Pilates Exercises Versus Intermittent Fasting Diet on Physical and Metabolic Aging Process in Obese Perimenopausal Women

Obesity is associated with a shorter life expectancy, partly due to its role in accelerating the aging process. The conditions and comorbidities linked to obesity mirror those of age-related diseases. Individuals with obesity are at a higher risk for various age-related conditions, including cardiovascular disease (CVD), hypertension, type 2 diabetes mellitus (T2DM), and cance.

Aging is a natural part of the human life cycle, characterized by a gradual loss of physiological integrity, leading to functional decline and increased vulnerability to mortality. Alongside the onset of age-related diseases in older adults, common aging phenotypes, such as redox imbalance, mitochondrial dysfunction, increased apoptosis, cellular senescence, insufficient autophagy, and chronic inflammation, are observed in both humans and animals. Similar mechanisms underpin the onset of age-related diseases in obesity and excessive calorie intake, suggesting that obesity accelerates aging through these interconnected pathways.

Pilates has gained popularity as a holistic exercise approach that emphasizes respiration, body control, and movement precision. Current research supports the positive effects of Pilates on respiratory muscle strength, balance, overall physical performance, and quality of life. Additionally, a recent systematic review and meta-analysis concluded that Pilates is an effective alternative for improving maximal oxygen uptake (VO2max) values.

Fasting, which involves abstaining from food for extended periods ranging from hours to days, triggers significant metabolic changes referred to as the 'metabolic switch'. One of the most important metabolic shifts during fasting is the increased production of ketone bodies, such as acetoacetic acid, β-hydroxybutyric acid (β-HB), and acetone, in the liver.

Given the heightened vulnerability of obese perimenopausal women to accelerated aging processes and metabolic dysfunction, there is a critical need to identify the most effective lifestyle interventions for this high-risk population. While both Pilates exercise and intermittent fasting show promise in addressing aging-related parameters through different mechanisms, no direct comparative studies have evaluated their relative efficacy on comprehensive physical and metabolic aging markers in obese perimenopausal women.

• Pilates exercise (Other): Each exercise will be ranged from 1 to 3 minutes, with a break of 10 seconds. The exercises include: Flat Abs: Pilates Hundred; Flat Abs: Roll-Up; Obliques: Twist and Reach; Lower Back: Shoulder Bridge; Lower Body: Kneeling Side Kicks; Lower Body: Leg Swings; Stamina: Wall Chair.
• Intermittent Fasting Diet (Other): This fasting regimen involves fasting for 16 hours each day and limiting eating to an 8-hour window. The 16:8 intermittent fasting protocol is relatively straightforward. It divides the day into two main periods: the fasting period which is 16 hours and the 8 hours eating window .

Primary outcomes

• Body weight [12 weeks]: Weight will be measured in kilograms by weight-height scale for all participants before and after treatment program.
• Body mass index [12 weeks]: It will be measured by weight-height scale by dividing body weight in kilograms by height meter square.
• Waist circumference [12 weeks]: The waist circumference will be measured in centimeters at the narrowest point between xipho-sternum and the iliac crest at the end of a gentle expiration.
• Hip circumference [12 weeks]: Hip circumference will be measured in centimeters at the maximum circumference at the level of the femoral trochanter.
• Waist-hip ratio [12 weeks]: It will be calculated by dividing waist circumference by hip circumference for all participants before and after treatment.
• Resting Heart Rate Measurement [12 weeks]: Resting heart rate (RHR) is the number of heartbeats per minute (bpm) when a person is at complete rest. It is a simple indicator of cardiovascular health. it will be measured by pulse oximeter. Normal Range: Adults: 60-100 bpm
• Maximum Heart Rate [12 weeks]: It will be calculated through equation: 220- age
• Maximum oxygen consumption (VO2 max) [12 weeks]: It will be calculated through the equation:VO2 max = 15.3 x (maximum heart rate / resting heart rate).

Secondary outcomes

• Assessment of the health-related quality of life [12 weeks]: It will be assessed using the short form (SF-36) questionnaire, which consists of 36 questions. Answers will be awarded a score on a five-point scale (0-4). The 36-question SF-36 evaluates eight health domains: physical functioning (10 questions), physical role limits (4 questions), bodily pain (2 questions), general health perceptions (5 questions), energy/vitality (4 questions), social function (2 questions), emotional role limits (3 questions), and mental health (5 questions). The scores will be transformed to range from 0 for the worst health to 100 for the ideal health.
• Total cholesterol (TC) [12 weeks]: Total cholesterol (TC) is the total concentration of cholesterol in the blood. Normal range: <200 mg/dL (<5.2 mmol/L)
• Triglycerides [Normal: <150 mg/dL (<1.7 mmol/L)]: Triglycerides (TG) are the primary form of fat stored in the body and circulate in the blood as an important source of energy. Elevated triglyceride levels are associated with an increased risk of cardiovascular disease. Normal: <150 mg/dL (<1.7 mmol/L)
• High-density lipoprotein [12 weeks]: High-density lipoprotein is commonly referred to as "good cholesterol" because it transports excess cholesterol from peripheral tissues to the liver for excretion, thereby reducing cardiovascular risk. Normal range for women: <50 mg/dL (<1.3 mmol/L)
• Low-density lipoprotein [12 weeks]: Low-density lipoprotein is often called "bad cholesterol," transports cholesterol from the liver to peripheral tissues. Elevated LDL-C is a major risk factor for atherosclerosis and cardiovascular disease. Normal: <100 mg/dL (<2.6 mmol/L)
• Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) [12 weeks]: It is a widely used index for estimating insulin resistance based on fasting plasma glucose and fasting serum insulin concentrations. It is commonly used in clinical research to assess insulin sensitivity. Normal insulin sensitivity: <2.0

Sex: Female, ages: 40 Years to 45 Years

Inclusion Criteria:

* Their body mass index will be ranged from 30 to 35 kg/m2.
* Waist hip ratio will be > 1.
* Total cholesterol (TC) will be > 200 mg/dl.
* Triglycerides (TG) will be > 150 mg/dl.
* Low-density lipoprotein (LDL) will be > 100 mg/dl.
* High-density lipoprotein (HDL) will be < 40 mg/dl.

Exclusion Criteria:

* Diabetes type I.
* Concomitant cardiac disorders.
* Pregnant or breastfeeding.
* Eating disorders as Anorexia.
* Thyroid disorders.
* Kidney disorders.
* Severe joint issues as arthritis and post-joint replacement.

• Doaa Osman, As Professor, Study director, Cairo University
• Mohamed Awad, Professor, Study chair, Cairo University