land versus aquatic exercise: effects on angptl4 and postural control in elderly men with metabolic syndrome

Background and purpose: metabolic syndrome (mets) is a cluster of disorders increasing cardiovascular risk. exercise is a key intervention, but the optimal environment (land vs water) for modulating metabolic hepatokines, like angiopoietin-like protein 4 (angptl4) and improving functional outcomes, like balance in the elderly with mets remains unclear. this study compared the effects of eight-week combined (aerobic+resistance) exercise programs performed on land versus in water on angptl4 levels, balance, and anthropometric indices in elderly men with mets.materials and methods:  in this quasi-experimental study, 45 elderly men (age: 63. 14±3.23 years) with mets were assigned to three groups: the water exercise (we) group, the land exercise (le) group, and  the control group (cg). the exercise interventions consisted of three sessions per week for eight weeks. fasting serum angptl4 levels, functional balance (static and dynamic), and anthropometric indices were assessed pre- and post-intervention. data were analyzed using repeated measures anova, friedman, and appropriate bonferroni and games-howell post-hoc tests.results: while angptl4 levels decreased slightly in the exercise groups and increased in the cg, these changes were not statistically significant (p>0.05). both exercise groups showed significant within-group improvements in dynamic balance and static balance with eyes open (p<0.05), but no significant between-group differences were found. body mass index (bmi) decreased significantly only in the we group (p<0.05).conclusion: eight weeks of combined exercise training, whether on land or in water, improved balance performance but did not significantly alter serum angptl4 levels in elderly men with mets. water-based exercise may offer a superior advantage for reducing bmi. the lack of significant change in angptl4 may suggest a complex relationship influenced by age, training duration, and measurement specificity, warranting further investigation.