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Effect of a High Intensity Interval Training (HIIT) on Serotonin and Cortisol Levels in Obese Women With Sleep Disorders

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Background: Physical and physiological changes in obese middle-aged women cause hormonal changes, which are threatening factor for quality of life and health of elderly. Objectives : The purpose of this study was to investigate the effect of a one-week HIIT on serotonin and cortisol levels in obese women with sleep disorders. Methods: The research method was semi-experimental with pre-test post-test design, in which 34 middle-aged obese women with mean age of 47.11 ± 2.3, body mass index of 33.4 ± 2.7, and body fat percentage of 35.8 ± 2.3 were selected based on convenience sampling. Subjects were randomly divided to experimental groups (HIIT exercises) and control group. The experimental group performed a training program for one week, including three sets of RAST protocol (six bouts of 35 meters with 10 seconds of rest between each) with a four-minute rest between each set. Pittsburgh sleep test was used to diagnose sleep disorders (score 11 and above). Actiwatch 8 was used to evaluate quality of sleep in the post-test. In order to to measure the serotonin and cortisol levels, a serotonin kit from the German company LBL and SSGN kit was used, respectively. Independent and dependent t-test were used for data analysis at P ≤ 0.05. Results: The results suggested that cortisol level of HIIT training group was decreased significantly after the exercise intervention (P = 0.01; t = 0.93). On the other hand, the serotonin levels of the HIIT training group was significantly lower (P = 0.001; t = 11.02), while in the control group, the change was not significant (P = 0.15; t = 1.53) and the quality of sleep in the training group was improved significantly (P = 0.001; t = 6.52). Conclusions: In conclusion, HIIT exercises can improve the quality of sleep through hormonal changes and as a result, improve the physiological functions of middle-aged women.
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Women Health Bull. In Press(In Press):e83303.
Published online 2018 November 27.
doi: 10.5812/whb.83303.
Research Article
Effect of a High Intensity Interval Training (HIIT) on Serotonin and
Cortisol Levels in Obese Women With Sleep Disorders
Khadijeh Irandoust 1, * and Morteza Taheri1
1Imam Khomeini International University,Qazvin, Iran
*Corresponding author: Associate Professor of Sport Sciences, Imam Khomeini International University,Qazvin, Iran. Tel:+98-9122826152, Email: parirandoust@gmail.com
Received 2018 August 13; Revised 2018 November 15; Accepted 2018 November 17.
Abstract
Background: Physical and physiological changes in obese middle-aged women cause hormonal changes, which are a threatening
factor for quality of life and health of elderly.
Objectives: The purpose of this study was to investigate the effect of a one-week HIIT on serotonin and cortisol levels in obese women
with sleep disorders.
Methods: The research method was semi-experimental with pre-test post-test design, in which 34 middle-aged obese women with
mean age of 47.11 ±2.3, body mass index of 33.4 ±2.7, and body fat percentage of 35.8 ±2.3 were selected based on convenience
sampling. Subjects were randomly divided to experimental groups (HIIT exercises) and control group. The experimental group
performed a training program for one week, including three sets of RAST protocol (six bouts of 35 meters with 10 seconds of rest
between each) with a four-minute rest between each set. Pittsburgh sleep test was used to diagnose sleep disorders (score 11 and
above). Actiwatch 8 was used to evaluate quality of sleep in the post-test. In order to to measure the serotonin and cortisol levels, a
serotonin kit from the German company LBL and SSGN kit were used, respectively. Independent and dependent t-test were used for
data analysis at P 0.05.
Results: The results of this study showed that cortisol level of HIIT training group was decreased significantly after the exercise
intervention (P = 0.01; t = 0.93). On the other hand, the serotonin levels of the HIIT training group was significantly lower (P = 0.001;
t = 11.02), while in the control group, the change was not significant (P = 0.15; t = 1.53) and the quality of sleep in the training group
was improved significantly (P = 0.001; t = 6.52).
Conclusions: In conclusion, HIIT exercises can improve the quality of sleep through hormonal changes and as a result, improve the
physiological functions of middle-aged women.
Keywords: High Intensity Interval Training, Serotonin, Cortisol, Sleep Disorders
1. Background
A common problem throughout the world is over-
weightness and obesity, which has caused metabolic syn-
drome diseases, such as diabetes, hypertension and fatty
liver, and has incurred economic and social costs (1). Based
on research evidence, obesity, regardless of physical and
physiological effects, has led to behavioral disorders, such
as insomnia and sleep disorders (2). A study by Spiegel et al.
concluded that sleep disorders for several consecutive days
increased the resistance of peripheral tissues to insulin,
impaired glucose tolerance, increased hunger, and food in-
take, all of which led to hormonal imbalance in the body
(3). It was shown in another study that a lower the qual-
ity of sleep is associated with more stressful hormones pro-
duced in the body (4). In this regard, specific protocols for
the prevention and treatment of these disorders have been
developed and proper exercise has always been an effective
method (5). Sleep is a kind of restorative treatment that af-
fects the homeostatic adjustment of body physiology, au-
toimmune nervous system, endocrinology, and immune
system, and plays an important role in regulating phys-
iological and psychological behaviors (6). Prevention of
sleep disorders is important due to its vital role in various
functions of the body (7). Regarding the circadian rhythm,
hormonal homeostasis is among subjects pursued by re-
searchers. In this regard, the use of excersize protocols
with the goal of regulating this cycle can bring about bet-
ter effectiveness for these interventions (8,9). High in-
tensity interval training (HIIT) is one of the exercise types
that has been taken into consideration by researchers in
the recent decades. This exercise involves repetitive ses-
sions with short periods of intense intensity, approaching
Copyright © 2018, Women’s Health Bulletin. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0
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Irandoust K and Taheri M
the maximum VO2 max (10). Unlike aerobic exercises, the
HIIT protocol has less been studied in middle aged people.
With regards to age-related physiological changes, exer-
cise training can probably have different effects on middle-
aged people compared to young individuals. On the other
hand, no research has been done on the effect of HIIT exer-
cises on serum serotonin levels, cortisol, and the quality of
sleep in middle-aged women. In general, any strategy that
can reduce stress hormones and release more hormones of
vitality and improve sleep quality, can be effective in pre-
venting obesity consequences.
2. Objectives
Attempts were made to investigate the effect of a one-
week HIIT on serotonin and cortisol levels in obese women
with sleep disturbances.
3. Methods
The research method was semi-experimental with pre-
test and post-test design. The sample size was calculated
based on Equation 1:
(1)n=σ2
1+σ1
2Z1
α
2+Z1β2
d2
In this regard, 34 middle-aged obese women (with
mean age of 47.11 ±2.3 years and body mass index of 33.4 ±
2.7 kg/m2), who referred to the Sports Counseling Center of
Sport and Youth Administration of Qazvin in 2017, were se-
lected based on convenience sampling. Inclusion criteria
were age of 40 to 50 years old, lack of regular resistance ex-
ercise in the past six months, having sleep disorders (score
11 and above in Pitsburg scale), and having physical activ-
ity readiness. Individuals were excluded from the study
due to the absence from the training session and measure-
ment phases. In order to eliminate the possible effects of
nutritional status and physical fitness level of the subjects
on the results of the study, their status was measured us-
ing the N4 Software and Physical Activity Readiness ques-
tionnaire (PAR-Q). Furthermore, PAR-Q was used with the
subjects responding before participation in the training. If
they answered the questionnaire questions positively, they
were excluded. The PAR-Q is a tool for screening and evalu-
ating the readiness of participation in physical activity (11),
the reliability and validity of which has been reported in
previous studies (12). All measurements were performed
at the exercise physiology laboratory of Imam Khomeini
International University. Written consents were obtained
prior to the study. Subjects were selected first through con-
venience and purposive sampling and then divided to ex-
ercise and control groups based on random allocation, us-
ing a table of random numbers. Five subjects discontinued
the study due to absence from either training session or
measurement sessions. Pittsburgh sleep test was used to
diagnose sleep disorders (score of 11 and above). The mea-
surement of blood pressure was carried out by the physi-
cian. The experimental group performed a training pro-
gram for one week, including three sets of the RAST proto-
col (six bouts of 35 meters with 10 seconds of rest between
each) with a four-minute rest between each set. All train-
ing sessions were conducted between 8 am and 11 am (13).
To control the intensity of the training, Polar’s pulsator
(manufactured by Polar, Finland) was used. During this
period, the control group did not participate in any regu-
lar training program and were only examined in the pre-
test and post-test. The second stage of blood sampling was
performed with the same initial test conditions, 48 hours
after the last exercise session. A blood sample was taken
from an antecubital vein in the sitting position and was
taken by a lab technician at Imam Khomeini International
Sport Sciences Laboratory. Blood samples were then rinsed
at 3000 rpm and centrifuged for 10 minutes (with Hettich-
Germany), and the extracted plasma was then stored at-
17°C until measurement. Serotonin serum levels were mea-
sured from the serum Kit (LBL Company; Germany). Corti-
sol was measured using the Canadian SSGN kit and ELISA
method. To measure the quality of sleep, an actigraphic
technique was used using the Actiwatch edition 8 (made
in England). The study protocols and procedures were ap-
proved by the Ethics Committee of Imam Khomeini Inter-
national University. Independent and dependent t-test was
used for data analysis at P 0.05.
4. Results
At baseline, there was no significant difference be-
tween the experimental and control groups in the level of
physical activity of readiness, systolic and diastolic pres-
sure, and quality of sleep (respectively, P = 0.61; P = 0.44; P =
0.31; P = 0.39). As shown in Table 1 (paired t-test), there were
no significant differences in the indices related to obesity
(fat percentage and BMI) in the two groups in the post-test
(respectively, P = 0.42; P = 0.51), while the systolic and dias-
tolic pressure in the experimental group after the interven-
tion was significantly improved (respectively, P = 0.0.04; P
= 0.0.03).
As shown in Table 2, there was no significant difference
between the micronutrients and macronutrients of the
two groups before the beginning of the study (P 0.05).
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Irandoust K and Taheri M
Table1. General Characteristics of Subjects
Variable Experimental Group Control Group P Value Independent
t-test
Pre-test Post-test Pre-test Post-test
Fat percentage (%) 33.4 ±2.2 33.3 ±2.6 33.1 ±2.4 33.2 ±2.5 0.66
BMI (kg/m2)23.5 ±1.5 23.1 ±1.8 23.2 ±2.2 23.1 ±2.3 0.41
Systolic pressure (mmHg) 134.1 ±2.1 131.1 ±2.6* 134.3 ±2.4 134.5 ±2.3 0.04
Diastolic pressure (mmHg) 88.2 ±3.1 83.4 ±2.7* 85.2 ±2.8 86.4 ±2.4 0.03
Table2. Comparison of Micronutrients and Macronutrients at Baseline
Food Analysis HIIT Group Control Group P Value
Carbohydrate (g) 234 ±35.1 238 ±44.2 0.13
Protein (g) 1.51 ±6.9 48 ±2.5 0.47
Protein (g) 62.4 ±7.6 68.2 ±6.3 0.13
Selenium (mg) 84.3 ±7.5 94.1 ±5.3 0.51
Vitamin E (mg) 4.1 ±0.9 4.4 ±1.1 0.73
Calcium (mg) 8.572 ±70.1 8.478 ±58.2 0.17
Vitamin C (mg) 51.2 ±4.3 45.1 ±3.2 0.09
Fiber (g) 41.2 ±3.2 13 ±5.4 0.19
Cholesterol (mg) 76.3 ±4.1 66 ±3.7 0.29
As shown in Table 3, paired t-test results suggested that
the cortisol level of the HIIT training group decreased sig-
nificantly after the exercise intervention (P = 0.01; t = 0.93),
while there was no significant difference for the control
group (P = 0.71; t = 0.26). On the other hand, the results
showed that the level of serotonin in the HIIT training
group decreased significantly after the intervention (P =
0.001; t = 11.02), while it was not significant for the control
group (P = 0.15; t = 1.53). Quality of sleep was improved sig-
nificantly in the training group (P = 0.001; t = 6.52), while
it was not significant in post-test for the control group (P =
0.08; t = 1.11).
As shown in Figure 1, mean difference of post and pre-
test was significantly different in both groups; the differ-
ence between the pre-test and post-test of training group
was significantly different (P = 0.035; t = 2.227).
As shown in Figure 2, mean difference of post and pre-
test was significantly different in both groups (P = 0.001; t
= 10.734).
As shown in Figure 3, independent t-test suggested that
mean difference of post and pre-test was significantly dif-
ferent in both groups (P = 0.001; t = 5.35).
5. Discussion
Physical and physiological changes in obese middle
aged women cause hormonal changes, which is a threat-
*
0
2
4
6
8
10
12
14
16
HIIT Training Control
Cortisol, mg/dlit
Pretest
Posttest
14.19 13.36
Figure 1. Comparison of cortisol levels in experimental and control groups
ening factor for quality of life and health of elderly. There-
fore, the aim of this research was to investigate the effect
of a one-week HIIT on serotonin and cortisol levels in obese
women with sleep disorders. It was found that decrease in
cortisol hormone levels was accompanied by an increase in
serotonin hormone following HIIT training. Another find-
ing was the improvement of sleep quality in the training
group. Concerning improvements in sleep in the training
group, the results are consistent with the study by Taheri
and Irandoust (2). They pointed out that an aerobic ex-
ercise would improve the sleep quality of obese individ-
Women Health Bull. In Press(In Press):e83303. 3
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Irandoust K and Taheri M
Table3. Cortisol and Serotonin Levels and Quality of Sleep Before and After the Intervention
Variables HIIT Group (n=15) Control Group (n=14)
Pre-test Post-test Pre-test Post-test
Cortisol (mg/dL) 14.19 ±2.34 11.84 ±1.73* 13.36 ±1.31 13.20 ±1.47
Serotonin (ng/ml) 236.93 ±68.82 351.10 ±78.56* 249.20 ±87.78 242.40 ±77.49
Quality of sleep (%) 51.08 ±12.36 67.90 ±11.92* 52.48 ±12.43 55.12 ±12.50
*
0
50
100
150
200
250
300
350
400
450
HIIT Training Control
Serotonin, ng / mL
Pretest
Posttest
Figure 2. Comparison of serotonin levels in experimental and control groups
*
0
10
20
30
40
50
60
70
80
Hiit Training Control
Quality of Sleep, %
Pretest
Posttest
52.48
51.08
Figure 3. Comparison of quality of sleep in experimental and control groups dis-
cussion
uals. Along with the results of this study, Song MR and
Song LR showed that implementation of regular aerobic
exercise results in improved sleep quality in older women
(14). Regarding the improvement in sleep quality follow-
ing aerobic exercise, a possible reason may be a decrease
in the percentage of body fat, in particular visceral fat,
which can lead to better breathing during sleep and cre-
ate a better quality of sleep. Regarding the effectiveness
of HIIT exercises, it is important to note that the high ac-
cumulation of acidic lactate in the body following these
exercises increases muscular fatigue and leads the body
further towards relaxation (15,16). In contrast to the re-
sults of this study, Arazi et al. found no significant differ-
ence in cortisol levels after combined strength-endurance
exercise (17), while Rosa et al. observed a decrease in cor-
tisol levels after combined exercise (18). Another finding
was that HIIT exercises increase serum levels of serotonin.
One possible reason can be attributed to the positive effect
of physical activity on cerebral mechanisms affecting sero-
tonin and dopamine secretion (19). On the other hand, it
has been shown that increased serotonin can be a factor
in improving quality of sleep (13). Based on research ev-
idence, HIIT exercise increases tryptophan, which enters
brain cells and stimulates serotonin synthesis and circula-
tion in the bloodstream (20,21). In summary, It was indi-
cated that HIIT exercises can lead the body to release and
improve physiologic relaxation, which itself facilitates the
process of sleep as an effective behavior in the body. Be-
sides the positive consequences of exercise therapy in gen-
eral health of common people and athletes (22,23), it can
be used to cure problems, such as sleep disorders and hor-
monal imbalance. One of the study limitations was the
relatively low number of subjects. Its recommended to
recruit more subjects in future research to increase the
generalizability of the results. Having more control over
psychological characteristics of subjects through different
psychological tests in terms of inclusion criteria is another
point that should be considered by researchers.
5.1. Conclusion
High intensity interval training (HIIT) can help im-
prove sleep quality through hormonal changes and as a re-
sult, improve the physiological functions of middle-aged
women.
Acknowledgments
The present study was financially supported by the re-
search vice-chancellor of Imam Khomeini International
University.
Footnotes
Conflic of Interests: None declared.
4Women Health Bull. In Press(In Press):e83303.
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Irandoust K and Taheri M
Ethical Considerations: The study protocols and pro-
cedures were approved by the Ethics Committee of Imam
Khomeini International University.
Funding/Support: The research was granted by Imam
Khomeini International University.
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Women Health Bull. In Press(In Press):e83303. 5
... With regard to exercise, testosterone plays a key role in the strength and development of skeletal muscles, bones and erythrocytes (Buresh et al., 2009). Cortisol is a catabolic hormone secreted from the adrenal cortex in response to physical and psychological stress (Irandoust & Taheri, 2018). Metabolism is affected by cortisol's release as cortisol maintains the blood glucose levels during physical exercise; the mechanism involved refers to the increase of amino acid and lipid mobilization by skeletal muscle and adipose tissue (Galbo, 2001). ...
... Metabolism is affected by cortisol's release as cortisol maintains the blood glucose levels during physical exercise; the mechanism involved refers to the increase of amino acid and lipid mobilization by skeletal muscle and adipose tissue (Galbo, 2001). Cortisol facilitates this process by stimulating the liver to create the enzymes involved in the gluconeogenesis and glycogenesis pathways, transforming the amino acids and glycerol into glucose and glycogen (Irandoust & Taheri, 2018). Testosterone and cortisol are sensitive to exercise (Budde et al., 2015;Budde et al., 2010). ...
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... Cortisol is one of the important hormones secreted into blood stream. It is a catabolic hormone secreted from the adrenal cortex in response to physical and psychological stress (1). Metabolism is affected by cortisol's release when cortisol maintains the blood glucose levels during physical exercise; the mechanism involved refers to the increase of amino acid and lipid mobilization by skeletal muscle and adipose tissue (2,3). ...
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