Effects of 8-weeks cinnamon intake with and without high intensity interval training on blood lipids profile in overweight girls of aged-high school

Subject Areas : Exercise Physiology and Performance

Saber  Rezanejad ¹ (Esfahan.Sepahanshar)
Mina  Tarahhomi ² (esfahan)
Akram  khani Rozveh ³ (Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran.)
Mehdi  Kargarfard ⁴ (Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran)

Received: 2023-06-24 Accepted : 2023-08-18 Published : 2023-12-01

Keywords: overweight, Cholesterol, Triglycerides, Cinnamon, High-Density Lipoprotein, Low-Density Lipoprotein, Intense Exercise,

Abstract :

Background: Obesity and overweight are among the most common complications among high school students, which can be associated with cardiovascular diseases. Modifying the lifestyle through sports activities and herbal medicines is one of the solutions to combat this problem. The purpose of this study was to evaluate the effect of an 8-week cinnamon consumption with and without high-intensity interval training on blood lipid profiles in high school-aged overweight girls.Methods: In this semi-experimental study with a pre-test and post-test design, 36 overweight women aged 15-18 years were randomly assigned to one of the 3 groups: intense interval training (n=12), cinnamon supplementation (n=12) and intense interval training+cinnamon (n=12). The intense interval training program was conducted three times a week for 8 weeks in the two intervention groups. Each session, lasting 30-35 minutes, involved high-intensity exercises at 90-95% of peak oxygen consumption. Diet groups received cinnamon supplements at the rate of 6 grams/day for a period of 8 weeks. Body measurements (weight, body mass index) and serum levels of blood fats (cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein) were measured before and after the study. The data were analyzed using the dependent t-test and analysis of covariance at a level less than 0.05.Results: After 8 weeks of intervention, a significant decrease in body weight and body mass index and a significant increase in HDL cholesterol were observed in the intense interval training and intense interval training + cinnamon groups compared to the cinnamon alone group (p≤0.05). However, Bonferroni's follow-up test did not show significant differences in cholesterol, triglyceride and low-density lipoprotein levels between the groups (p≥0.05).Conclusion: High-intensity intermittent exercise with cinnamon consumption can reduce body composition and some blood lipids more effectively than cinnamon supplementation in overweight high school girls.

References:

Ouerghi, N., Fradj, M. K. B., Bezrati, I., Khammassi, M., Feki, M., Kaabachi, N., & Bouassida, A. (2017). Effects of high-intensity interval training on body composition, aerobic and anaerobic performance and plasma lipids in overweight/obese and normal-weight young men. Biology of sport, 34(4), 385-392.
Mousavi, S. M., Karimi, E., Hajishafiee, M., Milajerdi, A., Amini, M. R., & Esmaillzadeh, A. (2020). Anti-hypertensive effects of cinnamon supplementation in adults: A systematic review and dose-response Meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition, 60(18), 3144-3154.
Pulungan, A., & Pane, Y. S. (2020). The benefit of cinnamon (Cinnamomum burmannii) in lowering total cholesterol levels after consumption of high-fat containing foods in white mice (Mus musculus) models. F1000Research, 9.
Alsoodeeri, F. N., Alqabbani, H. M., & Aldossari, N. M. (2020). Effects of cinnamon (Cinnamomum cassia) consumption on serum lipid profiles in albino rats. Journal of lipids.
Zhu, C., Yan, H., Zheng, Y., Santos, H. O., Macit, M. S., & Zhao, K. (2020). Impact of cinnamon supplementation on cardiometabolic biomarkers of inflammation and oxidative stress: a systematic review and meta-analysis of randomized controlled trials. Complementary therapies in medicine, 53, 102517.
Hadipour, E., Shahangian, S. S., Ramazani, E., & Salmasi, Z. (2023). Effect of Cinnamon and its Biologically Active Compounds on the Components and Symptoms of Metabolic Syndrome. Journal of Mazandaran University of Medical Sciences, 33(219), 123-140.
Ainehchi, N., Khaki, A., Farshbaf-Khalili, A., Hammadeh, M., & Ouladsahebmadarek, E. (2019). The effectiveness of herbal mixture supplements with and without clomiphene citrate in comparison to clomiphene citrate on serum antioxidants and glycemic biomarkers in women with polycystic ovary syndrome willing to be pregnant: a randomized clinical trial. Biomolecules, 9(6), 215.
Hadipour, E., Fereidoni, M., Tayarani, Najaran, Z. (2020). Betanin attenuates oxidative stress induced by 6-OHDA in PC12 cells via SAPK/JNK and PI3 K pathways. Neurochem Res. 45(2): 395-403.
Buchan, D. S., Ollis, S., Young, J. D., Cooper, S. M., Shield, J. P., & Baker, J. S. (2013). High intensity interval running enhances measures of physical fitness but not metabolic measures of cardiovascular disease risk in healthy adolescents. BMC public health, 13(1), 1-12.
Racil, G., Ben Ounis, O., Hammouda, O., Kallel, A., Zouhal, H., Chamari, K., & Amri, M. (2013). Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. European journal of applied physiology, 113(10), 2531-2540.
Hadipour, E., Tayarani, Najaran, Z., Fereidoni, M. (2020). Vitamin K2 protects PC12 cells against Aβ (1-42) and H2O2-induced apoptosis via p38 MAP kinase pathway. Nutr Neurosci. 23(5): 343-352.
Wang, J. G., Anderson, R. A., Graham III, G. M., Chu, M. C., Sauer, M. V., Guarnaccia, M. M., & Lobo, R. A. (2007). The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertility and sterility, 88(1), 240-243.
Park, S. Y., Kim, Y. D., Kim, M. S., Kim, K. T., & Kim, J. Y. (2023). Cinnamon (Cinnamomum cassia) water extract improves diarrhea symptoms by changing the gut environment: a randomized controlled trial. Food & Function, 14(3), 1520-1529.
World Health Organization. Obesity and Overweight. (2021). Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 19 May 2022).
Mousavi, S. M., Rahmani, J., Kord-Varkaneh, H., Sheikhi, A., Larijani, B., & Esmaillzadeh, A. (2020). Cinnamon supplementation positively affects obesity: A systematic review and dose-response meta-analysis of randomized controlled trials. Clinical Nutrition, 39(1), 123-133.
Jamali, N., Kazemi, A., Saffari-Chaleshtori, J., Samare-Najaf, M., Mohammadi, V., & Clark, C. C. (2020). The effect of cinnamon supplementation on lipid profiles in patients with type 2 diabetes: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine, 55, 102571.
Camacho, S., et al. (2015). Anti-obesity and anti-hyperglycemic effects of cinnamaldehyde via altered ghrelin secretion and functional impact on food intake and gastric emptying. Scientific reports. 5: p. 7919.
Miyazaki, M., et al. (2012). Increased hepatic expression of dipeptidyl peptidase-4 in non-
alcoholic fatty liver disease and its association with insulin resistance and glucose metabolism. Molecular medicine reports. 5(3): p. 729-733.
Chao, M., et al. (2009). Improving insulin resistance with traditional Chinese medicine in type diabetic patients. Endocrine. 36(2): p. 268-274.
Gurd, B.J., et al. (2010). High-intensity interval training increases SIRT1 activity in human
skeletal muscle. Applied Physiology, Nutrition, and Metabolism. 35(3): p. 350-357.
Rashidlamir A , Alizadeh A, Ebrahimiatri A, Dastani M. (2012). The Effect of Four-Week Period of Aerobic Exercise with Cinnamon Consumption on Lipoprotein Indicates and Blood sugar in Diabetic Female Patients (Type 2). Journal of Shahid Sadoughi University of Medical ciences. Vol. 20, No. 5, Nov- Pages: 605-614.
Biddle, S.J. and A.M. Batterham. (2015). High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head? International Journal of Behavioral Nutrition and Physical Activity. 12(1): p. 95.
Tayarani, Najaran, Z., Hadipour, E., Mousavi, SM., Emami, SA., Mohtashami, L., Javadi, B. (2021). Protective effects of Lavandula stoechas L. methanol extract against 6-OHDA-induced apoptosis in PC12 cells J. Ethnopharmacol. 273: 14023.
Keramati, M., Musazadeh, V., Malekahmadi, M., Jamilian, P., Jamilian, P., Ghoreishi, Z., et al. (2022). Cinnamon, an effective anti-obesity agent:Evidence from an umbrella meta-analysis. J Food Biochem. 46(8): 14166.
Santos, HO., da, Silva, GA. (2018) To what extent does cinnamon administration improve the glycemic and lipid profiles? Clin Nutr ESPEN. 27:1-9.
Dehghan, T., & Abedi, B. (2020). Effect of 12-Week Body Pump with Consumption of Cinnamon and Honey on Resistin, Visfatin and Insulin Resistance in Overweight Children. Iranian Journal of Nutrition Sciences & Food Technology, 15(1), 1-10.
Ainehchi, N., Khaki, A., Farshbaf-Khalili, A., Hammadeh, M., & Ouladsahebmadarek, E. (2019). The effectiveness of herbal mixture supplements with and without clomiphene citrate in comparison to clomiphene citrate on serum antioxidants and glycemic biomarkers in women with polycystic ovary syndrome willing to be pregnant: a randomized clinical trial. Biomolecules, 9(6), 215.
Wu, T., Huang, W., He, M., Yue, R. (2022). Effects of cinnamon supplementation on lipid profiles among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis. Complement Ther Clin Pract. 49: 101625.
Maleki, S., Behpoor, N., & Tadibi, V. (2020). Effect of 8 weeks of resistance training and supplementation of cinnamon on plasma levels of leptin and adiponectin in overweight women. Journal of Practical Studies of Biosciences in Sport, 8(16), 132-142.
Ohnuma, K., R. Hatano, and C. (2015). Morimoto, DPP4 in anti-tumor immunity: going beyond the enzyme. Nature immunology. 16(8): p. 791.
Meissner, E.G., et al. (2015). Dynamic changes of post-translationally modified forms of CXCL10 and soluble DPP4 in HCV subjects receiving interferon-free therapy. PLoS One. 10 (7): p. e0133236.
Malin, S.K., et al. (2013). Lower dipeptidyl peptidase-4 following exercise training plus weight loss is related to increased insulin sensitivity in adults with metabolic syndrome. Peptides. 47: p. 142-147.

Full-Text:



Effects of 8-weeks cinnamon intake with and without high intensity interval training on blood lipids profile in overweight girls of aged-high school

 

Abstract

 

Background and aim: Obesity and overweight is one of the most common complications among high school students, which is also associated with cardiovascular diseases. Modifying the lifestyle through sports activities and herbal medicines is one of the solutions to combat this problem. The purpose of this study was to evaluate the effect of 8 weeks of cinnamon consumption with and without high intensity interval training on blood lipids in overweight girls of aged-high school.

Materials and Methods: In this semi-experimental study with a pre-test and post-test design, 36 overweight women aged 15-18 years were randomly assigned into 3 groups: intense interval training (n=12), cinnamon (n=12) and intense interval training+cinnamon (n=12). An intense interval training program was performed in two intervention groups with equal volume, three times a week with an intensity of 90-95% of peak oxygen consumption, 30-35 minutes per session for 8 weeks. Diet groups received cinnamon supplement at the rate of 6 grams/day for a period of 8 weeks. Body measurements (weight, body mass index) and serum of blood fats levels (cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein) were measured before and after the study. The data were analyzed using the dependent t-test and analysis of covariance at a level less than 0.05.

Results: After 8 weeks of intervention, a significant decrease in body weight and body mass index and a significant increase in HDL cholesterol were observed in the intense interval training and intense interval training + cinnamon groups compared to the cinnamon alone group (p≤0.05). However, Bonferroni's follow-up test did not show significant differences in cholesterol, triglyceride and low-density lipoprotein levels between groups (p≥0.05).

Conclusion: High-intensity intermittent exercise with cinnamon consumption can reduce body composition and some blood lipids more effectively than cinnamon supplementation in overweight high school girls.

Keywords: Cholesterol, Triglycerides, High-Density Lipoprotein, Low-Density Lipoprotein, Cinnamon, Intense Exercise, Overweight

 

 

 

 

 

Introduction

Obesity is a chronic malady that its contagion rate in children, teenagers and adults is enhancing and is considered a global epidemic. Obesity has become a main global health problem and is associated with main chronic diseases such as cancer, cardiovascular diseases, and diabetes. Also, because of body shape problems, it has a negative effect on people's self-confidence, that can eventually lead to severe depression and mental health problems (1,2). Because conventional treatments similar to limited diet and lifestyle changes have not been very effective (2), people are looking for new, easier and more successful methods such as supplementing with herbal medicines to reach their ideal body (3,4).Cinnamon is a flavoring additive that is used to improve the smell, taste and color of food for a long time. The main components found in cinnamon are cinnamic acid, cinnamaldehyde, eugenol and coumarin. It has been reported that these components have antimicrobial properties (3,4).

 Cinnamon is also rich in antioxidants such as polyphenols and glutathione. Therefore, it can be considered as a strong anti-inflammatory agent and may protect against cancer 3,4) Cinnamon can reduce the risk of heart diseases by reducing LDL cholesterol and increasing HDL cholesterol (5,6). New studies emphasize the importance of cinnamon as a spice that may be a natural treatment for serious diseases such as type 2 diabetes, chronic digestive problems, cardiovascular diseases and even cancer and Alzheimer's. Using of cinnamon is effective on lipid profile in improving overweight and fat people. Cinnamon causes a significant decrease in insulin resistance, fasting blood sugar, total cholesterol, triglycerides, liver enzymes and the inflammatory factor CRP-hs. Also, cinnamon sap can reduce glucose, insulin and cholesterol levels in people with high serum glucose (7).

On the other hand, obesity caused by an increase in the number of fat cells (hyperplasia), which usually occurs in early childhood or middle childhood, is seen in people with a body mass index higher than 40 kg/m2. Therefore, obesity caused by changes in body mass because of lack of movement and inappropriate diet is one of the growing problems of today's generation, especially during adolescence, so that this challenge is in the process of becoming a global crisis. Available treatments for obesity and overweight include lifestyle changes, exercise, nutrition, oral medications, and surgery. Traditional treatment with the use of some plants or plant sap is known all over the world. Sports activity is a non-pharmacological intervention available to the general public, which may play a central role in the treatment of overweight and obese children and teenagers (8).

 Lack of proper physical activity and bad diet are the main reasons for obesity in developed countries. Sports activity, especially high-intensity interval training, is a non-drug intervention available to the general public, which can play a pivotal role in treating overweight and obese people. In addition, high-intensity interval training (HIIT) is a type of exercise that consists of 30 seconds of sprinting separated by recovery intervals (9). A set of evidence has shown comparable or superior improvements in cardiorespiratory fitness using HIIT compared to moderate endurance exercise (9,10). Based on this, it was suggested that HIIT is a useful alternative to traditional endurance-based exercise recommendations to promote health. The use of HIIT interventions is often considered impractical and intolerable by middle-aged and elderly individuals. However, young people, especially those who are overweight, have difficulty in performing long-term endurance-based activities and may not have much interest (1). Various sports interventions, including high-intensity interval training (HIIT) which is defined between short periods of high-intensity interval training and periods of active rest have shown positive effectiveness in populations with specific clinical conditions (11) in such a way that it reduces the risk of cardiovascular diseases and metabolic indicators in them (12), therefore, it shows the possible use of HIIT training in obese people. In addition to exercise therapy, the use of herbal medicines, especially cinnamon, because of its strong antioxidant and anti-inflammatory properties, can decrease the risk of cardiovascular diseases by reducing LDL cholesterol and increasing HDL cholesterol (5,6).

 However, studies on the anti-obesity properties of cinnamon are controversial and contradictory. Several clinical trials have shown that the using of cinnamon has beneficial effects on body composition indices (13). On the other hand, others did not support such a finding. As far as we know, no study has investigated the findings of this topic. Considering the health benefits of HIIT in comparison with various sports activities in the treatment of obesity, as well as cinnamon supplementation in controlling the risk factors of cardiovascular diseases and the lack of a combined intervention (for example, HIIT + cinnamon) and questions related to their combined effects in controlling obesity (14,15) as well as lifestyle modifications as the first line of treatment for fat and overweight communities, this study helps to close the gap in the literature regarding the synergistic effects of HIIT and cinnamon on fat profile and body composition in overweight  high school age girls helps health professionals. In addition, the findings of this study support the optimization of sports activity prescription along with drug therapy for this population.

Obesity and overweight is one of the most common complications among high school students, which is also associated with cardiovascular diseases. Modifying the lifestyle through sports activities and herbal medicines is one of the solutions to combat this problem. The purpose of this study was to evaluate the effect of 8 weeks of cinnamon consumption with and without high intensity interval training on blood lipids of high school girls. Therefore, the present study was conducted as a comprehensive and controlled experimental study to evaluate the effects of cinnamon supplementation on body weight, body mass index, and cardiovascular risk factors in overweight female high school students. In this research, the researcher aims to compare the effects of high-intensity interval training with and without cinnamon supplementation on cardiovascular risk factors including total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in overweight high school girls do exercises.

Material and methods

The current research is semi-experimental, practical and cross-sectional, which was studied using a pre-test and post-test design in the population of overweight high school girls. For this goal, 36 overweight students were voluntarily selected and then randomly placed in three groups: HIIT training (12 people), HIIT training + cinnamon (12 people) and cinnamon (12 people). After explaining to all the participants about the objectives, method and implementation of the research, obtaining the permission to enter the study and completing the consent form, body measurement characteristics such as height, weight, body mass index and also the studied variables such as TC, TG, LDL, HDL were measured as a pre-test. Then, for 8 weeks under HIIT training and consuming cinnamon supplement three times a week they received after each meal in the amount of 1.5 grams filled inside 500 mg capsules along with the main meals for 8 weeks. At the end of the study, all dependent variables were measured as a post-test.

The inclusion criteria in this study included female gender, age range of 15 to 18 years, having a body mass index between 25 and 29.99 kg/m2, not having an allergy to cinnamon supplements, and the exclusion criteria included these items that in Absence of 3 training sessions in a row and 5 sessions alternately or having acute diseases such as cardiovascular diseases, uncontrollable high blood pressure, arthritis, respiratory diseases, kidney diseases, covid-19, acute orthopedic problems and joint pains. Having hormonal disorders, being absent in each of the different stages of variable measurement, participating in regular exercise programs and also using any dietary supplements were excluded from the study.

The intended training protocol included 3 sessions per week for 35 minutes (15 minutes warming and numbing, 4 repetitions of 4 minutes of HIIT training and 1 minute of rest after each 4-minute period) for 8 weeks. 4-minute periods (consisting of 20 seconds of activity with an intensity of 90%-95% HRmax and 10 seconds of rest) and subsequently, 1 minute of active rest with 70% HR max after each 4-minute period were considered (16). The heart rate of the subjects was evaluated in all the training sessions using Polar heart rate monitor made in Finland to apply the principle of overload and the rate of progress during the intervention period.

Examples of movements during 35 minutes of training

Place of practice	time (minutes)	Activity: rest (seconds)	Active rest (end of each session with 70% heart rate, minutes)
1	4	10:20	1
2	4	10:20	1
3	4	10:20	1
4	4	10:20	1

Note 1: 1 minute of active rest is considered after every 4-minute activity.

Note 2: The warm-up and cool-down period was about 15 minutes before the start of HIIT training and

             at the end of the training session.

 

In this research, the height of all students was measured using a SEGA model height meter and their weight was measured with an Omron digital scale. BMI of the participants was calculated using the formula: dividing the weight of people in kilograms by height in square meters. In this study, all students were under nutritional counseling under expert supervision. All the participants were requested to visit the laboratory at 8:00 AM to evaluate the blood variables in fasting conditions. Then, 5 cc of blood was taken from the brachial vein of the left hand from each participant while sitting. The amount of high-density lipoprotein with the enzymatic method (selective solvent) and using the Byrex Fars kit with a sensitivity of 1 mg/dL, the low-density lipoprotein directly by the selective solvent method and using the Byrex Fars kit, the amount of triglyceride with Enzymic calorimetry method was used using the Byrex Fars kit and the sensitivity level was 3 mg/dL, and the cholesterol level was measured using the enzymatic-calorimetry method using the Byrex Fars kit and the sensitivity level was 74.7 mg/dL. All blood sampling procedures were performed at the beginning of the study and 48 hours after the last training session in the eighth week by the laboratory technician. After the blood collection was completed, the blood samples were poured into tubes containing EDTA. To separate the blood plasma, the samples were centrifuged for 15 minutes at a speed of 3000 revolutions per minute and at a temperature of 4°C. Also, plasma was kept in a freezer at -70°C until analysis.

The controllable limitations in this research included the fact that in terms of gender, all the subjects were obese girls of high school age, the age range of the subjects was 15 to 18 years, and all the subjects were physically healthy. But the uncontrollable limitations in this research included the subjects' motivation, the subjects' genetic status, the subjects' daily diet, the subjects' drugs, the subjects' mental and psychological factors, the subjects' sleep and rest.

Statistical Analysis

 After collecting and refining the raw data, descriptive statistics such as mean and standard deviation and inferential statistics were used. In the inferential statistics section, according to the level of data measurement, the Shapiro-Wilks test was used to determine the normal distribution of the data, the dependent t-test was used to compare the changes between the averages of each group before and after the study, and the analysis of covariance test was used for the comparison between groups. If the difference between groups was significant, Bonferroni's post hoc test will be used for paired comparison. In this research, SPSS version 23 statistical software was used for data analysis at a significance level of p≤0.05. 

Result

The results of the research showed that there is no significant difference between the average of the investigated variables in all three groups. In other words, the data of all three groups are homogeneous before the study. The physical and physiological characteristics of the studied groups were compared before and after the study, as shown in Tables 1-3.

Table1.The results of the paired t-test to compare the averages before and after in the cinnamon group

Variable	levels	Mean standard diviation	Number	The value of T	Digree the freedom	Significance level
Weight(kg)	Before	56.88 7.48	12	-1.95	11	0.07
	After	57.62 8.08	12
BMI (kg/m2)	Before	31.08 5.31	12	-1.98	11	0.07
	After	31.48 5.54	12
Cholesterol(mg/dl)	Before	182.33 36.44	12	-0.45	11	0.65
	After	182.75 42.39	12
Triglyceride(mg/dl)	Before	132.92 47.30	12	0.41	11	0.68
	After	127.42 49.73	12
High-density lipoporotein(mg/dl)	Before	36.67 5.42	12	-1.15	11	0.27
	After	37.83 25.97	12
Low density lipoporetein(mg/dl)	Before	111.17 25.97	12	-0.69	11	0.50
	After	115.33 24.01	12

 

As the results of Table 1 show, there is no significant difference between the mean of all the studied variables before and after consuming cinnamon.

Table2. The results of the paired t-test to compare the averages before and after in the cinnamon and HIIT group

Variable	levels	Mean standard diviation	Number	The value of T	Digree the freedom	Significance level
Weight(kg)	Before	62.60 + 7.93	13	4.05	12	0.002
	After	60.69 + 8.46	13
BMI (kg/m2)	Before	27.32 + 1.65	13	4.01	12	0.002
	After	26.47 + 2.03	13
Cholesterol(mg/dl)	Before	168.15 + 31.03	13	2.60	12	0.02
	After	157.46 + 27.60	13
Triglyceride(mg/dl)	Before	141.07 + 31.57	13	2.82	12	0.02
	After	118.77 + 38.84	13
High-density lipoporotein(mg/dl)	Before	36.38 + 5.01	13	-6.25	12	0.000
	After	42.69 + 5.51	13
Low density lipoporetein(mg/dl)	Before	103.85 + 25.79	13	2.92	12	0.01
	After	94.69 + 27.08	13

 

The results of Table 2 show that there is a significant difference between the mean of all the studied variables before and after the combination of cinnamon consumption and HIIT (p<0.05).

 

Table3.The results of the paired t-test to compare the averages before and after in the HIITgroup

Variable	levels	Mean standard diviation	Number	The value of T	Digree the freedom	Significance level
Weight(kg)	Before	60.61 + 6.75	12	2.43	11	0.03
	After	59.87 + 6.26	12
BMI (kg/m2)	Before	29.46 + 5.44	12	2.42	11	0.03
	After	29.08 + 5.11	12
Cholesterol(mg/dl)	Before	182.50 + 32.27	12	0.03	11	0.98
	After	182.25 + 47.33	12
Triglyceride(mg/dl)	Before	152.92 + 24.99	12	1.42	11	0.18
	After	143.75 + 30.50	12
High-density lipoporotein(mg/dl)	Before	37.00 + 4.28	12	-2.32	11	0.04
	After	39.92 + 3.89	12
Low density lipoporetein(mg/dl)	Before	120.00 + 44.00	12	0.89	11	0.39
	After	112.92 + 31.13	12

 

According to the findings in Table 3, there is a significant difference between the mean of only weight variables, body mass index and high-density lipoprotein before and after HIIT alone (p<0.05).

In the following, using the statistical method of analysis of covariance and in case of significance, using Bonferroni's follow-up test to compare the investigated groups in the studied variables. According to the results of Table 4, it can be observed that there is a significant difference between the studied groups (cinnamon consumption alone, cinnamon + HIIT consumption, HIIT alone) in the variable of weight with pre-test control. Therefore, the effectiveness of cinnamon consumption with and without HIIT on the weight of overweight subjects is confirmed.

Table 4.The results of covariance analysis to compare the wight between the post-intervention three group

Source	Sum of squares type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	2005.49	3	668.49	338.02	0.000
Cut off place	1.63	1	1.63	0.82	0.37
Pre-test weight (kg)	1943.39	1	1943.39	982.65	0.000
Group	42.88	2	21.44	10.84	0.000
Error	65.26	33	1.98
Whole	132750.79	37
The whole was corrected	2070.76	36

 

To evaluate, the significant difference between pairs of groups was determined by Bonferroni's follow-up test, the results of which are reported in Table 5. According to the results of the Bonferroni follow-up test in Table 5, there is a significant difference between the cinnamon+HIIT and HIIT alone groups in comparison with the cinnamon alone group in the weight variable. In other words, based on the data obtained in this research, it can be seen that the significant reduction in the subjects' weight was only due to HIIT training alone.

Table 5.The results of the pairwise comparison of weight variable between groups using Bonferroni test

Group(I)	Group(J)	Average difference(I-J)	Meaningful
Cinnamon and HIIT	cinnamon	-2.76	0.000
	HIIT	-1.20	0.12
HIIT	cinnamon	-1.55	0.04
	HIIT and cinnamon	1.20	0.12

 

As the results of Table 6 show, the difference between groups in the variable of body mass index is significant. Therefore, the effectiveness of cinnamon consumption with and without HIIT on the body mass index of high school girls is confirmed.

Table 6.The results of covariance analysis to compare body mass index between three groups after the intervention

Source	Sum of squares type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	815.74	3	271.91	575.05	0.000
Cut off place	0.00	1	0.00	0.000	0.96
Pre-test body mass index	658.55	1	658.55	1392.69	0.000
Group	9.17	2	4.59	9.69	0.000
Error	15.60	33	0.47
Whole	31830.14	37
The whole was corrected	831.35	37

 

Bonferroni's follow-up test (Table 7) was used to check which significant difference exists between which pair of groups. According to the results of Bonferroni's follow-up test in Table 7, there is a significant difference between cinnamon +HIIT groups and also HIIT alone in comparison with the cinnamon group alone exists in the variable of body mass index. In other words, based on the data obtained in this research, it can be seen that the significant reduction in the subjects' body mass index was only due to HIIT training alone.

Table7.Bonferroni results for the body mass index variable between group

Group(I)	Group(J)	Average difference(I-J)	Deviation error	Meaningful
Cinnamon and HIIT	Cinnamon	-1.28	0.29	0.000
	HIIT	-0.48	0.28	0.29

 

According to the results of Table 8, it is observed that there is no significant difference between different groups (cinnamon consumption alone, cinnamon consumption + HIIT, HIIT alone) in the cholesterol variable with pre-test control. Therefore, the lack of effect of cinnamon consumption with and without HIIT on cholesterol in overweight girls is confirmed.

Table 8. The result of covariance analysis to compare cholesterol between the three groups after the intervention

Source	Sum of squares  type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	38998.48	3	12999.49	20.85	0.000
Cut off place	89.33	1	89.33	0.14	0.70
Pre-test cholesterol (mg/dl)	32986.11	1	32986.11	52.91	0.00
Group	1482.11	2	741.05	1.19	0.32
Error	20571.11	33	623.38
Whole	1188499.00	37
The whole was corrected	59570.11	36

 

 

According to the results of Table 9, it can be observed that there is no significant difference between different groups (cinnamon consumption alone, cinnamon consumption together with aerobic exercise, aerobic exercise alone) in the triglyceride variable with pre-test control. Therefore, the lack of effect of 8 weeks of high intensity training in combination with cinnamon supplement on triglycerides of overweight girls is confirmed.

 

Table 9.The result of covariance analysis to compare triglyceride between the three groups after the intervention

Source	Sum of squares type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	24933.82	3	8311.27	7.93	0.000
Cut off place	1968.99	1	1968.99	1.88	0.18
Pre-test triglyceride (mg/dl)	20949.18	1	20949.99	19.98	0.38
Group	2065.11	2	1032.55	0.98
Error	34592.29	33	1048.25
Whole	681710.00	37
The whole was corrected	59526.11	36

 

 

According to the results of table 10, the difference between groups is significant. Therefore, the lack of effect of cinnamon consumption with and without aerobic exercise on HDL of overweight girls is rejected and we conclude with 95% confidence that cinnamon consumption along with HIIT has an effect on HDL of overweight girls.

Table 10.The result of covariance analysis to compare HDL between the three groups after the intervention

Source	Sum of squares type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	549.14	3	183.04	14.14	0.000
Cut off place	128.81	1	128.81	9.95	0.000
Pre-test High-density lipoprotein (mg/dl)	400.22	1	400.22	30.92	0.000
Group	164.20	2	82.10	6.34	0.000
Error	427.13	33	12.94
Whole	60818.00	37
The whole was corrected	976.27	36

 

Bonferroni's follow-up test was used to check that this significant difference exists between which pairs of groups, the results of which are reported in Table 11. According to the results of the Bonferroni follow-up test in Table 11, there is a significant difference between the cinnamon and HIIT groups in comparison with the cinnamon group in the HDL variable. In other words, based on the data obtained in this research, it can be seen that the combination of cinnamon and HIIT was able to affect the subjects' HDL levels.

Table 11.The results of the pairwise comparison of HDL variable between groups using Bonferroni test

Group(I)	Group(J)	Average difference(I-J)	Meaningful
Cinnamon and HIIT	cinnamon	0.05	0.000
	HIIT	3.20	0.10
HIIT	cinnamon	1.85	0.65
	HIIT and cinnamon	-3.20	0.10

 

According to the results of Table 12, it can be observed that there is no significant difference between the group of consuming cinnamon alone and consuming cinnamon together with HIIT in LDL variable with pre-test control. Therefore, the lack of effect of cinnamon consumption with and without aerobic exercise on LDL of overweight girls is accepted and we conclude that cinnamon consumption along with HIIT does not affect LDL of overweight girls.

Table 12. The result of covariance analysis to compare LDL between the three groups after the intervention

Source	Sum of squares type third	Degrees of freedom	Mean square	F	Meaningful
Modified model	18847.53	3	6282.51	20.37	0.000
Cut off place	3297.89	1	3297.89	10.69	0.000
Pre-test low-density lipoprotein(mg/dl)	15628.15	1	15628.15	50.67	0.000
Group	1556.53	2	778.26	2.52	0.09
Error	10178.20	33	308.43
Whole	454996.00	37
The whole was corrected	29025.73	36

 

Discussion

This study was conducted with the aim of evaluating the effects of 8 weeks of intermittent exercise combined with cinnamon supplementation on cardiovascular risk factors in overweight high school girls. The main findings of this study showed significant improvements in weight index, body mass index and HDL and no significant change in TC, TG, LDL indices after 8 weeks of HIIT training and cinnamon consumption in overweight high school girls. The findings of the current research indicated the effectiveness of HIIT training independent of cinnamon supplementation on weight loss and body mass index in overweight high school girls and the lack of effectiveness of cinnamon alone on both indices. This result with the results of were inconsistent (17).

Some researchers showed that  the consumption of cinnamon extract dissolved in water at the rate of  500 mg per day has an effect on improving body composition in pre-diabetic men and women. Also some researchers showed that cinnamon supplementation can significantly affect obesity caused by hyperinsulinemia. In this regard, another research also suggested that cinnamon oral supplement be used for weight control in patients with type 2 diabetes along with conventional treatments. Among the reasons for the discrepancy between this finding and the results of the current research, we can mention the difference in the studied samples, the type of training program, and on the other hand, the consumption dose of cinnamon. But the combination of cinnamon consumption with aerobic exercise had a significant effect on the weight of overweight people, and aerobic exercise alone had a significant effect on the weight of overweight people. This means that there is a significant difference between the weight before and after consuming cinnamon along with aerobic activity and aerobic activity alone (17,18). 

In addition, these results are in agreement with the findings of a study, who concluded that a 12-week program of regular aerobic exercise with moderate intensity can play an important role in controlling the weight of obese people, and also with the findings of Some studies, who stated that performing aerobic exercises caused a significant decrease in body mass index, body weight, waist-to-hip circumference ratio and a significant increase in maximum oxygen consumption, Some studies, who stated that performing intense intermittent exercises with  necessary precautions for overweight children. In the comparison between the three groups of cinnamon consumption alone, the combination of cinnamon consumption with HIIT and HIIT alone, it was observed that there is a significant difference between the cinnamon alone group and the cinnamon groups combined with HIIT exercise and also the HIIT exercise group in the weight variable. While this difference between cinnamon groups with HIIT training and aerobic training alone is not significant (19,20).

Among the effective adaptations following aerobic activities is the increase in the volume of mitochondria followed by the activity of lipolysis enzymes, which increases the capacity of fat catabolism during exercise. The evidence indicates that when performing physical activities, the amount of catecholamine hormones and growth hormone increases, and these hormones increase the amount of lipolysis. In addition, during sports activity, the secretion of 17-beta estradiol increases in women, which increases the use of fat reserves as an energy source during physical activity (21). An increase in the amount of lipolysis followed by an increase in the consumption of fatty acids for the purpose of metabolism and muscle energy production causes a decrease in the triglyceride reserves of stored fat tissue and subsequently weight loss (22).

On the other hand, cinnamon extract activates glycogen synthase enzyme, increases glucose absorption and inhibits glycogen synthase kinase 3-β (23). Cinnamon extract also activates insulin receptor kinase and prevents insulin receptor dephosphorylation, which leads to maximum insulin receptor phosphorylation (24). All these effects lead to an increase in insulin sensitivity. Also, cinnamon sap acts as a strong antioxidant, which leads to the health benefits of this substance (25).

Maintaining a low level of serum lipids, even when people did not consume cinnamon for 20 days, indicates the lasting effects of cinnamon, which shows that cinnamon does not need to be consumed daily. Since cinnamon does not contribute to calorie intake, those who are obese or have high levels of triglycerides, LDL cholesterol, or total cholesterol may benefit from regularly including cinnamon in their daily diet. In addition, cinnamon may be useful for the rest of the society to prevent and control the increase in blood lipid levels. 

The present study showed that cinnamon alone did not affect the cholesterol of overweight teenagers, which was consistent with the findings of Some studies (26,27). The results of the present research are contrary to the research of Some studies (28), who observed a decrease in cholesterol in people with type 2 diabetes in groups with different doses of cinnamon.In Some studies, cinnamon had a lowering effect on cholesterol in the studied mice. Among the reasons for the discrepancy, we can mention the difference in the statistical samples (people with type 2 diabetes, mice, patients with fatty liver), the use of different doses of cinnamon, the way of consuming cinnamon (20). The consumption of cinnamon with aerobic exercise showed a decrease in cholesterol, which is consistent with the Some research. (21), who found that in the comparison between the studied groups, the amount of cholesterol decreased in the cinnamon consumption group with aerobic exercise compared to the aerobic exercise group.

In addition, according to the results of the present research, cinnamon consumption alone did not have a significant effect on the triglycerides of overweight adolescents, which is in line with the findings Some studies (26), who found that after 12 weeks of cinnamon consumption in people with type 2 diabetes, there was no significant difference in triglycerides between the placebo and cinnamon consumption groups. Consistent with and contrary to the some research (28), who observed a decrease in triglycerides of people with type 2 diabetes in groups with different doses of cinnamon (29), Some studies who found that cinnamon sap reduces the number of triglycerides in an animal model with type 2 diabetes (20).  Some other studies who showed that the consumption of cinnamon causes a significant decrease in triglycerides in patients with non-alcoholic fatty liver disease. The reason for the discrepancy is the difference in the consumed doses and statistical samples.

The results of the test showed that with eight weeks of aerobic exercise on obese teenage girls, triglycerides in the experimental group decreased significantly. We found that consumption of cinnamon with aerobic exercise showed a decrease in triglyceride levels. The researchers say that the main mechanism of reducing the plasma concentration of triglyceride, total cholesterol and low-density lipoprotein after exercise is the increase of the lipoprotein lipase enzyme and the decrease of the hepatic liver triglyceride lipase enzyme. Lipoprotein lipase enzyme is one of the most essential enzymes in the process of regulating the metabolism of triglycerides and lipoproteins, which are often found in fat tissue and skeletal muscle. By performing aerobic activity due to the increase in muscle activity and then due to the increase in the demand for free fatty acids as a substrate for energy production and also the replacement of triglyceride and phospholipid reserves instead of glycogen reserves for energy production, an increase in the activity of the lipoprotein lipase enzyme occurs. As a result of this operation, cholesterol removal increases, followed by a decrease in triglycerides and total cholesterol, and low-density lipoprotein, which is the main factor in cholesterol transport, becomes denser and larger, and its plasma level will decrease (22).

The results of the present study showed that cinnamon alone had no effect on high-density lipoprotein in overweight adolescents. This result is consistent with the findings of Some studies (28), who found that the consumption of different doses of cinnamon in people with type 2 diabetes had no effect on high-density lipoprotein, Some other studies who found that after 12 weeks of cinnamon consumption in people with type 2 diabetes (26), there was no significant difference in high-density lipoprotein between the placebo and cinnamon consumption groups, contrary to the findings of Kim et al.'s research (29), who found that cinnamon extract increases high-density lipoprotein in an animal model with type 2 diabetes. The reason for the discrepancy can be the use of animal samples. On the other hand, aerobic exercise alone was effective in increasing high-density lipoprotein, which is consistent with the research of Kozechian et al(30), who found that 12 weeks of aerobic training showed significant changes in high-density lipoprotein in adolescents from the sixth week onwards, and Contrary to Asad's research (31), which showed that eight weeks of regular exercise does not cause significant changes in high-density lipoprotein in obese men, Haqiqi et al (32), which showed no change in high-density lipoprotein between the two control and experimental groups, Also, consumption of cinnamon with aerobic exercise showed a significant change in high-density lipoprotein, which is consistent with the results of the research of Rashidelmir et al (21), who found that 4 weeks of aerobic exercise with cinnamon consumption increases the amount of high-density lipoprotein.

Based on the results obtained in the current research, the consumption of cinnamon alone did not affect the low-density lipoprotein of overweight people, which is in line with the findings of Dondra (26), who found that after 12 weeks of cinnamon consumption in people with type 2 diabetes was no significant difference in low-density lipoprotein between the placebo and cinnamon consumption groups, Chen et al (27), who found that cinnamon extract had no effect on low-density lipoprotein in the low- and high-dose cinnamon groups. Consistent with and contrary to the research of Khan et al (28), who observed a decrease in low-density lipoprotein in people with type 2 diabetes in groups with different doses of cinnamon. On the other hand, aerobic exercise alone was not effective in reducing low-density lipoprotein, which is consistent with the research of Haqiqi et al. (32), which showed no change in low-density lipoprotein between the two control and experimental groups. Kazemi et al (20), which found insignificant changes in low-density lipoprotein levels and contrary to Asad's research (32), which showed that eight weeks of regular exercise causes a significant decrease in low-density lipoprotein in obese men. Abid Natanzi et al (22), the results of the intra-group test showed that with eight weeks of aerobic training, the amount of low-density lipoprotein in the experimental group decreased significantly, but the consumption of cinnamon with aerobic exercise showed a significant change in low-density lipoprotein that is consistent with the results of Rashidelmir et al.'s research (21), who found that 4 weeks of aerobic exercise combined with cinnamon consumption reduces the amount of low-density lipoprotein. 

Although the results of the present study do not support the effect of decreasing blood lipids because of using of cinnamon in overweight and fat participants, the significant reduction of blood lipid response after using cinnamon along with HIIT in overweight and fat participants that supports the previously observed items. Therefore, it is vital to conduct additional clinical trials with a combined acute and chronic design to understand whether the acute effect of cinnamon after eating can predict its health consequences after long-term consumption, and the findings of this research also showed that HIIT along with using cinnamon probably causes a significant reduction in the risk indicators of cardiovascular diseases in overweight high- school girls.

Considering that the simultaneous use of cinnamon along with HIIT was effective on the body composition indices of obese people, therefore it is suggested to use herbal medicines and especially cinnamon to control body weight in addition to daily sports activities. Also, considering that the simultaneous use of cinnamon along with HIIT was effective on blood fats including cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein of obese people, therefore it is suggested to people with high blood fat that the combination of these two for Reduce your fat use. It is suggested that the results of this research be made available to weight loss centers, health centers and health centers.

It is suggested to conduct a similar research with strict control of subjects' nutrition. A similar study should be conducted with a higher dose of cinnamon. A similar research should be conducted with different subjects with this research, or different age groups, or a sample with a different body mass index. In other researches, besides cinnamon, other sports exercises should be used and its results should be compared with the present research. A similar research should be done with different exercise intensities and precise control of variables. A high-intensity research should be conducted in one session on the level of research variables and its results compared with this research to determine the acute effect of exercise.

Conclusion

The main limitation of this pilot study is the small sample size. Future studies should have larger subjects with uniform characteristics such as age, physical fitness for overweight/obese students. The second limitation is to reduce the bias in the research findings. Although the results of the present study do not support the blood lipid lowering effect of cinnamon in overweight/obese participants, the significant reduction in blood lipid response after cinnamon consumption combined with HIIT in overweight/obese participants is supports the previously observed. Therefore, it is important to conduct additional clinical trials with a combined acute and chronic design to understand whether the acute postprandial effect of cinnamon can predict its health outcomes after long-term consumption.

At the end of this study, it is concluded that after eight weeks of intervention, a significant decrease in weight and body mass index of the HIIT group with cinnamon was observed compared to the cinnamon alone group. Also, the HIIT and cinnamon group had a significant reduction in blood fats such as; Cholesterol, triglyceride, low-density lipoprotein and a significant increase in high-density lipoprotein after the intervention. The findings of the research showed that HIIT along with the consumption of cinnamon probably causes a significant reduction in the risk indicators of cardiovascular diseases in overweight high school girls.

Competing interests

There is no competing of interest to disclose. 

Acknowledgments

We appreciate the assistance of all those who helped the researchers at various stages of the research, especially the subjects, Dr. Baradaran's laboratory, and the Department of Education of the 3rd district of Isfahan.

References

1.       Ouerghi, N., Fradj, M. K. B., Bezrati, I., Khammassi, M., Feki, M., Kaabachi, N., & Bouassida, A. (2017). Effects of high-intensity interval training on body composition, aerobic and anaerobic performance and plasma lipids in overweight/obese and normal-weight young men. Biology of sport, 34(4), 385-392.

2.       Mousavi, S. M., Karimi, E., Hajishafiee, M., Milajerdi, A., Amini, M. R., & Esmaillzadeh, A. (2020). Anti-hypertensive effects of cinnamon supplementation in adults: A systematic review and dose-response Meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition, 60(18), 3144-3154.

3.       Pulungan, A., & Pane, Y. S. (2020). The benefit of cinnamon (Cinnamomum burmannii) in lowering total cholesterol levels after consumption of high-fat containing foods in white mice (Mus musculus) models. F1000Research, 9.

4.       Alsoodeeri, F. N., Alqabbani, H. M., & Aldossari, N. M. (2020). Effects of cinnamon (Cinnamomum cassia) consumption on serum lipid profiles in albino rats. Journal of lipids.

5.       Zhu, C., Yan, H., Zheng, Y., Santos, H. O., Macit, M. S., & Zhao, K. (2020). Impact of cinnamon supplementation on cardiometabolic biomarkers of inflammation and oxidative stress: a systematic review and meta-analysis of randomized controlled trials. Complementary therapies in medicine, 53, 102517.

6.       Hadipour, E., Shahangian, S. S., Ramazani, E., & Salmasi, Z. (2023). Effect of Cinnamon and its Biologically Active Compounds on the Components and Symptoms of Metabolic Syndrome. Journal of Mazandaran University of Medical Sciences, 33(219), 123-140.

7.       Ainehchi, N., Khaki, A., Farshbaf-Khalili, A., Hammadeh, M., & Ouladsahebmadarek, E. (2019). The effectiveness of herbal mixture supplements with and without clomiphene citrate in comparison to clomiphene citrate on serum antioxidants and glycemic biomarkers in women with polycystic ovary syndrome willing to be pregnant: a randomized clinical trial. Biomolecules, 9(6), 215.

8.       Hadipour, E., Fereidoni, M., Tayarani, Najaran, Z. (2020). Betanin attenuates oxidative stress induced by 6-OHDA in PC12 cells via SAPK/JNK and PI3 K pathways. Neurochem Res. 45(2): 395-403.

9.       Buchan, D. S., Ollis, S., Young, J. D., Cooper, S. M., Shield, J. P., & Baker, J. S. (2013). High intensity interval running enhances measures of physical fitness but not metabolic measures of cardiovascular disease risk in healthy adolescents. BMC public health, 13(1), 1-12.

10.       Racil, G., Ben Ounis, O., Hammouda, O., Kallel, A., Zouhal, H., Chamari, K., & Amri, M. (2013). Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. European journal of applied physiology, 113(10), 2531-2540.

11.       Hadipour, E., Tayarani, Najaran, Z., Fereidoni, M. (2020). Vitamin K2 protects PC12 cells against Aβ (1-42) and H2O2-induced apoptosis via p38 MAP kinase pathway. Nutr Neurosci. 23(5): 343-352.

12.       Wang, J. G., Anderson, R. A., Graham III, G. M., Chu, M. C., Sauer, M. V., Guarnaccia, M. M., & Lobo, R. A. (2007). The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertility and sterility, 88(1), 240-243.

13.       Park, S. Y., Kim, Y. D., Kim, M. S., Kim, K. T., & Kim, J. Y. (2023). Cinnamon (Cinnamomum cassia) water extract improves diarrhea symptoms by changing the gut environment: a randomized controlled trial. Food & Function, 14(3), 1520-1529.

14.       World Health Organization. Obesity and Overweight. (2021). Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 19 May 2022).

15.       Mousavi, S. M., Rahmani, J., Kord-Varkaneh, H., Sheikhi, A., Larijani, B., & Esmaillzadeh, A. (2020). Cinnamon supplementation positively affects obesity: A systematic review and dose-response meta-analysis of randomized controlled trials. Clinical Nutrition, 39(1), 123-133.

16.       Jamali, N., Kazemi, A., Saffari-Chaleshtori, J., Samare-Najaf, M., Mohammadi, V., & Clark, C. C. (2020). The effect of cinnamon supplementation on lipid profiles in patients with type 2 diabetes: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine, 55, 102571.

17.       Camacho, S., et al. (2015). Anti-obesity and anti-hyperglycemic effects of cinnamaldehyde via altered ghrelin secretion and functional impact on food intake and gastric emptying. Scientific reports. 5: p. 7919.

18.       Miyazaki, M., et al. (2012). Increased hepatic expression of dipeptidyl peptidase-4 in non-

alcoholic fatty liver disease and its association with insulin resistance and glucose metabolism. Molecular medicine reports. 5(3): p. 729-733.

19.       Chao, M., et al. (2009). Improving insulin resistance with traditional Chinese medicine in type diabetic patients. Endocrine. 36(2): p. 268-274.

20.       Gurd, B.J., et al. (2010). High-intensity interval training increases SIRT1 activity in human

skeletal muscle. Applied Physiology, Nutrition, and Metabolism. 35(3): p. 350-357.

21.       Rashidlamir A , Alizadeh A, Ebrahimiatri A, Dastani M. (2012). The Effect of Four-Week Period of Aerobic Exercise with Cinnamon Consumption on Lipoprotein Indicates and Blood sugar in Diabetic Female Patients (Type 2). Journal of Shahid Sadoughi University of Medical  ciences. Vol. 20, No. 5, Nov- Pages: 605-614.

22.       Biddle, S.J. and A.M. Batterham. (2015). High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head? International Journal of Behavioral Nutrition and Physical Activity. 12(1): p. 95.

23.       Tayarani, Najaran, Z., Hadipour, E., Mousavi, SM., Emami, SA., Mohtashami, L., Javadi, B. (2021). Protective effects of Lavandula stoechas L. methanol extract against 6-OHDA-induced apoptosis in PC12 cells J. Ethnopharmacol. 273: 14023.

24.       Keramati, M., Musazadeh, V., Malekahmadi, M., Jamilian, P., Jamilian, P., Ghoreishi, Z., et al. (2022). Cinnamon, an effective anti-obesity agent:Evidence from an umbrella meta-analysis. J Food Biochem. 46(8): 14166.

25.       Santos, HO., da, Silva, GA. (2018) To what extent does cinnamon administration improve the glycemic and lipid profiles? Clin Nutr ESPEN. 27:1-9.

26.       Dehghan, T., & Abedi, B. (2020). Effect of 12-Week Body Pump with Consumption of Cinnamon and Honey on Resistin, Visfatin and Insulin Resistance in Overweight Children. Iranian Journal of Nutrition Sciences & Food Technology, 15(1), 1-10.

27.       Ainehchi, N., Khaki, A., Farshbaf-Khalili, A., Hammadeh, M., & Ouladsahebmadarek, E. (2019). The effectiveness of herbal mixture supplements with and without clomiphene citrate in comparison to clomiphene citrate on serum antioxidants and glycemic biomarkers in women with polycystic ovary syndrome willing to be pregnant: a randomized clinical trial. Biomolecules, 9(6), 215.

28.       Wu, T., Huang, W., He, M., Yue, R. (2022). Effects of cinnamon supplementation on lipid profiles among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis. Complement Ther Clin Pract. 49: 101625.

29.       Maleki, S., Behpoor, N., & Tadibi, V. (2020). Effect of 8 weeks of resistance training and supplementation of cinnamon on plasma levels of leptin and adiponectin in overweight women. Journal of Practical Studies of Biosciences in Sport, 8(16), 132-142.

30.       Ohnuma, K., R. Hatano, and C. (2015). Morimoto, DPP4 in anti-tumor immunity: going beyond the enzyme. Nature immunology. 16(8): p. 791.

31.       Meissner, E.G., et al. (2015). Dynamic changes of post-translationally modified forms of CXCL10 and soluble DPP4 in HCV subjects receiving interferon-free therapy. PLoS One. 10 (7): p. e0133236.

32.        Malin, S.K., et al. (2013). Lower dipeptidyl peptidase-4 following exercise training plus weight loss is related to increased insulin sensitivity in adults with metabolic syndrome. Peptides. 47: p. 142-147.

 

 

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