نشریه مطالعات کاربردی تندرستی در فیزیولوژی ورزش
سال نهم شماره 2 (پاییز و زمستان 1401)

The aim of this study was to investigate the effect of high intensity interval training on cardiomyocytes HSP70 and Caspase-3 gene expression levels in myocardial infarction (MI) male rat model. 

Thirty male Wistar rats (age: 16 wks, weight: 200 to 250 grams) were randomly divided into three groups of healthy control, MI control and MI training following induction of MI (verified by CK, LDH and CTnI as cardiac injury indices) via intraperitoneal injection of isoproterenol (100 mg/kg.day) within two consecutive days. HIIT was included on eight weeks (5 sessions per week), each session was consisted of 10 bouts of running occasions (each for 4 min) at 85 - 90% of vVo2max with 2 min rest intervals at 50 to 60% of vVO2max. The gene expression levels of HSP70 and Caspase-3 were evaluated using Real-Time PCR method and the data were analyzed using one-way analysis of variance and Tukey post hoc test at the significance level of p <0.05.

Cardiomyocytes HSP70 expression levels was lower in MI control than healthy control counterparts (p=0.001); However, in the HIIT group the expression levels of HSP70 and caspase-3 genes were respectively higher and lower compared to both of healthy control and MI control groups (p=0.001, p=0.001 respectively).

 It seems that HIIT could be efficient for inhibition of MI induced cardiac apoptosis. However further research is needed in this area because of study limitations and lack of similar evidence.

  studies have demonstrated a protective effects of female sex hormones against muscle membrane disorders in compared to men following high-intensity exercises. The aim of this study was to evaluate the creatine kinase, estrogen and progesterone responses to a single bout of high-intensity interval training (HIIT) and as well as the relationship between sex hormones and CK response in inactive young women.

24 young inactive women (18–30-year-old and VO2max<30 ml/kg/mil) with regular menstrual cycles were randomly divided in 2 groups: HIIT or experimental (n = 12) and control (n = 12). The experimental group performed HIIE by a treadmill with a slope of 2% in six repetitions (3 sets) for one minute with an intensity of 90-95% HRmax with a total rest time of ten minutes between sets and repetitions. Before and ten minutes after exercise, blood samples were collected to measure creatine kinase (CK), estrogen, progesterone and hemoglobin (plasma shift). Data analysis was performed by using ANCOVA test and linear regression at the statistical level of P <0.05 and SPSS 23.

 Significant increases were recorded in CK and estrogen in experimental group compared with control group (P<0.05). There was a significant relationship between baseline progesterone levels and CK response (P= 0.016). According to the results of linear regression, CK response to HIIE in women can be predicted based on the baseline progesterone level (31.8%).

 Given that progesterone led to decreased CK response, it seems that it is better to perform vigorous intensity exercises in the menstrual phases with high levels of progesterone (mid-luteal phase) in order to reduce further muscle damage in women.    However, due to the low predictive power of progesterone (31.8%), more studies are needed with more samples.

  The aim of the present was to Study of apoptotic changes of caspase 3 and 9 proteins and cytochrome c of heart tissue after High intensity interval training (HIIT) and thyme honey in type 2 diabetic rats.

The statistical population consisted of male diabetic rats that 20 rats were divided into 4 groups: control, HIIT, thyme honey, HIIT-thyme honey. The training protocol was implemented as eight weeks of HIIT and five sessions per week. Insulin was measured using the insulin kit and the ELISA method and the expression of caspase 3, caspase 9 and cytochrome-C genes by RT-PCR method. Statistical analysis was performed using SPSS version 22 software and two-factor analysis of variance and determination of effect size and Bonferroni post hoc.

compared to the control group, HIIT led to a significant decrease in glucose (0.0001) and insulin resistance index (0.001). HIIT increased the expression of caspase 9 genes (0.001) in cardiac cells compared to the control group.

It can be concluded that performing HIIT by diabetic patients can lead to an increase in the apoptotic factor. Therefore, the use of more moderated intensities, as well as the use of substances with antioxidant and anti-inflammatory properties, such as honey, along with exercise can be useful.

The present study aimed to investigate the effect of twelve weeks of combined training and subsequent eight weeks of detraining on apelin levels in type 2 diabetic women.  

In this experimental study, 30 postmenopausal diabetic women with an age range of 50 to 65 years, overweight (body mass index: 30.42 ± 0.835 Kg / m2) were divided into experimental (n=15) and control (n=15) groups. The experimental group trained for a 12 weeks. Training program (3 sessions per week) according to the combined aerobic program ( 50 to 75  percent of the maximum reserve heart rate) and then resistance training ( 50 to 75 percent of one maximum repetition) and then experienced three weeks of detraining. The apelin level, insulin, fasting blood sugar, insulin resistance, and percent body fat were measured. Data were analyzed by repeated measure ANOVA at a significance level of (p>0.05).

Serum Aplin level in the training group increased significantly at the end of the training period (p = 0.04) and decreased significantly in the detraining period (p = 0.001). Also, these changes compared to the control group was significant (p = 0.016). Fasting blood sugar and insulin levels in the training group compared to the control had a significant decrease at the end of the training and detraining period (p = 0.001).

Combined exercise seems to increase aplin and detraining can partially destroy the positive effects of exercise in this regard.

The aim of this study was to evaluate the effect of two months of high-intensity interval training (HIIT) on ABCA1, ABCG1 proteins and HDL (important factors in regulating reverse cholesterol transport (RCT) as a protective process of the heart) in type 2 diabetic male rats heart tissue.

In an experimental study, Forty 3-month-old adult male Wistar rats with a mean weight (251.13± 13.68 g) were randomly divided in four groups of 10 series including: healthy control (C: intraperitoneal injection of saline), healthy (T: running at 85-90% of maximum speed in 6 to 12 2-minute bouts; 5 days per week for eight weeks), diabetic control (D: diabetic on a high-fat diet with intraperitoneal injection of streptozotocin) and diabetics do training (D + T: diabetic with exercise). Western blot was used to evaluate the changes in the expression profile of ABCA1 and ABCG1 proteins in the heart tissue of rats. One-way analysis of variance and Bonferroni post hoc test were used to analyze the data.

The results showed that the levels of ABCA1 and ABCG1 proteins and HDL-C in the diabetic group were significantly lower than the control group (P = 0.005). Whereas, in the healthy (T) trained group, the levels of ABCA1 (P = 0.009), ABCG1 (P = 0.005) and HDL-C (P = 0.043) were Increased respectively 36%, 17% and 8% compared to the diabetic control group (D). On the other hand, HIIT training caused a non-significant increase in both proteins and HDL-C changes in the trained diabetic group (D + T) compared to the diabetic group (D) (P≥0.05).

The results indicate that the two-month intervention of HIIT training enhances the flow of HDL cholesterol by increasing the levels of ABCA1 and ABCG1 proteins in healthy rats; Which can be useful in improving the reverse cholesterol transfer from macrophages, and due to the increase of although non-significant indicators, HIIT may improve the cardiovascular complications of type 2 diabetes.

Regular participation in aerobic activities has a positive effect on health. The aim of the present study was to compare the effect of three   iso-caloric   protocols of long-term intermittent exercise, short-term intermittent exercise and continuous exercise on fat metabolism in healthy men.

 Nine healthy men with a mean age (25.62± 2.6 years) participated in this study voluntarily.  In the first session, the subjects sat in the laboratory for 20 minutes, then the first blood sample was taken from their brachial vein. Continuous exercise protocol was performed on the treadmill with an intensity of 65% VO2max and up to a certain calorie intake (250 Kcal). Immediately after the end of the exercise protocol, a second blood sample was taken, then they were rested for an hour and the recovery gases were collected during recovery. After one hour of recovery, a third blood sample was taken. The second and third blood samples of the next two protocols, like the previous protocol, were taken immediately and one hour after the end of the activity. The second session of the long-term intermittent protocol consisted of four-minute interval activity with an intensity of 85% VO2max and four-minute active rest periods with an intensity of 45% VO2max until the energy consumption was equal to the continuous exercise protocol.  The third session consisted of a short-term intermittent protocol with a 30-second to 30-second rest ratio, with a 100% VO2max activity intensity, and a 30% VO2max rest intensity. Data were analyzed using repeated measures and Bonferroni post hoc analysis of variance.  

Results:

 The results showed that exercise, regardless of its type and intensity, has a significant effect on fat oxidation (P = 0.00). The rate of fat oxidation during short-term intermittent protocol was higher than long-term protocol (P = 0.00). it was higher than long-term protocol (P = 0.00) and short-term protocol during continuous activity (P = 0.00). But fat oxidation related to the recovery period of long-term protocol sessions (P = 0.00) and short-term protocol sessions (P = 0.00) was more than continuous protocol.

 It can be concluded that the protocol of long-term intermittent activity for fat metabolism is superior to the other two protocols and this type of activity is recommended for people with reduced body fat.

  Afamin is a new biomarker of increased the risk of metabolic disease and is associated with insulin resistance. The aim of this study was to investigate the effect of eight weeks of CX WORX training on serum levels of Afamin and insulin resistance in overweight women.

 In this quasi-experimental study, 24 available women (body mass index above 25) were purposefully selected and randomly divided into two groups of control (age: 29.55±4.7 year, height: 162.5± 3.87 cm, weight: 72.25±6.73 kg) and exercise (age: 28.65±3.95 year, height: 164.5± 4.66 cm, weight: 75.83±5.71 kg). The CX WORX training program was performed includes initial warm-up, abdominal strength (1), static strength (1), static strength (2), abdominal strength (2), abdominal strength (3), and exercise (crunch, plank and weight plate), 3 sessions per week for eight weeks. Serum Afamin concentration was measured using ELISA method, and insulin resistance was calculated using the HOMA-IR model formula and fasting glucose and insulin values. Data were analyzed using independent and pair÷ed t-test.

The results showed that after the intervention, BMI (p=0.02), WHR (p=0.004), insulin resistance (p=0.0001) and Afamin (p=0.0001) in the exercise group were significantly lower compared to the control group. Also, after the intervention, BMI (p=0.001), WHR (p=0.02), insulin resistance (p=0.003) and Afamin (p=0.003) in overweight women in the exercise group decreased compared to the pre-test (P<0.001).

According to the results, it seems that CX WORX training can help to reduce afamine levels and improving insulin resistance in overweight people.

 One of the key factors involved in central nervous system  performance is neurotrophins, including BDNF, which decrease with menopause. The aim of this study was to determine the effect of a whole body vibration period on serum BDNF levels in obese postmenopausal women.

In this  semi-experimental study, 24 obese postmenopausal women aged 45-55 years  with an average weight 72/5±5 in Khorramabad city were divided into two groups of 12: 1- without training 2- whole body vibration training. Whole body vibration training group performs these exercises for 12 weeks and three times a week, with a frequency of 30-50 Hz, with an amplitude of 1-2 mm by applying 20 to 30 minutes of vibration, 5 to 15 minutes of upper and lower limb training. 48 hours before the start of the training program and 48 hours after the end of the 12 week training program; Blood sampling and body composition indices were measured. ELISA method was used to measure serum BDNF levels.  Data were analyzed using independent t-test and covariance at the significance level of 0.05.

Results Significant decrease in morphometric indices such as body fat percentage (P = 0.023), body mass index (P = 0.012), and body weight (P = 0.038), as well as significant increase At serum BDNF levels (P < 0.026), the whole body showed vibration compared to the control group.

It seems that the beneficial effects of vibration exercises on increasing BDNF can be a factor in reducing the negative effects of menopause on cognitive function, learning and memory, especially spatial memory.

By analyzing the indexed scientific outputs in databases, it is possible to obtain valuable information about the state of the scientific productions of individuals and organizations. Therefore, the main aim of the current research was to analyze twenty years (2002-2021) of Iranian science production in the field of "exercise physiology in the domain of health" and to draw the density of co-authorship based on the WOS database.

 The current research is descriptive-analytical and was carried out using the scientometric method. The statistical population of the research is the indexed documents (2002-2021) of Iranian researchers in "the field of exercise physiology in the domain of health" in the WOS database. VOSViewer software was used to draw scientific maps and Histcite software was used to extract information.

During the years 2002-2021, 1865 records related to Iran's exercise physiology in the domain of health were indexed in the Web of Science database and the growth trend was upward. Approximately 9% of the papers in the field of "exercise physiology in the domain of health" were written by a single author and 91% was the result of group efforts. The word Exercise with frequency of 667 is the most frequent word in exercise physiology in the domain of health articles. According to the findings, among the universities affiliated to the ministry of science, research and technology, the universities of Gilan (146), Tehran (142), Tarbiat Modares (114), Isfahan (110), and Kharazmi (109) have the first to fifth. As well, the findings indicated that the Mohammad Ali Azarbayjani, Mehdi Kargarfard, Hamid Arazi, Maghsoud Peeri, & Hamid Rajabi are among the first people in the list of important and influential authors in the field of exercise physiology in the domain of health in Iran with the co-authorship density of 383, 201, 180, 150, and 143, respectively. Mehdi Kargarfard is the most cited author in the field of exercise physiology in the domain of health in Iran with 679 citations (47 articles).

Only 8% of science production in the field of exercise physiology in the domain of health in Iran took place during the period of 2002-2011, and it shows that science production in this field is nascent. Iran has the 25th rank in the production of exercise physiology in the domain of health, and it is necessary to make more plans to strengthen Iran's global position.

Consumption of high-calorie, high-salt diets is one of the main factors in production of free radicals and consequent oxidative stress in cardiac tissue. The aim of the present study was to evaluate the effect of an eight-week sprint interval training (SIT) on oxidative/antioxidative status of cardiac tissue in male Wistar rats on a high-calorie, high-salt diet.

  It was an experimental study in which 32 male Wistar rats were randomly divided into four equal groups: normal diet group (ND), normal diet and exercise (ND/SIT), high-calorie high salt diet group (HCL/HS), and high-calorie high salt diet + exercise group (HCL/HS + SIT). The sprint interval training was performed for eight weeks, three times per week, and 4-9 reps per session. Forty-eight hours after the last training session, rats were sacrificed and the cardiac tissue removed and used for superoxide dismutase (SOD), glutathione peroxidase (GPX) activity, as well as total antioxidant capacity (TAC), and malondialdehyde (MDA) levels assessment.

Findings showed that eight weeks of SIT significantly increased the activity of SOD and GPX enzymes in the HCL/HS+SIT group. It also significantly reduced the MDA level in cardiac tissue of Wistar rats (P=0.001). But there was no significant change in TAC level after eight weeks of SIT training in the HCL/HS+SIT group (P=0.148).

Based on the findings of the present study, it seems that SIT training, despite its low volume, may help in preventing oxidative stress induced by a high-calorie, high-salt diet in the cardiac tissue of Wistar rats.

 Type 2 diabetes is associated with increased systemic inflammation that may be increased cardiovascular diseases for which exercise training is a potential therapy. The effects of high intensity interval training (HIIT) on inflammatory markers in Type 2 diabetes patients, however, require further elucidation. We therefore performed a systematic review and meta-analysis to investigate the effect of HIIT on inflammatory markers in Type 2 diabetes patients.

 PubMed, Scopus, and Web of Science were searched up to May 2022 for HIIT vs. Control or only HIIT studies on inflammatory makers i.e. CRP, IL-6 and TNF-α in Type 2 diabetes patients. The search was performed using the HIIT, inflammation and type 2 diabetes keywords. Standardized mean difference (SMD) effect sizes and 95% confidence intervals were calculated using CMA2 software.

Among the 257 extracted studies, 11 studies including 257 participants (143 women and 114 men) with an age range of 44 to 71 years were included in the meta-analysis. HIIT was beneficial for promoting a reduction in TNF-a [-0.62 (95% CI: -1.85 to -0.13), p = 0.01] and CRP [-0.65 (95% CI: -1.21 to -0.08), p = 0.02]. However, there were no significant evidence for an effect of HIIT on IL-6 [-0.31 (95% CI: -0.70 to -0.06), p = 0.10] in Type 2 diabetes patients.

 These results suggest that HIIT could induce improvements inflammatory cytokines as well as CRP in Type 2 diabetes patients.

An excessive increase in the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) and a decrease in the levels of Tumor necrosis factor beta1 (TGF-β1) are associated with creating an inflammatory environment, resulting in increasing pain hypersensitivity in Different models of nerve pain. This study aimed to investigate the effect of four weeks of physical activity in an enriched environment on TNF-α, IL-1β, and TGF-β1 in the dorsal horn of the spinal cord in the chronic course of Experimental autoimmune encephalomyelitis (EAE). 

Thirty female C57BL6 mice were divided into three groups: control, EAE, and enriched environment. After induction of EAE with MOG35-55, the environmental enrichment group lived in an enriched environment for four weeks. On day 30 post-induction (chronic period of the disease), pain sensitivity was assessed by tail immersion test in water, and then the animals were sacrificed and biopsied. TNF-α, IL-1β, and TGF-β1 protein levels were measured by immunohistochemistry. The data were analyzed by One-way analysis of variance at a significance level of 0.05.

The present study's findings showed that living in an enriched environment decreased the levels of TNF-α (p=0/00) and IL-1β (p=0/00) in the dorsal horn of the spinal cord and increased the level of TGF-β1 (p=0/00) protein compared to the EAE group. Also, physical activity in the enriched environment increased the delay time in extracting the tail from hot water in the chronic period of the disease (P = 0.00). 

Active lifestyle can reduce pain sensitivity in the animal model of MS disease (EAE) by reducing the levels of inflammatory factors TNF-α and IL-1β and increasing the levels of anti-inflammatory factor TGF-β1 in the dorsal horn of the spinal cord.

  Breast Cancer is a disorder caused by unregulated cell growth in breast tissue which rises significantly in worldwide and it is currently the most common cancer diagnosed in women. The aim of the present study was to explore a systemic review on the effects of moderate and high-intensity exercise training on the prevention and treatment of breast cancer.

Related articles to the role of exercise training in the prevention and treatment of breast cancer and involved molecular pathways were searched from valid databases including Pub Med, Google Scholar, Scopus, SID, and ISC between 2000 to 2021 years.

In related studies to the effect of exercise training on breast cancer prevention in individuals at high risk for breast cancer, results demonstrated a 20% reduction in risk of breast cancer in women who have a high level of physical activity compared to sedentary women. The findings related to the effect of exercise training on controlling breast cancer progress, indicates that exercise training directly through the effect on tumor intrinsic factors and molecular mechanisms can control or improve breast cancer without any side effect.

Exercise training can be considered as an important intervention in the prevention and complementary treatment of breast cancer by inhibiting cancer cell proliferation, inducing apoptosis, suppressing angiogenesis, regulating the inflammation environment, and improving the side effects resulting from cancer treatment.

 The purpose of this study was to determine the effects of aerobic, resistance, and combined exercise on serum levels of adiponectin, CTRP9 and glycemic indexes in patients with T2DM.

Sixty men with T2DM (mean age [X̅±SD]=51.45±4.26 years; body mass index: 31.52±1.01 kg/m2) were randomly assigned to combined  exercise group (CEx: n = 15), aerobic  exercise group (AEx: n = 15), resistance  exercise group (REx: n = 15), and the control group (CON: n= 15). Exercise programs consisted of aerobic exercises at either AEx (50% - 75% of HRR) and REx (40% - 80% of 1-RM), with equal volume, 3 times per week, 60 minutes per session for 12 weeks. Serum levels of adiponectin, CTRP9, fasting blood glucose (FBG), insulin, Insulin resistance (IR) were measured at baseline and at the end of the study. The data were analyzed using repeated-measures analysis of variance at a level less than 0.05.

After 12 weeks intervention, serum adiponectin and CTRP5 levels increased significantly, whereas the FBG, insulin, HOMA-IR and BMI levels decreased significantly in the CEx, AEx and Rex groups compared to the control group (P < .05).

  The present findings showed that 12-weeks of combined exercise has greater anti-inflammatory effects than aerobic or resistance exercise causing a significant decrease in FBG, insulin and IR and a higher increase in anti-inflammatory adipokines such as adiponectin and CTRP9 levels in T2DM.

Sirtuin1 (Sirt1) levels is associated with insulin resistance and insulin resistance can provide conditions for the development of non-alcoholic fatty liver disease (NAFLD). Thus the aim of this study was to investigate the effect of eight weeks of high intensity interval training (HIIT) and PortulacaOleracea extract on Sir1 level and insulin resistance in rats with NAFLD.

Twenty male Wistar rats aged six weeks were selected and after induction of non-alcoholic fatty liver,were randomly divided into four groups: control, HIIT, PortulacaOleracea extract, and HIIT+PortulacaOleracea extract. To induce NAFLD, the rats were fed a high-fat diet for 12 weeks. PortulacaOleracea supplement at 400 mg/kg was given to the experimental groups. HIIT was performed for 8 weeks, 5 sessions per week with 7 repetitions of 1 minute at 90% maximum speed accompanied by active rest intervals including 2 minutes of running at 20% maximum speed. Hepatic Sir1 level and insulin resistance were measured after 8 weeks of HIIT and consumption of purslane extract. To analyze the data, one-way analysis of variance and Tukey's post hoc test were used at the significance level of p<0.05.

Insulin resistance was significantly higher in control group than HIIT (P=0.012), PortulacaOleracea extract (P=0.037), and HIIT+PortulacaOleracea extract (P=0.014) groups.Sirt1 levels in control group was significantly lower than HIIT (p=0.035), PortulacaOleracea extract (P=0.01), and HIIT+PortulacaOleracea extract (P=0.001) groups. The level of liver Sirt1 in the PortulacaOleracea extract group was not different from the HIIT and HIIT+ PortulacaOleracea extract groups (p values 0.914 and 0.106, respectively), but the liver Sirt1 level in the HIIT group was significantly lower than the HIIT+extract group (p=0.031).

It seems that HIIT and PortulacaOleracea extract could improve insulin resistance in NAFLD by increasing Sirt1 levels and can play an important role in controlling the progress of this disease.

 Obesity and being overweight are the main causes of metabolic disorders like diabetes, hypertension, and cardiovascular disease. Adropine mediates exercise-induced changes and, in parallel, reduces the oxidation of muscle fatty acids, which can lead to a reduction in exercise-induced vascular stiffness. Therefore, the aim of this study was to compare and evaluate the effects of intense periodic aerobic exercise and intense intermittent exercise on adropine serum levels and their relationship with the lipid profile in overweight men.

 A total of 24 overweight young men, ranging in age from 25 to 35 years, were randomly selected as a sample in 3 groups, with 8 people each for aerobic exercise, intense intermittent exercise, and control. Both types of exercises were performed for 6 weeks, 3 sessions per week, and 45 to 65 minutes per session. Before and after the training interventions, blood samples were collected to measure and calculate the adropine serum levels and lipid profile in the 12-hour fasting state.

6 weeks of moderate-intensity aerobic exercise and intense interval exercise resulted in a significant increase in adropine (P=0.006) and HDL (P=0.001) as well as a significant decrease in triglycerides (P=0.002), cholesterol (P=0.017), LDL(P=0.001)  of overweight men .Also, there was a significant negative relationship between changes in adropine with triglycerides(P=0.002), cholesterol(P=0.017), and LDL(P=0.001), and a significant positive relationship between changes in adropine and HDL.

Aerobic exercise and interval exercise improving the lipid profile in overweight men, by reducing the lipid profile, it can be said that risk of cardiovascular disease is reduced. Adropine appears to play a role in these exercise induced changes. Therefore, special attention should be paid to the mediator role of adropine in these changes resulting from exercise.

 Despite the positive effects of HIIT training but it causes oxidative stressdue to high intensity; Therefore, the aim of this study was to investigate the effect of 6 weeks of High intensity interval training with fenugreek supplementation on plasma levels of malondialdehyde and glutathione peroxidase of obese and overweight women.  

 Accordingly 48 obese and overweight women with age average of 29.79± 7/8 years and a body mass index of 29.29 ± 2.6 kg / m2 were purposefully selected and randomly divided into 4 groups of 12. Individuals received exercise + placebo, exercise + supplement, supplement and placebo. supplement consuming groups consumed 500 mg fenugreek capsule daily for 6 weeks. The training groups performed an exercise protocol of HIIT training with maximum speed during 6 weeks  and three session per week. Blood samples were taken 48 hours before and  48 hours after the training period and  supplement consumption, and ELISA method was used to measure the research variables. Statistical analysis of data was performed by analysis of covariance and Scheffe post hoc tests at a significance level of P<0.05.

Significant decrease in malondialdehyde in exercise + supplement group (P = 0.048) compared to placebo group and significant increase in  exercise + placebo groups (p = 0.0001),  exercise + supplement (p = 0.0001)  and supplement groups (p=0/0001) were seen compared to the placebo groups But no significant difference was observed between the other groups.  

Fenugreek consumption along with regular High intensity interval training is a more appropriate intervention to improve the antioxidant status of obese or overweight people.