of this study can be justified based on the study by Batacan et al. (18); probably because of the baseline levels of lipid profile in normal-weight individuals and even in some overweight people, HIIT with different intensities had no significant effect on HDL, LDL, VLDL, and TG changes. However, it was noted in the present study that interval training in obese and overweight individuals may have lipolyzed visceral adipose tissue and released lipid metabolites into the bloodstream (18).

In the present study, the LDL, VLDL, and TG levels were significantly lower and the HDL levels were significantly higher in the PhI HIIT group than in the PhI control group. Nevertheless, the differences in CRP levels were not significant between the PhI HIIT and PhI control groups. It has been reported that HIIT significantly lowered the levels of LDL cholesterol, fat percentage, BMI, and cardiovascular risk factors (19). Moreover, HIIT significantly decreased TG, LDL, and total cholesterol levels and increased HDL (20). Besides, HIIT decreased TG and increased insulin sensitivity, but had no significant effect on cholesterol, HDL, and LDL variations (21). In addition, one session of resistance training and continuous training had no significant effect on CRP in overweight men (22); however, Pilates and endurance training reduced CRP in obese and elderly individuals (23). Differences in the type and intensity of training appeared to be effective in reducing CRP and the differences in these two factors may be the reasons for the difference of this study with the present study.

In coronary artery disease (Atherosclerosis), the elevated levels of HDL can have protective roles and induce the reverse transport of cholesterol from peripheral vascular tissue to the liver (24). The HDL-C levels appear to play a major role in the process of reverse cholesterol transport systemic circulation. Because the reverse transport of cholesterol leads to the process of removing excess cholesterol from peripheral tissue, an increase in plasma HDL concentrations may be effective in lowering cholesterol levels (25).

One of the possible causes of elevated HDL is weight loss and decreased plasma triglycerides, which appear to result in insulin improvement. One possible cause of increased HDL is the increase in lipoprotein lipase (LPL) as a result of exercise. Lipoprotein lipase is effective in converting VLDL to HDL; thus, by increasing its activity, the HDL levels increase; increased HDL can be due to the increased production in the liver and changes in various enzymes such as lecithin cholesterol acyltransferase and decreased hepatic lipase activity following exercise (26). Exercise also appears to improve metabolism, increase insulin sensitivity, improve endothelial function, and result in weight loss. Given the limitations of the measurement of some cytokines such as interleukin-6 and its direct association with serum levels of CRP, it seems that the lack of measuring this factor would be a limitation to the present study. Therefore, it is proposed to consider this variable in future studies. Given that the measured markers to prevent cardiovascular disease in individuals were inactive, the lack of the measurement of cardiac waves was the limitations of this study. Therefore, it is suggested that future studies evaluate cardiac waves in addition to these variables.

5.1. Conclusions

Although the lipid profile and CRP increase in inactive people, it appears that HIIT has favorable effects on lipid profile in PhA and PhI women. Nevertheless, given the unchanged level of some markers, further studies are needed.

Acknowledgements

References

  • 1.

    Hosseini SA, Bagheri A, Izadi M, Salehi O, Farkhaie F. [The effect of eight weeks of training and two weeks of detraining in office on vaspin and glycemic indices of male staff]. Iran Occup Health J. 2019;16(1):13-22. Persian.

  • 2.

    Pandey A, Patel KV, Vaduganathan M, Sarma S, Haykowsky MJ, Berry JD, et al. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018;6(12):975-82. [PubMed ID: 30497652]. https://doi.org/10.1016/j.jchf.2018.09.006.

  • 3.

    Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754. [PubMed ID: 29706967]. [PubMed Central ID: PMC5908901]. https://doi.org/10.3389/fimmu.2018.00754.

  • 4.

    Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16(1):132. [PubMed ID: 28679436]. [PubMed Central ID: PMC5498979]. https://doi.org/10.1186/s12944-017-0515-5.

  • 5.

    Rafie V. The effect of eight weeks of Yoga training on students' Mental Health at Marvdasht Branch of Islamic Azad University. Report Health Care. 2018;4(4):30-7.

  • 6.

    Guiraud T, Nigam A, Juneau M, Meyer P, Gayda M, Bosquet L. Acute responses to high-intensity intermittent exercise in CHD patients. Med Sci Sports Exerc. 2011;43(2):211-7. [PubMed ID: 20543746]. https://doi.org/10.1249/MSS.0b013e3181ebc5de.

  • 7.

    Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. 2018;5:135. [PubMed ID: 30324108]. [PubMed Central ID: PMC6172294]. https://doi.org/10.3389/fcvm.2018.00135.

  • 8.

    Rezaei S, Shamsi MM, Mahdavi M, Jamali A, Prestes J, Tibana RA, et al. Endurance exercise training decreased serum levels of surfactant protein D and improved aerobic fitness of obese women with type-2 diabetes. Diabetol Metab Syndr. 2017;9:74. [PubMed ID: 29021828]. [PubMed Central ID: PMC5613319]. https://doi.org/10.1186/s13098-017-0273-6.

  • 9.

    Akbarnejad A, Soori R, Bigdell MD, Sayyah M. [The Comparison of the effects of intermittent and continuous exercises on general inflammatory markers (CRP and Fibrinogen Serums) of young obese women]. Sport Biosci. 2014;5(4):21-33. Persian.

  • 10.

    Khammassi M, Ouerghi N, Hadj-Taieb S, Feki M, Thivel D, Bouassida A. Impact of a 12-week high-intensity interval training without caloric restriction on body composition and lipid profile in sedentary healthy overweight/obese youth. J Exerc Rehabil. 2018;14(1):118-25. [PubMed ID: 29511662]. [PubMed Central ID: PMC5833956]. https://doi.org/10.12965/jer.1835124.562.

  • 11.

    Behzare A, Gaeini AA, Mogharnasi M, Taherzadeh J, Seyedahmadi M, Keavanlou F, et al. [Comparison of intermittence and continuative exercise methods on hs-CRP and Lipids as predictors of coronary heart disease]. J North Khorasan Univ Med Sci. 2012;3(4):35-42. Persian. https://doi.org/10.29252/jnkums.3.4.35.

  • 12.

    Salimi Avansar M, Zar A. [Comparing the effect of endurance and high intensity interval trainings on levels of chemerin and protein of C-reactive plasma in obese children]. J Arak Univ Med Sci. 2017;20(2):54-66. Persian.

  • 13.

    Khademi Y, Azarbayejani MA, Hosseini SA. [The effects of combination of high intensity intermittent exercise and supplement flaxseed oil 1 ICAM- plasma concentration in male rats]. J Shahid Sadoughi Univ Med Sci. 2017;24(10):828-39. Persian.

  • 14.

    BashiriMoosavi F, Farmanbar R, Taghdisi MH, AtrkarRoshan Z. [Level of Physical Activity among Girl High School Students In Tarom County and Relevant Factors]. Iran J Health Educ Health Promot. 2015;3(2):133-40. Persian.

  • 15.

    Hemmati Nafar M, Kordi M, Cobineh S, Chopani S. [The effect of six weeks high intensity interval training (HIIT) on Acute]. Olympic Modern. 2014;1(1):47-57. Persian.

  • 16.

    Milyani AA, Al-Agha AE. The effect of body mass index and gender on lipid profile in children and adolescents in Saudi Arabia. Ann Afr Med. 2019;18(1):42-6. [PubMed ID: 30729932]. [PubMed Central ID: PMC6380115]. https://doi.org/10.4103/aam.aam_17_18.

  • 17.

    Musa DI, Adeniran SA, Dikko AU, Sayers SP. The effect of a high-intensity interval training program on high-density lipoprotein cholesterol in young men. J Strength Cond Res. 2009;23(2):587-92. [PubMed ID: 19209073]. https://doi.org/10.1519/JSC.0b013e318198fd28.

  • 18.

    Batacan RB Jr, Duncan MJ, Dalbo VJ, Tucker PS, Fenning AS. Effects of high-intensity interval training on cardiometabolic health: A systematic review and meta-analysis of intervention studies. Br J Sports Med. 2017;51(6):494-503. [PubMed ID: 27797726]. https://doi.org/10.1136/bjsports-2015-095841.

  • 19.

    Soori R, Ranjbar K, Salehian O, Eslam doost M. [The effect of high interval intensity training on plassma soluble intercellular adhesion molecule -1 (sICAM-1) in sedentary obese male]. J Sports Sci. 2013;5(3):91-102. Persian.

  • 20.

    Alahmadi MA. High-intensity interval training and obesity. J Novel Physiother. 2014;4(3). https://doi.org/10.4172/2165-7025.1000211.

  • 21.

    Paoli A, Pacelli QF, Moro T, Marcolin G, Neri M, Battaglia G, et al. Effects of high-intensity circuit training, low-intensity circuit training and endurance training on blood pressure and lipoproteins in middle-aged overweight men. Lipids Health Dis. 2013;12:131. [PubMed ID: 24004639]. [PubMed Central ID: PMC3846819]. https://doi.org/10.1186/1476-511X-12-131.

  • 22.

    Afzalpour ME, Miri M, Seghatoleslami A, Aashab Yamin R. [Effects of a resistance, interval, and continuing training session on serum intercellular adhesion molecule-1 and C- reactive protein in overweight men]. Sport Physiol. 2015;7(27):45-64. Persian.

  • 23.

    Pestana MAS, Netto EM, Silva Pestana MC, Silva Pestana V, Schinoni MI. Pilates versus resistance exercise on the serum levels of hs-CRP, in the abdominal circumference and body mass index (BMI) in elderly individuals. Motricidade. 2016;12(1):128. https://doi.org/10.6063/motricidade.6682.

  • 24.

    Lamina S, Okoye GC. Therapeutic effect of a moderate intensity interval training program on the lipid profile in men with hypertension: A randomized controlled trial. Niger J Clin Pract. 2012;15(1):42-7. [PubMed ID: 22437088]. https://doi.org/10.4103/1119-3077.94096.

  • 25.

    Sjoberg KA, Frosig C, Kjobsted R, Sylow L, Kleinert M, Betik AC, et al. Exercise increases human skeletal muscle insulin sensitivity via coordinated increases in microvascular perfusion and molecular signaling. Diabetes. 2017;66(6):1501-10. [PubMed ID: 28292969]. https://doi.org/10.2337/db16-1327.

  • 26.

    Verges B. Pathophysiology of diabetic dyslipidaemia: Where are we? Diabetologia. 2015;58(5):886-99. [PubMed ID: 25725623]. [PubMed Central ID: PMC4392164]. https://doi.org/10.1007/s00125-015-3525-8.