META-ANALYSIS OPEN ACCESS

Effects of Physical Activity on Thyroid Stimulating

Hormone Levels in Obese Metabolic Syndrome Patients: A
Meta-Analysis
Batool Hassan1, Basit Ansari2 and Sumaira Farooqui1
1
Ziauddin College of Rehabilitation Sciences, Ziauddin University, Karachi, Pakistan
2
Department of Health, Physical Education & Sport Sciences, University of Karachi, Karachi, Pakistan

ABSTRACT
Metabolic syndrome is a combination of multiple disorders that predispose an individual to risk of diabetes, obesity, cardiovascular
diseases (CVDs), cerebrovascular accidents (CVAs), and insulin-resistance. Hypothyroidism is the most prevalent metabolic disorder
causing obesity, followed by hypercortisolism and hypogonadism. Hence, this study aimed to determine the effects of various exercises
on thyroid stimulating hormone (TSH) levels in obese patients with metabolic syndrome. The study conformed to the preferred
reporting items for systematic reviews and meta-analysis (PRISMA) standards. The PubMed, Cochrane, Google Scholar, Medline, and
Biomed Central databases were searched using the keywords exercise, aerobic, rehabilitation, etabolic syndrome, and thyroid stimu-
lating hormone. Studies in English language published between 2010 and 2021 and that examined the efficacy of physical therapy
management with sham treatment on TSH levels in patients with obesity were included. The meta-analysis comprised of 526 patients
with metabolic obesity from 10 randomised controlled trials. The analysis revealed that when compared with the control group, exercise
had a moderate pooled effect on lowering TSH levels, with an effect size standardised mean difference (SMD) of -0.56 (95% Confidence
Interval (CI), -1.09−0.02) estimated using a random effects model, with an I2 of 86.61% (95% CI, 77.31–92.10) in the interventional
group. It was concluded that although a pooled moderate effect of training on TSH levels was observed when all the studies were anal-
ysed using a continuous measure analysis SMD model, an individual analysis of the studies revealed a mild effect, with many studies
also revealing the negative impact of training on TSH levels. Nonetheless, exercise-based intervention strategies are safe and effective
as a management strategy for hypothyroidism and obesity due to hypothyroidism.

Key Words: Thyroid hormone, Exercise, Metabolic syndrome, Obesity, TSH level.

How to cite this article: Hassan B, Ansari B, Farooqui S. Effects of Physical Activity on Thyroid Stimulating Hormone Levels in Obese
Metabolic Syndrome Patients: A Meta-Analysis. J Coll Physicians Surg Pak 2023; 33(11):1293-1298.

INTRODUCTION Furthermore, obesity, along with insulin-resistance, has

increased the risk of Type-2 diabetes mellitus, leading to a
According to the National Health and Nutrition Examination
vicious cycle of metabolic syndrome.4 The root cause of
Survey, the prevalence of metabolic syndrome in adolescents
metabolic dysregulation in the sexes is strongly associated with
and adults is rapidly increasing.1 In Pakistan, over the last few
obesity.5 According to the World Health Organization, the inci-
decades, 18–46% of the population had metabolic risk factors, as
dence of obesity is rising, with 57.8% of adults globally
compared to other South Asian countries.2 Metabolic syndrome
predicted to be considered obese by 2030. Obesity is an
is a combination of multiple disorders that predispose an indivi-
dual to the risk of diabetes, cardiovascular diseases (CVDs), cere- abnormal buildup of body fat that leads to health problems,
brovascular accidents (CVAs), and insulin-resistance.1 In addi- including cancer.6 Therefore, obesity is a critical public health
tion, endocrine disorders are the leading cause of obesity. The issue that should be addressed to avoid obesity-related health
most common endocrine condition is hypothyroidism, which complications.7 According to a study conducted in 2015, obesity
accounts for 58.3% of all cases—followed by hypercortisolism has become a global public health concern that has impacted
(9.3%) and hypogonadism (22.3%)—making hypothyroidism the rates of morbidity and mortality, along with the cost of
8
the primary source of endocrine causes of obesity.
3
health care. However, the development of these diseases is not
only intrinsically dependent on obesity, but also on the pres-
Correspondence to: Batool Hassan, Ziauddin College of ence of the fat mass and obesity-associated (FTO) gene.9,10 The
Rehabilitation Sciences, Ziauddin University, Karachi, genome-wide association study (GWAS) analysis, which
Pakistan involved multiracial populations, has documented the associa-
E-mail: [email protected]
tion between FTO gene and the risk of various types of cancers
.....................................................
Received: October 05, 2022; Revised: April 01, 2023;
and obesity.10
Accepted: July 20, 2023 Over the last three decades, there had been an exponential
DOI: https://doi.org/10.29271/jcpsp.2023.11.1293
growth in the prevalence of obesity; incidences of this condition

Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298 1293
Batool Hassan, Basit Ansari and Sumaira Farooqui

nearly doubled among the adult and childhood population and indicated low, medium, and large effects, respectively.
tripled among adolescents. This had led to healthcare practi- Cochrane’s Q statistic and the percentage of heterogeneity
tioners and policymakers devising strategies to manage the were used to determine the level of heterogeneity. I2 was calcu-
8
menace of worldwide diseases. Owing to the increasing risk of lated by dividing the number by Cochrane’s Q value and
obesity, all individuals, irrespective of age, gender, and demo- removing the degrees of freedom (Df) to obtain a percentage
graphic characteristics, are now susceptible to this condition. 2
value (I = Q-Df/Q) of 0–100% (p<0.05), where 0% denoted no
Hence, researchers are shifting their focus from devising heterogeneity between the studies and higher values denoted
preventive strategies to treatment approaches for obesity.11 a higher degree of variability.
Several guidelines from the Obesity Society had been prepared
to guide healthcare professionals in treating obesity; they RESULTS
outlined multiple therapies, such as lifestyle modifications, A total of 7230 articles were retrieved in the initial searching
increased physical activities, dietary changes, and medica- through six database searches. Nine hundred and thirty original
tions.12 articles were evaluated based on their titles and contents. The
Surgery is recommended in some cases. Several pieces of liter- relevant full-text articles were sorted and selected after
ature related to the effects of exercise in managing obesity are screening of abstract, n=526 and finally, n=10 studies met the
available. In these reports, aerobic or resistance exercises or inclusion criteria to be included in the study. The flowchart of
combinations of conditioning forms are emphasised. However, study inclusion is illustrated in Figure 1.
to the best of the authors’ knowledge, to date, no studies have
evaluated the exercise dose and associated response.13 The
study aimed to determine the effects of different exercises on
thyroid stimulating hormone (TSH) levels among patients with
obesity.
The PubMed, Cochrane, Google Scholar, Medline, and Biomed
Central databases were searched using the keywords exercise,
aerobic, rehabilitation, metabolic syndrome, and thyroid stimu-
lating hormone, to obtain studies on the effect of exercise on
TSH. The inclusion criteria was studies published in English
between 2010 and 2021 that examined the efficacy of physical
therapy management with a sham treatment on TSH levels in
patients with obesity. Trials without a control group or condi-
tion and participants with comorbidities were excluded.
Studies for which full-text articles were unavailable or those
that were published in a non-preferred language were
2
excluded. Obesity was defined as BMI > 30 kg/m . Physical
activity included aerobics, resistance training, and yoga.
Data abstraction and quality evaluation were performed using
the inclusion and exclusion criteria under a uniform method- Figure 1: PRISMA flowchart of studies.
ology. A data mining form was designed by extracting study
information, such as author’s name, publication year, targeted
population, and treatment duration (Table I). This study
followed the Preferred Reporting Items for Systematic Reviews
and Meta-Analysis (PRISMA) guidelines.
The risk of bias for random allocation, allocation concealment,
blinding of participants and outcome assessors, insufficient
outcome data, and selective reporting was evaluated using the
14
Cochrane tool.
Data were examined using MedCalc statistical software,
version 18.11.3. In a random-effects model, the pooled impact
was calculated using the continuous measurement stan-
dardised mean difference (SMD) method (I2 at 95% CI). The
data were evaluated using Hedges’ g statistics, SMD tables,
and forest plots. The findings were interpreted using Cohen’s Figure 2: Forest plot of continuous measure standardised mean differ-
rule of thumb, which stipulated that values of 0.2, 0.5, and 0.8 ence (SMD) for determining effect size.

1294 Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298
Effects of physical activity on thyroid stimulating hormone levels in obese metabolic syndrome patients

Table I: Features of the included studies.

Author Design Age Target Population Groups Intervention Outcome

Measures
Abbas et al., RCT 20–35 years Pregnant women with EG (n=21) EG: The treadmill-training programme was TSH
202115 hypothyroidism CG (n=21) performed for 3 sessions/week i.e. one every
other day for 12 weeks along with thyroxine
replacement doses (100 µg/day).
CG: The control group received thyroxine
replacement doses (100 µg/day).
Berahman et al., RCT 65–75 years Post-menopausal women EG (n=16) EG: The 12-week training programme TSH
202116 with metabolic CG (n=15) consisted of intermittent 60-minute water-
syndrome based rhythmic exercise training 3
times/week.
CG: Thyroxine treatment was administered to
the control group
Ebrahemi et al., RCT 45–55 years Overweight men EG (n=13) EG: Participants in the Pilates group TSH
202117 CG (n=13) performed Pilates training for 60–75 min, 3
times/week for 8 weeks
CG: No intervention
Pancar et al., RCT 20–22 years Healthy individuals EG (n=12) EG: A 6-week programme consisting of seven TSH
202018 CG (n=12) basic movements, including core strength
exercises was provided to the participants.
Exercise frequency was determined as 3
days/week.
CG: No exercise
Kiani et al., RCT 11–17 years Inactive girls EG (n=15) EG: Participants performed four weeks of TSH
202019 CG (n=15) moderate aerobic training, with 3
sessions/week at 70% maximal heart rate.
CG: No exercise
Sefat et al., RCT 8–15 years Overweight girls with EG (n=10) EG: The experimental group performed TSH
201920 hypothyroidism CG (n=10) weight training (40–65% of 1 RM) and aerobic
exercise concurrently for 8 weeks.
CG: The aerobic training programme
consisted of 30-minute sessions that began
at 60–70% heart rate reserve.
Rani et al., RCT 18–45 years Women with menstrual EG (n=45) EG: For a period of 6 months, participants TSH
201621 disorders CG (n=42) received yoga intervention and medication.
CG: Given prescribed medication
Chaturvedi et al., RCT 40–60 years Perimenopausal women EG (n=111) EG: Participants received Hatha yoga; 21 TSH
201622 CG (n=105) poses were performed. The duration of
intervention was 45-minute every day for 12
weeks.
CG: Seven functional exercises were
performed for a duration of 12 weeks.
Bansal et al., RCT 30–40 years Patients with EG (n=10) EG: The regular activity sessions were TSH
201523 hypothyroidism CG (n=10) provided in the form of sports or running. All
of the participants were stable on their
respective thyroxine replacement doses
(eltroxine) for 6 months.
CG: Patients had maintained their respective
thyroxine replacement doses (eltroxine) for 6
months.
Onsori et al., RCT 40 years or Sedentary women EG (n=15) EG: The training programme consisted of 12 TSH
201524 above CG (n=15) weeks of moderate-intensity aerobic
exercises with music, with three 60-minute
sessions/week.
CG: All participants were stable on their
respective thyroxine replacement doses.
CG = Control group, EG = Experimental group, TSH = Thyroid stimulating hormone, RCT = Randomised controlled trial, RM = Repetition maximum.

Table II: SMD on random-effects model within 95% of CI and statistical heterogeneity.

Study N1 N2 Total SMD SE 95% CI t p Weight (%)

Fixed Random
Abbas et al., 2021 21 21 42 -3.195 0.462 -4.128 to -2.262 3.73 9.05
Berahman et al., 2021 16 15 31 -0.345 0.353 -1.067 to 0.376 . . 6.39 10.16
Ebrahemi et al., 2021 13 13 26 -0.751 0.394 -1.564 to 0.0618 . . 5.12 9.75
Pancar et al., 2020 12 12 24 -0.913 0.416 -1.775 to -0.0514 . . 4.60 9.53
Kiani et al., 2020 15 15 30 0.162 0.356 -0.567 to 0.891 . . 6.27 10.12
Sefat et al., 2019 10 10 20 0.262 0.430 -0.642 to 1.166 . . 4.29 9.38
Rani et al., 2016 45 42 87 -0.421 0.215 -0.848 to 0.00697 . . 17.19 11.37
Chaturvedi et al., 2016 111 105 216 0.102 0.136 -0.165 to 0.370 . . 43.13 11.88
Bansal et al., 2015 10 10 20 -1.582 0.496 -2.624 to -0.540 . . 3.23 8.71
Onsori et al., 2015 15 15 30 0.557 0.362 -0.186 to 1.299 . . 6.05 10.06
Total (fixed effects) 268 258 526 -0.246 0.0891 -0.421 to -0.0707 -2.757 .006 100.00 100.00
Total (random effects) 268 258 526 -0.561 0.272 -1.096 to -0.0261 -2.060 .040 100.00 100.00

Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298 1295
Batool Hassan, Basit Ansari and Sumaira Farooqui

Table III: Cochrane collaboration’s tool for assessing risk of bias of included studies.

Author & Year Random Allocation Blinding of Blinding of Incomplete Reporting Bias
Sequence Concealment Participants and Outcome Outcome Data
Generation Personnel Assessment
Abbas et al., 202115 + + ? ? + +
Berahman et al., 202116 + + ? ? + +
Ebrahemi et al., 202117 + + + ? + +
Pancar et al., 202018 + + ? ? + +
Kiani et al., 202019 + + ? ? + +
Sefat et al., 201920 + + ? ? - +
Rani et al., 201621 + + + + + +
Chaturvedi et al., 201622 + + ? ? + +
Bansal et al., 201523 + + - - + +
Onsori et al., 201524 + + _ - + +
+ Low risk of bias, - High risk of bias, ? Unknown risk of bias.

Risk of bias was evaluated by using the Cochrane tool in the

following domains, as shown in Table III and Figure 3. All
studies showed a low risk of bias as they followed a
randomisation sequence. 15-24 All studies had concealed
allocation of participants. 15-24 Two studies considered
participant and personnel blinding;17,21 two studies showed
high risk of bias,23,24 whereas six studies showed an unknown
risk of bias.15,16,18,19,20,22 Seven studies showed an unknown risk
of bias,15-22 one study showed a low risk of bias,21 whereas
two studies showed a high risk of bias.23,24 One study showed
high risk of bias,20 while the remaining had a low risk of bias
in this regard. 15-18,21-24 A low risk of reporting bias was
demonstrated in all ten studies.15-24

DISCUSSION

The findings of this study revealed that based on random-

effects model, physical training has a moderate effect in
Figure 3: Cochrane risk of bias.
terms of reducing the levels of TSH in patients with
hypothyroidism and obesity. The analysis yielded an effect
The results of 10 randomised controlled studies showed size (ES) of -0.56, I2 = 86.361%, suggesting that physical
improved TSH levels in the physical therapy intervention training was effective for managing obesity by affecting
group in comparison to the group that was only on thyroid secretion. The studies included in this review
medication or sham treatment. The effect size of reflected a mild pool effect ranging from as low as -0.34515
physiotherapy intervention in terms of SMD in random- to as high as -3.19514. Six studies included in this analysis
effects model indicated an impact of 0.56, which, per indicated that exercises had a positive effect on TSH level,
Cohen’s rule of thumb, indicated that physical therapy when compared with strategies such as pharmacological
management had a moderate effect on decreasing the TSH management and sham approaches, whereas four studies
levels among individuals with obesity, as shown in Table II. reported that exercise-based intervention strategies were
The impact of physical therapy management was also less effective in reducing TSH levels among healthy
examined using a forest plot, to reflect the pool effects in individuals and those with obesity or hypothyroidism.
random-effects model at a 95% CI. However, individual SMD analyses of these four studies
revealed that the TSH level increased from 0.16 to 0.55 in
The level of inconsistency among the studies was 86.61 the exercise group. Altaye et al. conducted a study among
percent. Thus, the random-effects model was used to adolescent patients with intellectual disabilities and
evaluate the pool effects. The percentage of heterogeneity hypothyroidism that showed increased levels of
among the SMD of the included studies was determined triiodothyronine (T3), tetraiodothyronine (T4) and decreased
using the I2 test and Cochrane’s Q. With an effect size (SMD) levels of TSH after performing 16 weeks of moderate
of -0.56 (95% CI: -1.09 – 0.02) calculated using a random- intensity aerobic exercises.25
2
effects model (I of 86.61%), aerobic exercise had a
moderate overall effect on lowering individuals’ TSH levels, Similarly, in one study that evaluated the effects of acute
according to SMD by Hedges’ g statistics (95% CI, 77.31 – aerobic exercise using a cycled ergometer on TSH levels in
92.10, Table II, Figure 2). patients with hypothyroidism, the serum TSH levels were

1296 Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298
Effects of physical activity on thyroid stimulating hormone levels in obese metabolic syndrome patients

observed to be significantly reduced among the participants.26 2. Basit A, Shera AS. Prevalence of metabolic syndrome in
Another study involving university students aimed to Pakistan. Metab Syndr Relat Disord 2008; 6(3):171-5. doi:
determine the effects of a combination of aerobic and 10.1089/met.2008.0005.
resistance training exercises. Herein, in the aerobic training- 3. Patel R, Dave C, Mehta S, Mendpara H, Shukla R, Bajpai A.
alone and control groups, 10 weeks of training, performed 4 Metabolic impact of subclinical hypothyroidism in obese
days each week at an intensity of 45–55% for 30 minutes, children and adolescents. Indian J Pediatr 2021; 88(5):
significantly lowered the levels of TSH (p <.005) among 437-40. doi: 10.1007/s12098-020-03463-0.
sedentary males, whereas in the combined group, which 4. Korac B, Kalezic A, Pekovic-Vaughan V, Korac A, Jankovic
included the same aerobic protocol with the addition of push- A. Redox changes in obesity, metabolic syndrome, and
ups, sit-ups, and planks for 10 minutes, was also significantly diabetes. Redox Biol 2021; 42:1-17. doi: 10.1016/j.redox.
effective (p <0.005) in affecting TSH levels. Interestingly, the 2021.101887.
training effects were similar in the combination and aerobic 5. Ter Horst R, van den Munckhof IC, Schraa K, Aguirre-
training groups, indicating that adding a different form of Gamboa R, Jaeger M, Smeekens SP, et al. Sex-specific
exercise did not result in greater reductions in TSH levels.27 regulation of inflammation and metabolic syndrome in
However, further multiple-centre studies involving larger obesity. Arterioscler Thromb Vasc Biol 2020; 40(7):
sample should be performed to confirm the associated 1787-800. doi: 10.1161/ATVBAHA.120.314508.
effects. The findings of our meta-analysis clearly 6. Yu S, Xing L, Du Z, Tian Y, Jing L, Yan H, Lin M, et al.
demonstrated that exercise-based management approaches Prevalence of obesity and associated risk factors and
had a moderate effect in reducing TSH levels, and exercise- cardiometabolic comorbidities in rural Northeast China. Bio
based interventional strategies should be incorporated as a Med Res Int 2019; 2019:1-9. doi: 10.1155/2019/6509083.
distinct and adjunct approach to management in patients 7. Upadhyay J, Farr O, Perakakis N, Ghaly W, Mantzoros C.
with hypothyroidism, particularly in those with obesity. In Obesity as a disease. Med Clin North Am 2018; 102(1):
addition, studies incorporating the effects of exercise on T3 13-33. doi: 10.1016/j.mcna.2017.08.004.
and T4 levels in association with TSH levels must be 8. Cawley J, Meyerhoefer C, Biener A, Hammer M, Wintfeld N.
performed to further evaluate the effects of training on all Savings in medical expenditures associated with
thyroid gland biomarkers, to draw an association between reductions in body mass index among US adults with
thyroid biomarkers and physical training. obesity, by diabetes status. Pharmaco Economic 2015;
33(7):707-22. doi: 10.1007/s40273-014-0230-2.

CONCLUSION 9. Li M, Qian M, Kyler K, Xu J. Adipose tissue-endothelial cell

interactions in obesity-induced endothelial dysfunction.
Front Cardiovasc Med 2021; 8:1-9. doi: 10.3389/fcvm.
The analysis concluded that although a pooled moderate
2021.681581.
effect of training on TSH levels was observed when all the
studies were analysed using a continuous measure analysis 10. Relier S, Rivals E, David A. The multifaceted functions of
the fat mass and obesity-associated protein (FTO) in
SMD model, an individual analysis of the studies revealed a
normal and cancer cells. RNA Biol 2022; 19:132-42. doi:
mild effect, with many studies also revealing the negative
10.1080/15476286.2021.2016203.
impact of training on TSH levels. Nonetheless, a review of
11. Peirson L, Fitzpatrick-Lewis D, Morrison K, Ciliska D, Kenny
the literature revealed that exercise-based intervention
M, Ali MU, et al. Prevention of overweight and obesity in
strategies are safe and effective as a management strategy
children and youth: A systematic review and meta-analysis.
for hypothyroidism and obesity due to hypothyroidism. Can Med Assoc J 2015; 3(1):23-33. doi: 10.9778/cmajo.
20140053.
COMPETING INTEREST:
12. Wharton S, Lau DC, Vallis M, Sharma AM, Biertho L,
The authors declared no competing interest. Campbell-Scherer D, et al. Obesity in adults: A clinical
practice guideline. Can Med Assoc J 2020; 192(31):
AUTHORS’ CONTRIBUTION: 875-91. doi: 10.1503/cmaj.191707.
BH, SF: Conception and design, acquisition, analysis and 13. Heymsfield SB, Wadden TA. Mechanisms, pathophysio-
interpretation of data. logy, and management of obesity. N Engl J Med 2017;
BH, BA: Drafting the article and revising it critically for 376(3): 254-66. doi: 10.1056/NEJMra1514009.
important intellectual content.
14. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D,
All authors approved the final version of the manuscript to Oxman AD, et al. The cochrane collaboration’s tool for
be published. assessing risk of bias in randomised trials. BMJ 2011;
343:1-9. doi: 10.1136/bmj.d5928.
REFERENCES 15. Abbas MA, El Badrey SM, ElDeeb AM, Sayed AM. Effect of
aerobic exercises on the thyroid hormones in treated
1. Swarup S, Goyal A, Grigorova Y, Zeltser R. Metabolic hypothyroid pregnant women. J Adv Pharm Res 2019;
syndrome. (Updated 2022 Oct 24). In: StatPearls [Internet]. 9:49-53.
Treasure Island (FL): StatPearls Publishing; 2022.

Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298 1297
Batool Hassan, Basit Ansari and Sumaira Farooqui

16. Berahman H, Elmieh A. The effect of water-based rhythmic 22. Chaturvedi A, Nayak G, Nayak AG, Rao A. Comparative
exercise training on glucose homeostasis and thyroid assessment of the effects of hatha yoga and physical
hormones in postmenopausal women with metabolic exercise on biochemical functions in perimenopausal
syndrome. Horm Mol Biol Clin Investig 2021; 42(2):189-93. women. J Clin Diagn Res 2016; 10(8):1-4. doi: 10.7860/
doi: 10.1515/hmbci-2020-0062. JCDR/2016/18891.8389.

17. Ebrahemi Rokni F, Habibian M, Farajtabar Behrestaq S. The 23. Bansal A, Kaushik A, Singh CM, Sharma V, Singh H. The
effectiveness of pilates training and vitamin d intake on the effect of regular physical exercise on the thyroid function
hs-CRP and TSH in overweight men. J Inflamm Dis 2021; of treated hypothyroid patients: An interventional study at
25(1):31-8. doi: 10.32598/JQUMS.25.1.8. a tertiary care center in Bastar region of India. Arch
Med Health Sci 2015; 3:244-6.
18. Pancar Z. Effects of core exercises on thyroid metabolism
24. Onsori M, Galedari M. Effects of 12 weeks aerobic exercise
in men. Gaziantep Üniv Spor Bilim Derg 2020; 5:590-7. doi:
on plasma level of TSH and thyroid hormones in sedentary
10.31680/gaunjss.826057.
women. Eur J Sport Sci 2015; 4(1):45-9.
19. Kiani L, Byeranvand S, Barkhordari A, Bazgir B. The effects
25. Altaye KZ, Mondal S, Legesse K, Abdulkedir M. Effects of
of moderate intensity aerobic training on serum levels of
aerobic exercise on thyroid hormonal change responses
thyroid hormones in inactive girls. NAEP 2020; 2(3):
among adolescents with intellectual disabilities. BMJ Open
117-28. doi: 10.22054/NASS.2020.45178.1044.
Sport Exerc Med 2019; 5(1):1-4. doi: 10.1136/bmjsem-
20. Sefat SM, Shabani R, Nazari M. The effect of concurrent 2019-000524.
aerobic-resistance training on thyroid hormones, blood 26. Masaki M, Koide K, Goda A, Miyazaki A, Masuyama T,
glucose hemostasis, and blood lipid indices in overweight Koshiba M. Effect of acute aerobic exercise on arterial
girls with hypothyroidism. Horm Mol Biol Clin Investig 2019; stiffness and thyroid-stimulating hormone in subclinical
40:1-8. doi: 10.1515/hmbci-2019-0031. hypothyroidism. Heart Vessels 2019; 34(8):1309-16. doi:
21. Rani K, Tiwari SC, Kumar S, Singh U, Prakash J, Srivastava 10.1007/s00380-019-01355-8.
N. Psycho-biological changes with add on yoga nidra in 27. Akbulut T. Responses of uric acid, glucose, thyroid
patients with menstrual disorders: A randomised clinical hormones and liver enzymes to aerobic and combined
trial. J Caring Sci 2016; 5(1):1-9. doi: 10.15171/jcs.2016. exercises in university students. High Educ Stud 2020;
001. 10:109-14.

••••••••••

1298 Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(11):1293-1298