Document Type : Original Article

Authors

1 PhD Student in Sports Physiology, Department of Physical Education and Sports Sciences, Rasht Branch, Islamic Azad University, Rasht, Iran

2 Assistant Professor, Department of Physical Education and Sports Sciences, Rasht Branch, Islamic Azad University, Rasht, Iran

3 Professor, Department of Physical Education and Sports Sciences, Rasht Branch, Islamic Azad University, Rasht, Iran

Abstract

Introduction: Physical exercises, in conjunction with Tribulus supplementation, can serve as an alternative to prevent complications associated with menopause. This study investigated the impact of combined exercises and Tribulus supplementation on the sex hormones estrogen, testosterone, and the testosterone-to-cortisol ratio in overweight postmenopausal women.
Methods: In this study, 60 inactive postmenopausal women were selected based on voluntary entry criteria and were randomly divided into four groups of 15 individuals: combined exercise, supplement, combined exercise with supplement, and control. The combined training consisted of 10 weeks of aerobic and resistance training. The participants took a Tribulus supplement in the form of 500 mg capsules twice a day for ten weeks. The estradiol, cortisol, testosterone, and testosterone-to-cortisol ratios were measured before and after the training protocol. Data analysis was performed using SPSS version 25 software and repeated measures analysis of variance test.
Results: The results showed a significant decrease in cortisol levels in the three experimental groups (P=0.001). There was also a significant increase in the total testosterone-to-cortisol ratio among the three experimental groups and the control group (P=0.001). This significant increase was also observed between the exercise and supplement group (P=0.001) and between the supplement group and the combined exercise + supplement group (P=0.001). No significant difference was observed in follicle-stimulating hormone, estradiol, and dehydroepiandrosterone (P>0.05).
Conclusion: According to the results of this study, it is possible to use combined exercises with Tribulus supplement as an effective intervention to improve sex hormones in overweight postmenopausal women. 

Keywords

  1. Berin E. Resistance Training and Physical Activity in Postmenopausal Women: Effects on Vasomotor Symptoms, Quality of Life and Microcirculation: Linköping University Electronic Press; 2023.
  2. Kozakowski J, Gietka-Czernel M, Leszczynska D, Majos A. Obesity in menopause - our negligence or an unfortunate inevitability? Prz Menopauzalny. 2017;16(2):61-5.
  3. Barth C, Villringer A, Sacher J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 2015;9:37.
  4. Bittar ST, de Macêdo JO, Neto EAP, da Silva HG, Pfeiffer PA, Padilha JA, et al. The Benefits of Physical Activity on Climacteric Women. Menopause: A Multidisciplinary Look at. 2017:111.
  5. Huang WC, Wei CC, Huang CC, Chen WL, Huang HY. The Beneficial Effects of Lactobacillus plantarum PS128 on High-Intensity, Exercise-Induced Oxidative Stress, Inflammation, and Performance in Triathletes. Nutrients. 2019;11(2).
  6. Orta OR, Huang T, Kubzansky LD, Terry KL, Coull BA, Williams MA, et al. The association between abuse history in childhood and salivary rhythms of cortisol and DHEA in postmenopausal women. Psychoneuroendocrinology. 2020;112:104515.
  7. Monazzami A, Momenpur R, Alipour E, Yari K, Payandeh M. Effects of eight-week combined resistance and endurance training on salivary interleukin-12, tumor necrosis factor, cortisol, and testosterone levels in patients with breast cancer. International Journal of Cancer Management. 2021;14(2).
  8. Marchand GB, Carreau AM, Weisnagel SJ, Bergeron J, Labrie F, Lemieux S, et al. Increased body fat mass explains the positive association between circulating estradiol and insulin resistance in postmenopausal women. Am J Physiol Endocrinol Metab. 2018;314(5):E448-E56.
  9. Razzak ZA, Khan AA, Farooqui SI. Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. International journal of health sciences. 2019;13(4):10.
  10. Dupuit M, Maillard F, Pereira B, Marquezi ML, Lancha AH, Jr., Boisseau N. Effect of high intensity interval training on body composition in women before and after menopause: a meta-analysis. Exp Physiol. 2020;105(9):1470-90.
  11. Jablu DS, Hosseini RA. Effects of resistance and endurance exercises on serum androgens, cortisol and lactate in menopause women. Iran J Health Phys Act. 2012;3(1):21-9.
  12. León Ariza HH, Sánchez Caicedo MJ. Training in women, from physiology to practice. Physiological Mini Reviews. 2020;13..
  13. de Assis GG, Gasanov EV. BDNF and Cortisol integrative system - Plasticity vs. degeneration: Implications of the Val66Met polymorphism. Front Neuroendocrinol. 2019;55:100784.
  14. Son WM, Sung KD, Cho JM, Park SY. Combined exercise reduces arterial stiffness, blood pressure, and blood markers for cardiovascular risk in postmenopausal women with hypertension. Menopause. 2017;24(3):262-8.
  15. Samani NB, Jokar A, Soveid M, Heydari M, Mosavat SH. Efficacy of the Hydroalcoholic Extract of Tribulus terrestris on the Serum Glucose and Lipid Profile of Women With Diabetes Mellitus: A Double-Blind Randomized Placebo-Controlled Clinical Trial. J Evid Based Complementary Altern Med. 2016;21(4):NP91-7.
  16. Palacios S, Soler E, Ramirez M, Lilue M, Khorsandi D, Losa F. Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire. BMC Womens Health. 2019;19(1):58.
  17. Solakovic SS, Pavlovic R, Vrcic M, Solakovic E. Vascular Rehabilitation Benefits of Tribulus Terrestris (TT), Taurine and High Dose Alpha Lipoic Acid (ALA) Supplementation with Interval Walking Training Program after Surgical Vascular Bypass Treatment (Pilot Study). International Journal of Kinesiology and Sports Science. 2019;7(3):22-33.
  18. Ranjith Kumar R. Development and elucidation of mechanism of action of new leads to attenuate neuroinflammation in stroke model: The Tamilnadu Dr. MGR Medical University, Chennai; 2015.
  19. de Souza KZ, Vale FB, Geber S. Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial. Menopause. 2016;23(11):1252-6.
  20. Dalgaard LB, Oxfeldt M, Dam TV, Hansen M. Intramuscular sex steroid hormones are reduced after resistance training in postmenopausal women, but not affected by estrogen therapy. Steroids. 2022;186:109087.
  21. Zare R, Attarzade Hosseini S, Fathi M. Effect of Eight Weeks of Resistance Exercise on Adaptive Responses of Cortisol and Androgens in Postmenopausal Women. SSU_Journals. 2016;24(2):106-18. [In Persian].
  22. Nunes PRP, Barcelos LC, Oliveira AA, Furlanetto R, Jr., Martins FM, Resende E, et al. Muscular Strength Adaptations and Hormonal Responses After Two Different Multiple-Set Protocols of Resistance Training in Postmenopausal Women. J Strength Cond Res. 2019;33(5):1276-85.
  23. Carcelen-Fraile MDC, Aibar-Almazan A, Martinez-Amat A, Cruz-Diaz D, Diaz-Mohedo E, Redecillas-Peiro MT, et al. Effects of Physical Exercise on Sexual Function and Quality of Sexual Life Related to Menopausal Symptoms in Peri- and Postmenopausal Women: A Systematic Review. Int J Environ Res Public Health. 2020;17(8).
  24. Smith L, Yang L, Veronese N, Soysal P, Stubbs B, Jackson SE. Sexual Activity is Associated with Greater Enjoyment of Life in Older Adults. Sex Med. 2019;7(1):11-8.
  25. Jeon YK, Kim SS, Kim JH, Kim HJ, Kim HJ, Park JJ, et al. Combined Aerobic and Resistance Exercise Training Reduces Circulating Apolipoprotein J Levels and Improves Insulin Resistance in Postmenopausal Diabetic Women. Diabetes Metab J. 2020;44(1):103-12.
  26. Mora JC, Valencia WM. Exercise and Older Adults. Clin Geriatr Med. 2018;34(1):145-62.
  27. Son WM, Pekas EJ, Park SY. Twelve weeks of resistance band exercise training improves age-associated hormonal decline, blood pressure, and body composition in postmenopausal women with stage 1 hypertension: a randomized clinical trial. Menopause. 2020;27(2):199-207.
  28. Bharath LP, Choi WW, Cho JM, Skobodzinski AA, Wong A, Sweeney TE, et al. Combined resistance and aerobic exercise training reduces insulin resistance and central adiposity in adolescent girls who are obese: randomized clinical trial. Eur J Appl Physiol. 2018;118(8):1653-60.
  29. Rashti BA, Mehrabani J, Damirchi A, Babaei P. The influence of concurrent training intensity on serum irisin and abdominal fat in postmenopausal women. Prz Menopauzalny. 2019;18(3):166-73.
  30. Zhu W, Du Y, Meng H, Dong Y, Li L. A review of traditional pharmacological uses, phytochemistry, and pharmacological activities of Tribulus terrestris. Chem Cent J. 2017;11(1):60.
  31. Mazaro-Costa R, Andersen ML, Hachul H, Tufik S. Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women? J Sex Med. 2010;7(11):3695-714.
  32. Akhtari E, Raisi F, Keshavarz M, Hosseini H, Sohrabvand F, Bioos S, et al. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled study. Daru. 2014;22(1):40.
  33. Alghadir AH, Gabr SA, Al-Momani M, Al-Momani F. Moderate aerobic training modulates cytokines and cortisol profiles in older adults with cognitive abilities. Cytokine. 2021;138:155373.
  34. Liedtke S, Schmidt ME, Becker S, Kaaks R, Zaineddin AK, Buck K, et al. Physical activity and endogenous sex hormones in postmenopausal women: to what extent are observed associations confounded or modified by BMI? Cancer Causes Control. 2011;22(1):81-9.
  35. Vingren JL, Kraemer WJ, Hatfield DL, Anderson JM, Volek JS, Ratamess NA, et al. Effect of resistance exercise on muscle steroidogenesis. J Appl Physiol (1985). 2008;105(6):1754-60.
  36. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology (Bethesda). 2015;30(1):30-9.
  37. Farahmand M, Tehrani FR. The effect of medicinal plants in the treatment of sexual disorders: a narrative review. 2021;24(5):87-102. [In Persian].
  38. Naseri L, Khazaei M. A review on therapeutic effects of tribulus terrestris. Journal of Medicinal Plants. 2019;18(72):1-22. [In Persian].
  39. Ma Y, Guo Z, Wang X. Tribulus terrestris extracts alleviate muscle damage and promote anaerobic performance of trained male boxers and its mechanisms: Roles of androgen, IGF-1, and IGF binding protein-3. J Sport Health Sci. 2017;6(4):474-81.
  40. Kaur L. A Review on Antihypertensive Properties of Raphanus Sativus, Daucus Carota And Tribulus Terrestris.
  41. Abadjieva D, Kistanova E. Tribulus terrestris Alters the Expression of Growth Differentiation Factor 9 and Bone Morphogenetic Protein 15 in Rabbit Ovaries of Mothers and F1 Female Offspring. PLoS One. 2016;11(2):e0150400.
  42. Ozemek C, Hildreth KL, Blatchford PJ, Hurt KJ, Bok R, Seals DR, et al. Effects of resveratrol or estradiol on postexercise endothelial function in estrogen-deficient postmenopausal women. J Appl Physiol (1985). 2020;128(4):739-47.
  43. Shabani R. The Effect of Concurrent Aerobic–Resistance Exercise Training on Estrogen Level and Glucose Homeostasis of Menopausal Females with Blood Glucose Impairment. Iranian Journal of Rehabilitation Research. 2017;3(3):1-10. [In Persian].
  44. Sedighi M, Hosseeinpoor Delavar S, Behpour N, Tadibi V. The effect of a resistance training course with citrulline malate supplementation on resting serum BDNF, nitric oxide and estrogen levels in postmenopausal women. Jundishapur Scientific Medical Journal. 2020;19(1):109-22.
  45. Rodríguez-Landa JF, Cueto-Escobedo J. Introductory chapter: a multidisciplinary look at menopause. A Multidisciplinary Look at Menopause London: Intechopen. 2017:1-5.
  46. Coyoy A, Guerra-Araiza C, Camacho-Arroyo I. Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause. Horm Metab Res. 2016;48(8):489-96.
  47. Nie X, Jin H, Wen G, Xu J, An J, Liu X, et al. Estrogen Regulates Duodenal Calcium Absorption Through Differential Role of Estrogen Receptor on Calcium Transport Proteins. Dig Dis Sci. 2020;65(12):3502-13.