{'fraction_non_alphanumeric': 0.023818720226599716, 'fraction_numerical': 0.015578730526586843, 'mean_word_length': 5.307348761672757, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
EFFECTS OF PLYOMETRIC EXERCISE ON CONCOMI- TANTS OF FITNESS AND METABOLIC PROFILE IN TYPE 2 DIABETES PATIENTS

Background: The prevalence of type 2 diabetes mellitus has been on the increase both in high and medium/low income countries. This increase is associated with health and economic consequences, especially in low sub-Saharan Africa that is resource stricken. Availability of affordable and easy to implement treatment intervention will surely reduce these health and economic sequealae of type 2 diabetes mellitus. This study was carried out to investigate the effects of plyometric exercise on concomitants of fitness and metabolic profile in type 2 diabetes patients. Methods: Simple random sampling technique was employed to recruit participants (n=27) for this study after meeting the inclusion criteria. Physical and physiological measurements were taken from the participants before and after six weeks of plyometric exercise for the experimental group and the control who did not participate in plyometric exercise. Results: A total number of twenty seven (control= 13) participated in the study and there are not significant differences in the physical and physiological parameters of the two groups. There are significant differences in the physiological parameter after six (6) weeks of plyometric exercise among the experimental groups while there are no significant differences among the control group. The eta squared statistics of few parameters show that the effect sizes range between medium and large association. Conclusion: It is concluded that among the concomitants of fitness, plyometric exercise is effective only in improving muscle fitness and body composition.


INTRODUCTION
Type 2 diabetes is one of the fastest growing public health problems in both developed and developing countries [1]. It accounts for approximately 90% of diabetes cases worldwide and is associated with a large economic burden and premature mortality [2]. It is estimated that the number of people with diabetes in the world will double in coming years, from 171 million in 2000 to 366 million in 2030 [1]. According to the International Diabetes Federation (IDF) over 5 million people suffer from diabetes mellitus in Africa and the number is expected to increase to 15 million by 2025 [3]. The estimated prevalence of diabetes mellitus in Africa is 1% in rural areas, up to 7% in urban sub-Sahara Africa, and between 8-13% in more developed areas such as South Africa and in population of Indian origin [4]. The prevalence in Nigeria has been reported to vary from 0.65% in rural Mangu (North) to 11% in urban Lagos (West) and data from the World Health Organization (WHO) suggests that Nigeria has the greatest number of people living with diabetes mellitus in Africa [5,6]. Type 2 diabetes is considered a late-onset chronic disease as a result of tissue resistance to insulin. However, it was observed that individuals with lower levels of physical fitness have high levels of insulin resistance as well as fewer glucose transporters [7,8]. Insulin resistance syndrome continues to gain support as an important risk factor for premature coronary artery disease, hyperinsulinemia, central obesity and overlap of metabolic abnormalities such as hypertriglyceridemia and low level of high density lipoprotein, altered low density lipoprotein, and elevated free fatty acids [8]. Therefore, regular physical activity should be integrated to promote good metabolic fitness, a state associated with reduced risk for many chronic diseases [9].
Several measures have been directed towards the management of type 2 diabetes mellitus. These include dietary adjustment, drug therapy as well as exercise therapy [10]. Exercise has been found to improve insulin sensitivity, glucose concentration and also improve concomitants of physical fitness among individuals with type 2 diabetes mellitus [11,12]. Circuit training, aerobic exercises and progressive resistance training have been shown to improve physical fitness among normal individuals and diabetes patients [13,14,15].
Plyometric exercises are designed to be more similar in form of sport specific skills and involve light resistance to allow for explosive speed, thus can do much for improving sport specific speed and power [16]. These exercises promote muscle recruitment, improve muscle strength, and increase muscle endurance, enhances posture and balance, weight loss and decrease the risk of injuries [16]. Previous studies have used plyometric training in improving physical fitness among in apparently healthy individuals and athletes but its effect is yet to be determined among Type 2 diabetes patients [17,18,19]. This study was carried out to investigate on the effects of plyometric exercise on concomitants of fitness and metabolic profile in type 2 diabetes patients.

MATERIALS AND METHODS
The study population was Nigerian adults with Type II diabetes mellitus who were attending Aminu Kano teaching Hospital for their management. The participants were randomly assigned into experimental and control groups after meeting the inclusion criteria. Simple random sampling technique was used to recruit 27 subjects for this study into experimental and control groups by balloting.
Inclusion criteria were Type 2 DM for a minimum duration of six months, age between 30 -60 years, stable cardiovascular status/fitness as carefully selected by the Consultant Physician/Endocrinologist and informed consent to participate while exclusion criteria were other classes of DM (except type 2 DM), changes during the previous 2 months in oral hypoglycemic, antihypertensive, or body weight (5%), established renal disease as identified by the Consultant Physician/Endocrinologist, limitation in physical activity/activity of daily living because of disease, presence of co-morbidities that make participation inadvisable such as cardiovascular disease, significant peripheral neuropathy and diabetes mellitus foot syndrome, amputation, musculoskeletal disorders and arthritis and decline of consent.

Measurements
Blood pressure, body composition, muscle power, muscle endurance, muscle strength, muscle flexibility of the participants were measured using standardized methods and techniques [20,21]. Also, fasting blood sugar (FBS) and random blood sugar (

Training Procedure
Participants in the exercise group trained for 30 minutes, 2 times per week on non-consecutive days for six weeks. Prior to the commencement of the training, there was one session of demonstration of the various exercises and each subject was made to practice the exercises.
Warm-up: This was done prior to the main exercise so as to prepare the cardiovascular system and the body for plyometric training and to reduce the risk of injury during the exercise. Subjects performed 5minutes of cycling on a bicycle ergo meter. Then 2 minutes of stretching (dynamic) e.g. striding was performed by each participant after the cycling as it is easier to stretch a muscle when it is warm. Subjects held each stretch for 15seconds.
Plyometric training: Subjects performed 2 sets of 10 repetitions of each plyometric exercises which include squat jumps, plyometric push-ups, and ring drills 2 times per week for 20mins with 1-2 minutes of rest periods in between sets. Progression was made from low intensity plyometric exercises (squat jumps and plyometric push-ups) to moderate intensity exercise (ring drills).
Cool down: Subjects performed 3 minutes of cycling on the bicycle ergometer. This was performed after the plyometric exercise sessions were completed. This slowly decreases the cardiovascular work and overall metabolism that were elevated during plyometric training because a sudden stop of exercise could be dangerous.

DATA ANALYSIS PROCEDURE
Descriptive statistic of the mean and standard deviation was used to describe characteristics of the participants. Inferential statistics of paired-samples t-test was computed to determine differences in pre and post intervention within the experimental group after 6 weeks of intervention and control group in fitness parameters following 6 weeks of initial measurement. The effect sizes of the variables were determined using Paired Squares eta. Statistical significance was set at an alpha level of 0.05. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0.

RESULTS
As shown in the table 1 below, the mean BMI indicates that participants in both experimental and control groups are overweight and within the middle age category, having blood pressure within the normal range and the participants have a body fat percentage within the normal range (20-30%). There are no significant differences between physical and physiologic parameters of both experimental and control groups at baseline as shown in table 1 below.

DISCUSSION AND CONCLUSION
This study was carried out to evaluate the effects of plyometric training on concomitant of fitness and metabolic profile among Nigerians adults with type 2 diabetes mellitus. The outcome reveals significant improvement in concomitant of fitness and metabolic profiles of the experimental group, but without any significant improvement in that of the control group.
The significant increase in muscle strength identified by this study is in line with previous studies conducted wheretype 2 diabetics patients were subjected to aerobic and progressive resistance exercises [22,23,24]. The results of this study is also similar to that of Masamoto, Larson,Gates and Faigenbaum (2003) who reported plyometric training to be effective in improving muscular strength, but this was carried out on athletes making it difficult to compare it with the present study [25]. This could, however, be due to the impact of the exercise on muscle fibers leading to their hypertrophy as well as increase utilization of stored fat for energy during the exercise. The findings of this study also indicate that subjects in the experimental group did improved significantly in muscle power and flexibility over those in the control group after the training. This is in line with the study by Faigenbaum et al (2007) [17]. This difference could be due to the fact that subjects in this study were diabetic, older and unfit unlike subjects in previous study whom were apparently healthy adolescent or young adults and athletes.
Comparison of the pre and post blood pressure reduction in blood pressure of the resistance exercise group shows a reduction in the blood pressure but no reduction in the blood pressure of the control group. There are conclusive evidences on the positive effects of resistance exercises on blood pressure. Kelley and Kelley (2000) in a meta-analysis reported that progressive resistance exercise has positive effects on reducing resting systolic and diastolic blood pressure in adults [26]. Also, Cornelissen and Fagard (2005) posited that moderate resistance exercise could be part of the non-pharmacological intervention strategy in the prevention and management of high blood pressure [27]. It is also pertinent to point out that the American Heart Association and American College of Sports Medicine endorsed the use of resistance exercise as an integral part of exercise to enhance health and cardiovascular disease prevention [28,29].
Glycemic control is, however, an important and challenging aspect in people with type 2 diabetes and exercise along with other management helps to address this problem. An increasing interest has been seen over the last decade on the role of resistance exercise in the management of type 2 diabetes mellitus regarding improvement in insulin sensitivity [30]. The outcome of this study shows significant decrease in blood glucose concentration which is consistent with the findings of Gordon et al (2008), Baum, Votteler and Schiab (2007) and Brooks, Layne, and Gordon (2007) who found significant improvement in blood glucose con-centration after subjecting T2DM patients to aerobic and progressive resistance exercises [31,32,33]. Though this present study was unable to control well for dietary intake and medications taken by the participants, there was significant reduction in the blood glucose as a result of resistance exercise. In a recent study, it is reported that resistance exercise provides type 2 diabetes mellitus subjects similar effects to aerobic exercises and it is a useful alternative for people who are unable to participate in aerobic exercise [34].
Resistance exercises have been suggested to be more accessible for of training for less mobile groups of subjects [35] and also acting as an alternative to aerobic exercises for more mobile individuals [33]. This study further revealed that plyometric training has significant effect in decreasing blood lipid after six weeks of exercise. Though our study recruited both male and female as subjects, Bemben and Bemben (2000) reported earlier that resistance exercises had significant positive effects on high-density lipoprotein cholesterol (HDL-C) among postmenopausal women of Oklahoma [36]. Also, our findings are supported by the studies of Arora, Shenoy, and Sandhu (2009) and Lightenberg, Hoekstra, Bol, Zonderland and Erkelans (1999) who used higher frequency, longer duration of exercise and study accounting for the improvement in blood lipids especially total cholesterol and triglycerides [14,37]. Contrary to our findings, Patel et al., (2015) reported in a pilot study that an 8-week resistance training programme did not improve lipid profile in obese/overweight peri-pubertal boys [38]. However, it has been shown by various authors that the outcome of low-to moderate-intensity resistance training leads to greater reduction in lipid profiles than high-intensity resistance training among [39,40].
The American College of Sports Medicine (2002) states that improved muscle fitness (i.e. muscle strength and endurance) is proportionate to improved or maintained glucose tolerance, fat free mass and resting metabolic rate and ability to carry out activities of daily living [21]. The outcome of our study is in line with ACSM (2002) submission because of the significant improvements in muscle fitness and at the same time significant decrease in blood glucose concentration and blood lipids [21]. The use of exercise in the prevention and management of type 2 diabetes mellitus has been well supported. American Diabetes Association (ADA, 2002) opined that promotion of exercise in the prevention and management of type 2 diabetes mellitus must be viewed as a high priority [41]. Plyometric exercise is a form of exercise that is easy, cheap, less instructive and requires minimal supervision, which is suitable for patients from with scarcity of health resources.
This study, therefore, concludes that among the concomitants of fitness, plyometric exercise is effective only in improving muscle fitness and body composition.
Low-moderate intensity plyometric exercise for 2 times per week should be incorporated in the treatment regimen for type 2 diabetes patients or as home program so as to improve their level of physical fitness.
• Further research should employ longer duration, larg-er sample size, and higher frequency and intensity of plyometric exercise to determine its effect on blood lipids. • Further research should be conducted to investigate the impact of plyometric exercise on blood glucose concentration ensuring their control for dietary intake and no change in medications during the period of the study.