A STUDY OF THE EFFECTS OF JOGGING ON SELECTED RISK FEATURES AND BIOMARKERS OF CARDIO-METABOLIC SYNDROME OF ADOLESCENTS IN KANO CITY, NIGERIA  

ABSTRACT

This study assessed the effects of jogging on selected risk factors and biomarkers of cardiometabolic syndrome (CMS) of adolescents in Kano Metropolis, Nigeria. For the purpose of this study, an experimental research design was used in which the participants were randomly assigned into two groups (experimental and control). Forty (40) male adolescents between the ages of 14 and 17 years, whose body mass indexes (BMI) (kg/m2) were above

85^th percentile, constituted the population of the study. The participants‘ body mass index (BMI), visceral fat, systolic blood pressure (SBP), diastolic blood pressure (DBP), C- reactive protein (CRP) and micro-albuminuria were measured at base line, during intervention (6^th week) and post-intervention (12^th week). Jogging exercise was performed in group, 3 days per week for 12 weeks at low-to-moderate intensity. Descriptive statistics of mean, standard deviation and standard error of the estimate were used to analyze the data of each variable. Inferential statistics of two-way repeated-measures ANOVA was used to test the hypotheses at an alpha level of 0.05. The results of this study showed that jogging exercise caused significant reduction on the BMI (p = 0.037), SBP (p = 0.017), DBP (p = 0.029) and CRP (p = 0.014), but not on the visceral fat (p = 0.296) and microalbuminuria (p = 0.911) of male adolescents in Kano metropolis. Based on these results, it was concluded that low-moderate intensity jogging exercise of 12 weeks duration reduced selected risk factors and biomarkers of CMS among adolescents in Kano metropolis. It was recommended that regular jogging exercise can be utilized to reduce the risk factors and prevent the development of biomarkers of CMS among adolescents.

CHAPTER ONE

1.0 INTRODUCTION

 

1.1 Background of the Study

Cardio-metabolic syndrome (CMS) is an area that has received much attention in recent time, due to the prevalence of the syndrome worldwide. It has become a major threat to the global public health (American Heart Association (AHA), 2009; International Diabetes Federation (IDF), 2012; American Diabetes Association (ADA), 2016). CMS is described as a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus (T2DM), which occur together more often than by chance alone (Matthew, Singh & Arora, 2011; Okafor, 2012). Research indicates a strong association between CMS and subsequent risks for diabetes and cardiovascular event. Mathew et al. (2011) suggested that it may be a risk factor for the incident of chronic kidney disease.  Studies have shown that the syndrome develops during childhood and is prevalent among overweight children and adolescents (Weiss, Bremer, and Lustig, 2013; Skinner, Perrin, Moss & Skelton, 2015; Mansour, Nassef, & Malt, 2016).  

The World Health Organization (WHO) (1999), adapted a criterion for defining CMS in children, which requires three or more of obesity, abnormal blood glucose, high systolic blood pressure (SBP), high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C) or high total cholesterol (TC). The criterion for the CMS in adults developed by the United States (US) National Cholesterol Education Programme (NCEP) (2001), was modified and revised by many investigators as child-specific definition which includes abnormalities in any three of high blood glucose, high TG, high systolic blood pressure (SBP), high diastolic blood pressure (DBP), low HDL-C and high body mass index (BMI). The IDF (2007), provided a definition of CMS for use in children as an individual who has central adiposity plus at least two of the following criteria: high TG, low HDL-C, high SBP, high DBP, high fasting plasma glucose or previously diagnosed T2DM.

Studies (Okafor, 2012; Broodai, Cherry, Scattar & Relly, 2014) revealed that several risk factors exist for the syndrome. Obesity is the most common component that characterizes CMS. It is commonly associated with insulin resistance. In Africa, it has been observed that unhealthy weight gain and CMS are not limited to adult population. Adolescent and young people are also affected (IDF, 2007; Okafor, 2012; Weiss et al., 2013). The BMI cut off points are used generally to establish overweight/obesity as recommended by IDF (2007). However, BMI does not provide any insight into regional fat distribution, but visceral fat does. Anthropometric measures of waist circumference and abdominal skin fold are used for rapid, but accurate estimation of visceral fat (Chen, Chen, Chuang, Chiang, Chiao & Chang, 2014). Recently, digital machines from different manufacturers are used to estimate visceral fat after entering height and gender information. Previous research findings suggest that abdominal visceral fat affects the metabolic processes and is an important risk factor for morbidity and mortality and more often a common component that characterizes CMS (Srinivasan, Myers, & Berenson, 2002). The visceral fat (also known as organ fat or intra-abdominal fat) is located inside the abdominal cavity.

Elevated blood pressure is associated with an increased CMS risk (Thoenes, Bramiage, Zhong, Shang, Volpe, & Spink, 2012). Hypertension is frequently clustered with other metabolic disorders, such as an elevated BMI, waist circumference (WC), fasting glucose, low HDL-C, all of which are associated with adverse cardiovascular outcomes. According to the guidelines of European Society of Hypertension (ESH) and European Society of Cardiology (ESC) (2003), an intensified diagnostic and therapeutic measures are required in patients with an elevated SBP and DBP because of their associations with several other cardio-metabolic risk markers (ESH, ESC, 2003).

The C-reactive protein (CRP) is found in the blood plasma, the level of which rises in response to body inflammation. Research suggests that patients with elevated basal level of CRP are at risk of T2DM, hypertension and CVD (Dehgan, Kardys, Demant, Litterlinden, Sijbrands, Bootsma, Stipen, Hofman, Schram, & Witterman, 2007; Horluchi & Moge, 2011) Increased CRP is also an extra criterion for CMS (IDF, 2007). The results of numerous studies suggest that CRP is elevated in children and adolescents with higher CVD risk (Jarvisalo et al., 2007). Some studies have shown that childhood CRP values predict adult CRP (Juonala et al., 2006). It is not yet clear whether high CRP levels during childhood and adolescence lead to an increased risk of CVD in later life.

Micro-albuminuria is a term used to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amount of albumin into the urine. Microalbuminuria is an indicator of CVD, T2DM and hypertension. The IDF (2007), identified the increase in urine albumin as an extra criterion for CVD and T2DM screening. The prevalence of microalbuminuria in Nigerian adolescents is high (Okpere & Anochie, 2012). The prevalence of microalbuminuria is rapidly increasing worldwide to the extent that some international organizations such as American Diabetes Association (ADA, 2016), called for annual screening for albumin in children with diabetes. The International Diabetes Federation (2007), identified increase in urine albumin as an extra criterion for CVD and T2DM. It is unlikely that microalbuminuria directly causes the cardiovascular disease. Instead, the patho-physiology is not completely elucidated. It seems that microalbuminuria is an early marker of generalized endothelial dysfunction and permeability (Weir, 2007; Gerstein et al., 2001).

The pathological processes and risk factors of CMS have been shown to begin during child-hood. Researchers believed that the risk of developing the CMS is likely triggered or exacerbated by concurrent obesity, physical inactivity, poor eating habits, and hormonal changes associated with puberty (WHO, 2002; Pettman, Misan, Owen, Warren, Coates, Buckley & Peter, 2008). Physical activity levels of Nigerian youths are moderate while sedentary behaviour (inactive lifestyle) are high (Akinroye, Oyeyemi, Odukoya, Adeniyi, Adedoyin, Ojo, Alawode, Ozomata, & Awotidebe, 2014). As a response to the increased global sedentary and consequent risks of negative cardio-metabolic outcomes, particularly among adolescents, one response that has been adopted by many organizations concerned with health and environment is the promotion of ―active life style‖, which seeks to promote walking, jogging and cycling as safe and common to organized exercise training and sports. In many countries today, the most commonly used vehicle for road transport is a bicycle, which resembles walking and jogging. Given that many journeys are for relatively short distances, there is considerable scope for adolescents to replace car use with walking or cycling to schools and markets.

1.2. Statement of the Problem

The on-going global rise in the prevalence of CMS among all age and ethnic groups is accompanied by a higher increase in serious health risks, such as T2DM and the development of cardiovascular damage. The CMS is becoming a major challenge to the public health in the developing world. For example, 30% of obese Saudi children had three or more of the components of the CMS (Taha, Ahmed & Sadiq, 2009). Data in Kuwait indicate the same (30%) prevalence with Saudi adolescents (Boodai, Chery, Sattar & Reilly, 2014). Contrary to earlier thoughts, CMS is no longer rare in Africa. In Nigeria, using the IDF criteria, 14.3% of CMS was found among overweight and obese adolescents 14 years of age and above (Onyenekwu, Dada & Babatunde, 2017). This warrants effort to develop preventive and risk-reduction strategies which are easier and natural like jogging exercise (Okafor, 2012).

Previous research works suggests that the occurrence of CMS in pre-adult life persists into adulthood and the existence of obesity in childhood predisposes and individual to developing CMS in adulthood (Okafor, 2012; Onyenekwu et al., 2017). Early detection followed by lifestyle intervention is vital to halt the progression of CMS and safeguard the future health of children and adolescents. Adolescents who have one risk factor are likely to have others as well, especially if they are overweight. Similarly, body fat, blood pressure and inflammatory biomarkers are all affected by puberty (Cook, Weitzman, Auinger, Nguyen & Dietz, 2003) Thus, puberty is a crucial time for the development of CMS. The rapid prevalence and severity of obesity in children is likely to lower the age of onset of T2DM and increase the incidence of CVD worldwide. The understanding of the pathophysiology and improvement of the preventive and therapeutic approaches to CVD involve knowledge of novel risk factors and biomarkers. Although several risk factors and biomarkers are evidenced, substantial research is required for the identification and prevention strategies to reduce cardio-metabolic risk in children and adolescents.

The underlying patho-physiology of CMS is probably multi-factorial with obesity and hypertension being the most common components occurring among adolescents (Okafor, 2012; Skinner et al., 2015). Obesity is a significant health problem that has reached epidemic proportion around the world. Childhood obesity is not limited to industrialized countries; recent studies revealed rapidly increasing prevalence of obesity among school children in developing countries. With at least 1.1 billion children or close to 20% of the world‘s population being overweight, which point to the fact that the incidence of the CMS is expected to continue to rise among children and adolescents by 2030 (Mathew et al., 2011). Onyenekwu et al. (2017), found 97% prevalence of obesity making it the most prevalent risk factor among Nigerian adolescents followed by hypertension with 40% prevalence. In Nigeria, the prevalence of hypertension in adolescent boys between the ages of 13 and 17 years was put at 16.9% in the urban area with less prevalence in the semiurban area (Ejike, Ugwu & Ezeanyika, 2010).

There is paucity of data on the prevalence of CMS and its risk factors among the Hausa Fulani of north-western Nigeria. The Hausa Fulani usually have lean physique that should prevent from CMS. However, with modernization some have become obese and adopted sedentary life-style that is risk factors for CMS (Sabir, Jimoh, Iwuala, Isezue, Bilbis, Aminu, Abubakar & Sa‘idu, 2016). Hence, more studies, involving adolescents are required to standardize the definition of CMS in children, establish relevant cut-off points for research and determine the efficacy of various exercise modalities.

Available data suggest that the presence of cardiovascular risk factors that constitute the

CMS is linked to the level of aerobic fitness in children and adolescents (Makowski & Copper, 2000; Nassis, Papantakou & Skenderi, 2005; Tjønna, Stølen & Bye, 2008; Louise, Naylor, Davis & Green, 2016). However, evidence from the previous studies is moderate. Most of the data are cross-sectional and conflicting (Ramirez-Lopez, Gonzalez-Villalponde & Sanchez-Corana, 2001; Kelishade, Razaghi & Gouga, 2007). There is need for studies that directly measure the effect of exercise on the CMS risk factors and biomarkers.

Moreover, the pattern of physical activity in terms of both volume and intensity on individual components of CMS has not been well studied on adolescents, especially in Nigeria (Haram, Kemi, Lee, Bendheim, Al-Share, Waldum, Gilligan, Koch, Britton, Najjar & Wisloff, 2008; Gardener, Parker, Krshman & Charmers, 2013). Few studies available were in conflict, some (Taha et al., 2009; Banks, Manlhiot, Dobbin, Gibson, Stearne, Davies-Shaw, Chahal, Fisher & McCrindle, 2012; Jago, Drews, McMurray, Baranowski, Galassetti, Foster, Moe & Buse, 2013), demonstrated positive relationship between changes in fitness and CMS parameters; while others do not (Marcell, McAuley, Trastadottir & Reaven, 2005; Nassis, Papantakou & Skenderi, 2005). This calls for a thorough understanding of the phenomenon to enable optimal preventive measures at an affordable scale with socio-economic cost. Similarly, international public health authorities (Centres for Disease Control and Prevention (CDC), 2008; WHO, 2010), suggest that children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily, but this higher intensity is more challenging to the cardiovascular system and can only be achieved by a few. Therefore, there is need to evaluate doseresponse relationship between cardio-metabolic risk and physical activity, especially lowto-moderate intensity exercise in adolescents of varying anthropometry categories. Hence, the choice of this study to determines the effects of jogging exercise on the adolescent population.

Regular walking and jogging is a healthy, low-to-moderate intensity exercise that can be enjoyed by people of all ages from young children to older adults. It is said to be an important form of aerobic exercise, which is relatively simple and affordable that can provide some benefit. It is also fun for the adolescents, cheap and affordable. Presently, in Kano metropolis, there tends to be an increase in the number of children trekking or riding bicycles to schools and markets, but no study has attempted to evaluate the health effects, especially among children with CMS risk. This study therefore hopes to determine the effects of jogging on risk factors and biomarkers of CMS among adolescents in Kano Metropolis, Nigeria.

1.3 Research Questions

This research attempted to answer the following questions:

1. Will regular jogging exercise modify body mass index of male adolescents in Kano

Metropolis?

2. Will regular jogging exercise modify visceral fat of male adolescents in Kano Metropolis?
3. Will regular jogging exercise modify systolic blood pressure of male adolescents in Kano

Metropolis?

4. Will regular jogging exercise modify diastolic blood pressure of male adolescents in Kano

Metropolis?

5. Will regular jogging exercise modify C-reactive protein of male adolescents in Kano

Metropolis?

6. Will regular jogging exercise modify micro-albuminuria of male adolescents in Kano

Metropolis?

1.4. Basic Assumptions

Based on the research questions, it is assumed that:

1. Cardio-metabolic syndrome risk factors and biomarkers are prevalent among adolescents in

Kano Metropolis.

2. Overweight/obesity is likely associated with the incidence CMS risk factors among adolescents in Kano Metropolis.
3. Jogging exercise can modify risk factors and biomarkers of cardio-metabolic syndrome of male adolescents in Kano Metropolis.

1.5 Research Hypotheses

To achieve the purpose of this study, the following hypotheses were tested:

Major Hypothesis:

There is no significant effect of regular jogging exercise on the risk factors and biomarkers of CMS on male adolescents of Kano Metropolis, Nigeria.

Sub-hypotheses: 

1. There is no significant effect of regular jogging exercise on body mass index of male adolescents in Kano Metropolis, Nigeria.
2. There is no significant effect of regular jogging exercise on visceral fat of male adolescents in Kano Metropolis, Nigeria.
3. There is no significant effect of regular jogging exercise on systolic blood pressure of male adolescents in Kano Metropolis, Nigeria.
4. There is no significant effect of regular jogging exercise on diastolic blood pressure of male adolescents in Kano Metropolis, Nigeria.
5. There is no significant effect of regular jogging exercise on C-reactive protein of male adolescents in Kano Metropolis, Nigeria.
6. There is no significant effect of regular jogging exercise on micro-albuminuria of male adolescents in Kano Metropolis, Nigeria.

1.6 Significance of the Study

Many studies have been conducted on risk factors and biomarkers of CMS and the therapeutic value of exercise, with most of the studies focusing on adults and high intensity exercises. It is believed that exercising at moderate-to-vigorous-intensity is associated with low CMS risk score; and that low intensity may not be sufficient to influence CMS risk factors in adolescents. Similarly, guidelines from international health authorities encourage exercising at moderate-to-vigorous intensity to improve cardio-metabolic health. The result of this study will clarify whether exercising at low-to-moderate intensity exercises like jogging, is sufficient to modify the risk factors and biomarkers of CMS in adolescents.

Nigerian youths, including Hausa Fulani of the north-western states are at risk of adiposity and other CMS risk factors (Akinpelu, Oyewole & Oritogun, 2008) and more interventions targeting this population especially involving jogging exercises, which are suitable are warranted for these youths. It is hoped that the findings of this study will provide parents, teachers as well as exercise specialists with clear information on the benefit of jogging exercise in minimizing the risk of overweight and its associated health problems.

1.7 Delimitation of the Study This study is delimited to:  

1. Male adolescents between the ages of 14 and 17 years in Kano Metropolis.
2. Overweight/obese adolescents (BMI = / > 85^th percentile for their own age) who were not involved in any organized exercise programme.
3. Aerobic exercise (group jogging)
4. Six risk factors/biomarkers of CMS (body mass index, visceral fat, systolic blood pressure, diastolic blood pressure, C-reactive protein and micro-albuminuria).

A STUDY OF THE EFFECTS OF JOGGING ON SELECTED RISK FEATURES AND BIOMARKERS OF CARDIO-METABOLIC SYNDROME OF ADOLESCENTS IN KANO CITY, NIGERIA