Exercise-induced change in FGF21 and adiponectin and their association with metabolic syndrome in older women: a randomized controlled trial

초록

Background: Metabolic syndrome is common in older adults and increases cardiometabolic risk. The fibroblast growth factor 21 (FGF21)-adiponectin axis regulates metabolic homeostasis, but its exercise responsiveness may differ by metabolic status. This study investigated the effects of exercise on circulating FGF21, adiponectin, and the FGF21/adiponectin ratio in older women with and without metabolic syndrome. Methods: Sixty older women (75.2 +/- 4.3 years) were classified by metabolic syndrome status and randomly assigned to control or exercise groups. Exercise groups completed a 10-week supervised combined exercise program consisting of body-weight resistance and cross-linked elastic resistance band training (3 sessions/week, 60 min/session), while controls maintained their usual lifestyle. Blood biomarkers, body composition, physical fitness, and metabolic parameters were assessed before and after the intervention and analyzed using two-way repeated-measures ANOVA. Results: The FGF21-adiponectin axis was modulated by the intervention. Adiponectin increased in both exercise groups (NMSE: mean change, 1.23; 95% CI, 0.98-1.49; d = 1.04; MSE: mean change, 0.86; 95% CI, 0.31-1.40; d = 0.71). FGF21 increased in the NMSE group (mean change, 16.75; 95% CI, 5.46-28.05; d = 0.40) but decreased in the MSE group (mean change, -15.91; 95% CI, -28.35 to -3.48; d = -0.33). The FGF21/adiponectin ratio decreased in both exercise groups, with a greater reduction in MSE (NMSE: mean change, -2.18; 95% CI, -4.18 to -0.18; d = -0.29; MSE: mean change, -6.48; 95% CI, -9.82 to -3.15; d = -0.86). Secondary outcomes, including body composition, physical fitness, lipid profiles, insulin resistance markers, and inflammatory markers, also improved with small-to-large effect sizes. Conclusion: Combined exercise improved metabolic health and modulated the FGF21-adiponectin axis in older women, with differential FGF21 responses by metabolic status. The reduced FGF21/adiponectin ratio may indicate exercise-induced metabolic adaptation. Trial registration: KCT 0011558.

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