Journal of Exercise & Organ Cross Talk

Abstract This randomized controlled trial evaluated the effects of combined mobile-based digital education ("DiabetiFit Pro") and aerobic-resistance exercise on treatment adherence, glycemic control, and tissue markers (lipotoxicity, sarcopenia, and necrosis) among underserved type 2 diabetes patients. In this 12-week RCT, 250 patients (mean age 54.3±10.7 years; HbA1c 9.2%) from underserved Iranian regions were randomized to intervention (n=125; 3 weekly sessions: 10-min app-based education +35-50 min ACSM-guided exercise) or control (n=125; usual care). Primary outcomes were HbA1c and MMAS-8 adherence scores. Secondary outcomes included glycemic variability and tissue biomarkers. Analysis used ITT with ANCOVA, regression, and χ² (α=0.05). Intervention produced superior HbA1c reduction (-1.70% vs -0.70% control; between-group diff: -1.00%, η²=0.18, p<.001) and adherence gains (+1.30 vs +0.40 points; η²=0.16, p<.001). High adherence increased from 23.2% to 48.8% (χ²=22.45, p<.001). Dose-response: modules completed explained 11.5% HbA1c variance (β=-0.34); app hours predicted 16.8% adherence variance (β=0.41). Favorable lipotoxicity/ sarcopenia improvements observed. Combined digital education-exercise interventions significantly enhance adherence, glycemic control, and tissue health in underserved T2DM populations, demonstrating dose-response efficacy and clinical meaningfulness per ADA standards. Health systems should scale such integrated mHealth platforms.

Abstract Osteosarcopenic adiposity (OSA) syndrome significantly impacts hepatic disorders more than each of the tissues alone. The purpose of this study is to evaluate the effects of elastic resistance training modality on hepatic health markers, including fatty liver index (FLI), lipid accumulation product (LAP), hepatic steatosis index (HSI), and Framingham steatosis index (FSI)), in the elderly with OSA. Sixty-three eligible patients aged 60-80 years meet the inclusion criteria, including a) body fat percentage (BFP) ≥32%; b) body mass index (BMI) ≥30 kg/m²; c) T-score of L1-L4, and/or total femur or femoral neck -2.5≤T-score ≤-1.0; d) gait speed (10-meter walk test (10MWT) ≤1 (m/s²); and e) skeletal muscle index (SMI) ≤28% or ≤7.76 kg/m². The participants were randomly assigned to experimental (n=32) or control (n=31) groups. The experimental group completed a 12-week elastic-band resistance training program [3x/week; 60 min/session]. The results showed a statistically significant benefit from the elastic-band resistance training on LAP (P=0.033), FLI (P=0.001), HSI (P=0.008), and FSI (P=0.001). Our findings show that an elastic-band resistance exercise training program can improve hepatic function. This relatively low-cost, highly accessible form of exercise can be easily implemented to enhance the health of this population across a wide range of settings.

Abstract Sarcopenia, an age-associated phenomenon, is characterized by the reduced skeletal muscle mass and function. Research studies indicate that a wide range of factors can play a key role in the onset of muscle atrophy and its progression, especially during old age. However, the pathophysiology of this event is not well understood and there are many unresolved issues yet. Performing different training methods (aerobic, resistance, and concurrent) is among the strategies that may be beneficial for the prevention and improvement of sarcopenia by affecting the signaling pathways of muscle cells. On the other hand, the way in which this type of training affects the signaling pathways involved in sarcopenia has not been well understood. Even the previous research has been incapable of well introducing an effective training method for the elderly at risk for sarcopenia. Generally, in this review article, we investigate and summarize the important and key mechanisms that may contribute to sarcopenia. In the following, we have examined the effect of regular physical activity on cellular signaling pathways involved in sarcopenia, as well as the usefulness of aerobic, resistance, and concurrent activities in adaptation and prevention of the pathology of sarcopenia in the elderly.

Abstract Dear Editor-in-Chief
 
Recently, telocytes (TCs) have been identified in various organs of the body, which are unique stromal cells (Manetti et al., 2019). Telopodes (very long and thin cytoplasmic projections) in TCs connect directly with other TCs and adjacent structures (including blood vessels, nerve endings, smooth muscles, glandular elements) through direct homo- and heterocellular junctions, or extracellular vesicles. Studies also show that TC damage and dysfunction is involved in the pathogenesis of inflammatory and fibrotic diseases, especially aging, and may be considered as therapeutic agents in the future (Chaitow, 2017). On the other hand, the evidence suggests that sarcopenia and fertility-related aging syndromes, due to their complex etiology, make pharmacological or nutritional prescriptions ineffective in their prevention and treatment (Kwak & Kwon, 2019). Therefore, the use of multidimensional strategies such as exercise programs with nutritional interventions may be more effective in preventing these age-related diseases (Nascimento et al., 2019; Pascual-Fernández et al., 2020). Research suggests that TCs may play a critical role in such matters as cross-talk preservation, regenerative mechanisms, and support for localized stem cell differentiation. In 2021, Ravalli et al. examined the presence of TCs in the anterior tibialis muscle of healthy rats under the endurance training protocol compared with sedentary rats. TCs in this study included CD34/CD117 and CD34/vimentin, which were identified by double-positive immunofluorescence staining technique. They showed that TCs in sedentary rats decreased significantly after 16 weeks. In contrast, trained rats showed a constant number of TCs after 16 weeks. In short, it can be stated that the protective relationship between TCs and regular sports activity may present new opportunities in the field of regenerative medicine and supports the hypothesis that a possible adaptative stimulus for TCs in sarcopenia and other musculoskeletal disorders is the promotion of physical activity (Ravalli et al., 2021; Rocha et al., 2021).
In order to support the repair and reconstruction of skeletal muscle, studies performed by transmission electron microscopy also show that there is a close spatial relationship between TCs and satellite cells in adult skeletal muscle. This association is probably due to the intracellular signaling mechanism of endocrine and paracrine, and although their exact function in skeletal muscle regeneration has not yet been fully understood, TCs containing vascular endothelial growth factor and platelet-derived growth factor receptor beta has been discovered in the interstitial part of skeletal muscle. In this way, TCs play an important role in promoting satellite cell self-renewal, vascular stability, facilitating angiogenesis, and preventing fibrosis (Cretoiu & Popescu, 2014; Manetti et al., 2019; Yin et al., 2013).
It is important to note that as age increases, skeletal muscle mass and potential for post-injury regeneration decrease. However, the role of intrinsic changes in satellite cells in these reductions has been controversial because studies have documented a decrease in the number of satellite cells with increasing age in mice. On the other hand, some results indicate that there is not significant reduction in this case. Moreover, evidence suggests that the potential for innate regeneration of satellite cell pools is impaired with age. Although the number of satellite cells in old muscle decreases, the inherent myogenic potential and self-renewal capacity of satellite cells remain unchanged. Factors that can play a role in the activation and differentiation of satellite cells are: paired/homeodomain box transcription factors PAX3 and PAX7 and basic helix-loop-helix myogenic regulatory factors (MRFs) such as MYF5, MRF4, MYOD (Myogenic determination gene number 1) and myogenin (Arpke et al., 2021; Mierzejewski et al., 2020).
Unlike satellite cells and fibroblasts, skeletal muscle TCs express the c-kit cell surface marker. TC-specific antigenic markers are not yet fully understood; however, CD34 is currently used as the most reliable marker to detect TCs at the site of light microscopy, also known as TCs/CD34 + stromal cells (Manetti et al., 2019; Yin et al., 2013). The positive effects of regular physical activity on the number of satellite cells have been expressed, at the same time, skeletal muscle that contracts and relaxes is likely to be affected by the mechanical support of TCs during exercise (Ceccarelli et al., 2017; Kondo & Kaestner, 2019). Studies have shown evidence and conclusions about TCs, although, little research has been done on TCs in mammalian skeletal muscle tissue. At present, there is no direct experimental evidence and results that conclusively support a TCs-satellite cells morpho-functional interaction following skeletal muscle injury (Manetti et al., 2019). However, due to the beneficial role of exercise on satellite cells and TCs in the prevention of age-related muscle disorders, there are still many issues that need to be addressed, including identifying TC-specific biomarkers and their role in sarcopenia. Therefore, the role of regular physical activity on new interstitial cells such as TCs will be a new treatment for age-related diseases such as sarcopenia, which requires further investigations (Ravalli et al., 2021; Wang et al., 2016).