The Effect of a Walking Training Program at the LIPOXmax Point on the Body Mass Index in Male Type II Diabetes in the 40–60 Age Group

Abstract

The study aims to identify the effect of a training program by walking to the point LIPOXmax on the BMI of male diabetics (type II); we relied on the experimental approach because of its adequacy with the study, while the study sample was composed of 12 people with type II, which were randomly selected from the study population. We used the pre- and post-measurement of the training program using an impedancemetry device to measure the body mass index, as well as calculating the LIPOXmax walking rhythm, which varies from one patient to another. Finally, the results of the study showed that walking to the point LIPOXmax positively affects the reduction in the body mass index in men with type II diabetes in age group 40–60 years old.

1. Introduction

The health level of the people is one of the most important indicators of the advancement and progress of countries. That is why many developed countries seek to provide various services to their members, including providing health care, for all ages, in an effort to make money and effort. They are sure that this will bring benefits to them in the short- and long-term. Where human health can be likened to a regression line that tends from top to bottom, when the whole life of the individual is activity, vitality and happiness; this means that health is located at a point above the line, but when health is at a point on the line and in the direction down, most of his daily activities may stop [1]. The underlying relationship between the behavior of individuals and health, led to major transformations in the last three decades of the twentieth century, in the understanding and development of health, and the possibility of its impact on the individual level. Therefore, health education is one of the most important areas of modern public health, and is considered an essential part of any public health program [2]. For this reason, studying and understanding behavioral practices belonging to health, in its various directions, is the first step towards the process of planning for them and finding ways to develop them, which ultimately reflects on healthy growth, and this is in line with what the World Health Organization (WHO) advocates. In the same context, this organization was confirmed by the report of Dr. Alaa Alwan: Efforts must be focused on the prevention and treatment of classes of global killers, including diabetes mellitus [3]. The prevalence of diabetes for the last 30 years has been considered a significant increase among the world’s population to the extent that it has become a real danger [4]. The global prevalence of diabetes in adults (aged 20–79 years) will be 6.4%, affecting 285 million adults in 2010, and will rise to 7.7% and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in the number of adults with diabetes in developing countries and 20% in developed countries [5]. According to some predictive studies, which conclude: a 2010 study, which concluded that the prevalence of diabetes in adults globally (ages 20–79 years) is 6.4%, and may affect 285 million adults in 2010, and could increase to 7.7%, or 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in the number of adults with diabetes in developing countries and 20% in developed countries [5]. According to another study, the prevalence of diabetes for all age groups worldwide was estimated at 2.8% in 2000 and 4.4% in 2030. It is also expected that the total number of people with diabetes will increase from 171 million in 2000 to 366 million in 2030 [4]. On September 16, 2022, the World Health Organization announced on its official website: The number of people with diabetes increased from 108 million in 1980 to 422 million in 2014. In high-income countries [6], this meant that the current stats far exceeded what was expected. According to the World Diabetes Federation, which states in 2021 that 537 million adults (20–79 years) suffer from diabetes, 1 in 10 people, and this number is expected to reach 643 million by 2030. According to the same source, about 2 million people suffer from diabetes. Diabetes in Algeria, according to the 2021 report of the International Diabetes Federation (FID) and published in the framework of World Diabetes Day [7]. That diabetes mellitus is a health problem that affects the life of an insulin-dependent person. While there is general agreement on the value of physical activity in the prevention and management of many diseases, it is considered among the therapeutic tools in daily medical practice. It is also difficult to convince long-term inactive patients to engage in regular physical activity [8]. Walking is one of the practices that have emerged to achieve a better lifestyle, as it reflects the safety of the heart and lungs, and walking is among the sports recommended by the World Health Organization [7]. Up to the age of 65, the activity practiced can be of a moderately intense aerobic nature (aerobic exercise, cycling, and running), but practiced regularly. For example, it is possible to program 150–300 min per week if the effort is of moderate intensity [7]. Classification of physical activities: light intensity between 25 and 30% VO2 max, moderate intensity between 40 and 50% VO2 max [9]. There are many methods of treatment to reduce the level of sugar in the blood, such as reducing some materials rich in fats and some drugs that work to reduce the level of glucose in the blood, as well as walking briskly, which are considered among the means of treatment, and are easy to implement and do not have side effects such as medicines. Medium-intensity physical activity helps reduce body fat, and with very simple steps, the body can burn approximately 60 calories per 1.2 km compared to burning calories in the normal state of the body, but if the speed increases by 2.8 km in 30 minutes, the body will burn 200 calories [10]. The walking rhythm of LIPOXmax is also used in training when weight loss is necessary for overweight people, to adjust exercise intensity and load in diabetic patients [11]. The LIPOXmaxcorresponds to the intensity of exercise for which the oxidation of lipids is maximal. This metabolic index is determined by calorimetry during a progressive stress test. LIPOXmax can be used as a training target in various pathologies, including obesity and diabetes [12]. A [13] in 2002, under the title: Determining the intensity of exercise that leads to maximum fat oxidation, the aim of this study was to develop a test protocol to determine the intensity of exercise in which the rate of fat oxidation is at. Eighteen moderately trained cyclists performed a graded-fatigue exercise test, with 5-minute phases in 35-watt increments, four to six continuous prolonged (CE) tests performed at constant work rates, corresponding to GE test work rates were applied on separate days. Seven other subjects were given three different GE tests to exhaustion. Lipid oxidation was measured using indirect calorimeters, (indirect calorimetry). It is concluded that a protocol with phases (3 min) per phase and 35 W increments of work rate can be used to determine (maximal) fat oxidation. Fat oxidation rates are high over a wide range of intensity (LIPOXmax). However, with high-intensity (maximum) exercise, fat oxidation rates are significantly reduced [13]. An exercise intensity of 40%, VO2 max is sometimes used to target LIPOXmax training [12]. The body mass index, (IMC) “Indice de Masse Corporelle” formerly called the (Quenelle) index, is a measure of indicating nutritional status in adults, defined as a person’s weight (kg) divided by the square of a person’s height in meters (kg/m²)), and the mathematical equation is as follows:

$$\text{BMI}=\text{weight}\left(\text{kg}\right)/\text{height}{\left(\text{m}\right)}^2$$E1

BMI is based on the effect of excess body fat and is highly associated with obesity. BMI was developed as an indicator of disease risk. With an increase in BMI, some of the common conditions related to overweight and obesity include cardiovascular disease, high blood pressure, and diabetes, etc. [14].

Many studies have dealt with the subject of studying walking and its relationship to health in patients with diabetes and obesity on different samples, including:

A study Mohammed Zerf, in 2019, under the title: Effects of walking training performed using continuous and interval methods on weight loss as effective strategies among postpartum women, to estimate the effect of walking intensity (interval training vs. traditional cardio) on postpartum weight loss. Materials and methods: A total of 39 postpartum women participated in this study. Moderate obese BMI and high-risk waist circumference, first births at the same school and social status. Subjects participated in this study to lose excess weight within three months of giving birth. Results: Our results indicate that interval training with brisk walking is a powerful tool for developing effective weight loss management strategies. Conclusions: That postpartum woman, who use walking to amplify their weight loss, use the following exercise program: at least three sets of 400 m (wf ≈ SR) × 5 per day, nine 400 m (wf ≈ SR) × 5 sets per week, and 36 sets of 400 m (wf ≈ SR) × 5 per month [15].

A study Achten. J, Gleeson. M, Jeukendrup. A.E in 2002, under the title: Determining the intensity of exercise that leads to maximum fat oxidation. The aim of this study was to develop a test protocol to determine the intensity of exercise in which the rate of fat oxidation is at methods: Eighteen moderately trained cyclists performed a graded-fatigue exercise test, with 5-minute phases in 35-watt increments, four to six continuous prolonged (CE) tests performed at constant work rates, and corresponding to GE test work rates were applied on separate days. Seven other subjects were given three different GE tests to exhaustion. Lipid oxidation was measured using indirect calorimeters, (indirect calorimetry). Conclusions: It is concluded that a protocol with phases (3 min) per phase and 35 W increments of work rate can be used to determine (maximal) fat oxidation. Fat oxidation rates are elevated over a wide range of intensity (LIPOXmax). However, with high-intensity (maximum) exercise, fat oxidation rates are significantly reduced [13].

A study Monique Mendelson, Michel Guinot, Anne Favre-Juvin, Bernard Wuyam, and Patrice Flore, in 2014, under the title: Methodological aspects of LIPOXmax measurement: Application conditions for people with metabolic pathologies. Lipoxmax corresponds to the exercise intensity for which lipid oxidation is maximal. This metabolic index is determined by calorimetry during a progressive stress test. Lipoxmax can be used as a training target in various pathologies, including obesity and diabetes. The objective of this review of question is to state the methodological aspects of the measurement of the LIPOXmax by paying a particular attention to the validity of the gaseous exchanges, the particularities of the protocol of determination, and the factors of variability and reliability. Secondly, the interest and feasibility of adapted physical activities targeting LIPOXmax in people with metabolic disorders will be explored [12].

2. Theoretical framework

2.1 The problem statement

Despite the importance of walking for diabetes, we noticed patients resorting to medicines directly, and through the results of previous studies, we need field studies for different societies, to highlight the benefit of walking, to be a scientific addition that can benefit this group of patients, as well as access to Experimental facts regarding this type of adapted program. Therefore, the problem of the study is:

Can walking exercise at (LIPOXmax) point contribute to the effect on body mass index (BMI) in patients with type II diabetes (40–60 years)?

2.2 The significance of the study

The importance of the study was also represented in the fact that individuals do not feel danger to their health except when they pass the danger stage of body weight, but this is not very important if we know that the major problem is the increase in the percentage of fat in our bodies, which appears on the morphology of our bodies after large accumulations, and because of its symptoms Negative effects on the health of the individual, the causes of which are due to laziness, lethargy, lack of physical activity, and malnutrition.

2.3 Study objectives

Among the objectives of the study is to identify the physical activity represented by the activity of walking, which has a physical and psychological health impact, as this activity is suitable for different ages and for both sexes, and it can be performed at any time and in all available spaces, and at a lower cost so that anyone can reap the benefits and fruits of sports. Health through a simple and easy program that ensures moving many parts of his body on a regular basis and for a specific period. Providing a precisely tuned program for practicing physical activities for this group, and adjusting the correct rhythm for each patient, when practicing walking, and this is according to the characteristics of each individual.

3. Methodology

3.1 Exploratory study

The association which monitors diabetics at the level of the wilaya of Laghouat was contacted, in order to tap into the database of patients registered at the level of the municipality of Laghouat. When the study population has been identified (all patients with type II diabetes) for the purpose of determining the study sample, which comprises 10% of the total study population.

Subsequently, we contacted the patients, in order to persuade them to practice physical activity, in particular walking, without specifying or explaining the main objective of this study (in order to exclude psychological effects on the sample of the study).

Since the nature of the subject determines the choice of the method used and based on the subject of our study, we must follow the experimental method.

3.2 Research group and sample

The population studied consisted of all diabetic patients (type II) residing in the municipality of Laghouat. Their number was determined by the social association of the wilaya of Laghouat of diabetics, and they are about 120 patients with type II diabetes, whose age varies between (40–60 years).

The sample members consist of people with diabetes mellitus (type II), as we selected the sample in a simple random way represented by 10% of the population, which included 12 men, whose ages ranged between (40–60 years old).

At the end of the study, the results of the subjects who underwent pre- and post-tests were taken into account, and they did not miss the sessions of the adapted program. Where the researchers applied the program to (20) patients from the study community, but at the end of the program (08) individuals were excluded due to their interruption of the program several times, that is. more than (03) absences whose results are not taken into account in the study. As for the control sample, its presence brings a positive methodological complement, which testifies to the results of the experimental sample, but it was not retained for the following reasons:

The psychological pressures experienced by diabetics and the difficulty in convincing them to participate in this type of study. The comparison of the results of the pretest and the posttest of the experimental sample can give a clear picture of the results of the pilot program and be sufficient for approval.

3.3 Fields of study

This experiment extended for a period of 3 months from 01/01/2019 to 31/03/2019, starting from conducting the pretests up to the posttest.

This study was carried out at the level of the municipal stadium of Laghouat (Abdelkader Ben Hamid).

3.4 Data collection tools

Used devices:

• Tanita Impedancemeter BC-545 N.

It measures body mass index and other measurements.

• Heart rate monitor (cardiofréquencemètre KHALANJI).

• Calculating the walking pace at (LIPOXmax), an exercise intensity of 40%, VO2 max was used to target LIPOXmax training [12].

This experiment extended for a period of 03 months from 01/01/2019 to 31/03/2019, starting from conducting the pretests up to the posttest.

The measures proposed in the study were presented to a group of specialists (from sports training, biomedical aspect of sport, and doctor), and they agreed on the relevance of the measures and the method of their application, as well as how to implement the program proposed for this category in order to achieve the objectives set without exposing the health of the members of the sample to loads that could affect their health.

Test programming: We conducted the pre-measurements one day before applying the program, where the sample members were collected, and how to make the measurements and the application of the program were explained, and the same measurements were applied to all sample members (12 patients), and the sample members were subjected to the same post-measurements one day after the end of the program, that is. after 03 months.

3.5 Program time and content

SeeTable 1.

	Progressive intermediate cycle.
Weeks	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday	Monday
01/01/2019	Mesures anthropométriques
S1	47 mn			47 mn			47 mn
S2	50 mn			50 mn			50 mn
S3	43 mn		43 mn		43 mn		43 mn
S4	48 mn		48 mn		48 mn		48 mn
S5	53 mn		53 mn		53 mn		53 mn
S6	58 mn		58 mn		58 mn		58 mn
S7	58 mn	58 mn		58 mn		58 mn	58 mn
S8	54 mn	54 mn		54 mn	54 mn		54 mn
S9	58 mn	58 mn		58 mn		58 mn	58 mn
S10	58 mn	58 mn		58 mn		58 mn	58 mn
S11	58 mn	58 mn		58 mn		58 mn	58 mn
S12	52 mn	52 mn		52 mn	52 mn	52 mn	52 mn
24/03/2019	Mesures anthropométriques

Table 1.

The time for the suggested walking sessions in terms of weeks.

Source: Authors, 2022.

Program time: The proposed walking training program was applied for a period of (12 weeks), meaning a period of 03 months, from Tuesday 01/01/2019 to Sunday 24/03/2019, between (03 training units per week) and (06 training units per week). This is according to the requirements of the program, as well as the characteristics of the patients. Between 150 and 300 minutes per week of moderate intensity were programmed.

Note: Follow the muscle stretches for (10 minutes) after each walking session.

Statistical tools: In order to verify the hypotheses, the study conducted a statistical study using the SPSS program, through which the obtained data were processed, as it included: the arithmetic mean, the standard deviation, and the T-test.

4. The applied aspect

See Table 2.

Body mass index measurement.
	Experimental sample
	Pretest	Posttest
Number	12	12
Arithmetic mean	24.31	27.00
Standard deviation	1.94	1.82
	Difference between the averages	2.69
	T-value	−22.5
	Significance level	0.00
	Degrees of freedom	22
	Statistical significance	Significant

Table 2.

Significance of differences in measuring body mass index between the pretest and the posttest for the experimental group.

Source: Authors, 2022.

4.1 Analysis and discussion

From the results in Table 2, we note that the arithmetic mean of the pre-measurement scores, the body mass index measurement in the body is (24.31) with a standard deviation of (1.94). The arithmetic mean value of the post-measurement for the same group is (27) with a standard deviation of (1.82) and the value of the difference between the arithmetic mean between the pre- and post-measurements was (2.69), and this indicates that there are differences between the two measurements, and this is justified by the value of the T-test, whose value amounted to (–22.5) at the significance level of (0.00), which is less than the value (0.05), and this result proves that there are statistically significant differences between the scores of the pre-measurement and the scores of the post-measurement of the BMI of the experimental group.

Walking exercise at (LIPOXmax) had a positive effect on the body mass index of patients with type II diabetes (40–60 years), where the results of the statistical analysis showed that there were statistically significant differences between the pre-and post-measurement of the body mass index. This indicates that the decrease in BMI could be due to the content of the walking activity program applied to this sample, which is mainly based on walking exercises at LIPOXmax. This explains the possibility of the LIPOXmax walking program affecting the percentage of fat in the body. And from it, it is the one that affected the body mass index, and this is consistent with the study [10], which shows that regular walking leads to the prevention of obesity in patients with obesity. Diabetes reduces relative weight and improves body mass index levels in the age group 30–50 years. It also agrees with the study of [13], whose results concluded that the rates of fat oxidation rise over a wide range of LIPOXmax intensity, by using a special protocol to control this intensity.

It also agrees with the study [16], which says that physical activity in patients with diabetes (type II) with a diet leads to an improvement in cardiorespiratory fitness and a decrease in body mass index. A study [17] showed that walking in diabetic patients has a positive effect on the health of patients through a decrease in biological blood values, and it also improves flexibility, endurance, heart work, and weight reduction, in addition to a decrease in body mass index.

And from it, we can say that we have answered the study’s question, the practice of walking at the “LIPOXmax” point has a positive effect on the body mass index of patients with type II diabetes (40–60 years).

Through the results of the study, we concluded that brisk walking is the optimal pace to reach the appropriate intensity at the LIPOXmax point for a group (40–60 years old) of diabetic patients who do not practice physical activity. It is the lack of regular physical activity that explains the observed elevation of the heart rate at the slightest movement or physical activity, especially if it is associated with weight gain, which elevates the heart rate at rest compared to people practicing physical activity on a regular basis. Walking at LIPOXmax represents the values of maximum heart rate and resting heart rate, and from this the study sample, based on the movements resulting from brisk walking, which stimulate the body to reach LIPOXmax and thus burning the greatest percentage of body fat. Unlike regular exercisers, who may need a little more effort to reach the fat oxidation peak, that is. the LIPOXmax point.

5. Conclusions

From what we have found, we can say that the application of an adapted program accompanying this group of patients, which focuses on walking at the “LIPOXmax” point, has proven effective in helping diabetics in reducing body fat percentage and thus controlling excess body weight. The study showed that it is enough to practice walking alone without the need for fast running, or high-intensity physical activities, or anaerobic activities, to control the complications resulting from excess body fat in patients with type II diabetes.

From it, it can be said that the first goal that we seek is to promote a healthy lifestyle to combat the effects of type II diabetes and to benefit from the dissemination of sports culture with scientific standards, especially for those with diabetes who have excess weight.