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Baker MK, Kennedy DJ, Bohle PL, Campbell D, Wiltshire JH, Singh MAF. Core self-evaluation as a predictor of strength training adoption in older adults. Maturitas 2011; 68:88-93. [DOI: 10.1016/j.maturitas.2010.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 01/22/2023]
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Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33:e147-67. [PMID: 21115758 PMCID: PMC2992225 DOI: 10.2337/dc10-9990] [Citation(s) in RCA: 862] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, Virginia, USA.
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Hazley L, Ingle L, Tsakirides C, Carroll S, Nagi D. Impact of a Short-Term, Moderate Intensity, Lower Volume Circuit Resistance Training Programme on Metabolic Risk Factors in Overweight/Obese Type 2 Diabetics. Res Sports Med 2010; 18:251-62. [DOI: 10.1080/15438627.2010.510049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Laura Hazley
- a Carnegie Research Institute, Leeds Metropolitan University , Leeds, United Kingdom
| | - Lee Ingle
- a Carnegie Research Institute, Leeds Metropolitan University , Leeds, United Kingdom
| | - Costas Tsakirides
- a Carnegie Research Institute, Leeds Metropolitan University , Leeds, United Kingdom
| | - Sean Carroll
- a Carnegie Research Institute, Leeds Metropolitan University , Leeds, United Kingdom
| | - Dinesh Nagi
- a Carnegie Research Institute, Leeds Metropolitan University , Leeds, United Kingdom
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Ng CLW, Goh SY, Malhotra R, Østbye T, Tai ES. Minimal difference between aerobic and progressive resistance exercise on metabolic profile and fitness in older adults with diabetes mellitus: a randomised trial. J Physiother 2010; 56:163-70. [PMID: 20795922 DOI: 10.1016/s1836-9553(10)70021-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
QUESTION Is progressive resistance training as effective as aerobic training of similar duration in sedentary older adults with diabetes mellitus? DESIGN A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Sixty people with Type 2 diabetes mellitus with glycosylated haemoglobin (HbA1c) between 8% and 10% in the past month. INTERVENTION One group undertook progressive resistance exercise and the other group undertook aerobic exercise. Both groups completed 18 sessions over 8 weeks. In each session, the progressive resistance exercise group did nine resistive exercises while the aerobic exercise group did 50 minutes of aerobic exercise. OUTCOME MEASURES HbA1c, blood glucose, lipid profile (total, high- and low-density cholesterol and triglycerides), weight, body mass index, body fat, waist circumference, waist:hip ratio, blood pressure, and peak oxygen consumption. RESULTS Forty-nine (82%) participants completed the intervention. HbA1c reduced by a similar amount in both groups (MD 0.1%, 95% CI -0.3 to 0.5). However, significant between-group differences occurred in change in waist circumference in favour of progressive resistance exercise (MD -1.8 cm, 95% CI -0.5 to -3.1), and in change in peak oxygen consumption in favour of aerobic exercise (MD 5.2 ml/kg, 95% CI 0.0 to 10.4). CONCLUSIONS Progressive resistance exercise has similar effects to aerobic exercise and therefore offers a useful alternative for patients unable to participate in aerobic exercise. TRIAL REGISTRATION NCT01000519.
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Affiliation(s)
- Cindy L W Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore.
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Colagiuri S, Vita P, Cardona-Morrell M, Singh MF, Farrell L, Milat A, Haas M, Bauman A. The Sydney Diabetes Prevention Program: a community-based translational study. BMC Public Health 2010; 10:328. [PMID: 20534170 PMCID: PMC2898827 DOI: 10.1186/1471-2458-10-328] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 06/10/2010] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity. Prevention is an essential component of strategies to reduce the diabetes burden. There is strong and consistent evidence from randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet, increases physical activity and achieves weight loss in at risk people. The current challenge is to translate this evidence into routine community settings, determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes. Methods/Design The Sydney Diabetes Prevention Program (SDPP) is a translational study which will be conducted in 1,550 participants aged 50-65 years (including 100 indigenous people aged 18 years and older) at high risk of future development of diabetes. Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention. The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals: 5% weight loss, 210 min/week physical activity (aerobic and strength training exercise), limit dietary fat and saturated fat to less than 30% and 10% of energy intake respectively, and at least 15 g/1000 kcal dietary fibre. This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months. The effectiveness and costs of the program on diabetes-related risk factors will be evaluated. Main outcomes include changes in weight, physical activity, and dietary changes (fat, saturated fat and fibre intake). Secondary outcomes include changes in waist circumference, fasting plasma glucose, blood pressure, lipids, quality of life, psychological well being, medication use and health service utilization. Discussion This translational study will ascertain the reach, feasibility, effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care. If demonstrated to be effective, it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, NSW, Australia.
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Multicomponent, home-based resistance training for obese adults with type 2 diabetes: a randomized controlled trial. Int J Obes (Lond) 2010; 34:1733-41. [PMID: 20531348 DOI: 10.1038/ijo.2010.109] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To investigate whether a home-based resistance training (RT) program that supplied high-quality equipment and qualified exercise specialists could provide benefits to obese patients with type 2 diabetes. METHODS A total of 48 obese individuals with type 2 diabetes were randomly assigned to either an RT (n=27) or a control group (n=21). Those in the RT group received a multigym and dumbbells and performed RT 3 days per week for 16 weeks at home. A qualified exercise specialist supervised training, with supervision being gradually decreased throughout the study. Primary outcome measures included strength and hemoglobin-A1C, whereas secondary outcome measures included other cardiovascular risk markers, key social-cognitive constructs and health-related quality of life. RESULTS Intention-to-treat analyses indicated a significant increase in upper and lower body strength for the RT group compared with controls (20-37% mean increases in the RT group). No significant reduction in A1C levels was observed. The RT group had unchanged high-density lipoprotein cholesterol levels in comparison to declines in the control group. Significant reductions in fasting insulin, and increases in RT-related self-efficacy and intentions, were also observed in the RT group. CONCLUSIONS Supervised home-based RT with high-quality equipment was effective for improving strength, along with other secondary outcomes in obese patients with type 2 diabetes.
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Adair JD, Wollner SB, DaCosta ME, Blackburn GL. Progressive Resistance Training for Patients with Class III Obesity. ACTA ACUST UNITED AC 2010. [DOI: 10.1089/obe.2010.0303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Black LE, Swan PD, Alvar BA. Effects of Intensity and Volume on Insulin Sensitivity During Acute Bouts of Resistance Training. J Strength Cond Res 2010; 24:1109-16. [DOI: 10.1519/jsc.0b013e3181cbab6d] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Acute Cardiovascular Alterations in Hypertensive Renal Patients During Exercise with Constant Load in the Interdialytic Period. HUMAN MOVEMENT 2010. [DOI: 10.2478/v10038-010-0011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Blackburn GL, Wollner S, Heymsfield SB. Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic. Am J Clin Nutr 2010; 91:289S-292S. [PMID: 19906805 PMCID: PMC3131844 DOI: 10.3945/ajcn.2009.28473d] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although rates of obesity have increased universally in the United States over the past 30 y, it is clear that certain individuals are more susceptible to weight gain than others. Extreme obesity [body mass index (in kg/m(2)) > 40] is increasing at rates greater than any other class of obesity in the United States. Severely obese patients often suffer from a wide variety of comorbidities. Although weight-loss surgery is the most effective treatment, it offers little in the way of large-scale containment due to its costly and invasive nature. Lifestyle interventions that induce modest weight loss and improve fitness can significantly lower disease risk. As medical professionals in the field of nutrition, we must focus first on the patient cohort that suffers most from the modern obesogenic environment. Lifestyle interventions specifically targeted toward the class III obese cohort should be a high priority in nutrition medicine.
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Affiliation(s)
- George L Blackburn
- Beth Israel Deaconess Medical Center, Center for the Study of Nutrition Medicine, Boston, MA, USA.
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Abstract
CONTEXT Exercise is recommended for individuals with diabetes mellitus, and several facets of the disease must be considered when managing the diabetic athlete. The purpose of this article is to review diabetes care in the context of sports participation. EVIDENCE ACQUISITION Relevant studies were identified through a literature search of MEDLINE and the Cochrane database, as well as manual review of reference lists of identified sources. RESULTS Diabetics should be evaluated for complications of long-standing disease before beginning an exercise program, and exercise should be modified appropriately if complications are present. Athletes who use insulin or oral insulin secretogogues are at risk for exercise-induced immediate or delayed hypoglycemia. Diabetics are advised to engage in a combination of regular aerobic and resistance exercise. Insulin-dependent diabetics should supplement carbohydrate before and after exercise, as well as during exercise for events lasting longer than 1 hour. Adjustment of insulin dosing based on planned exercise intensity is another strategy to prevent hypoglycemia. Insulin-dependent athletes should monitor blood sugar closely before, during, and after exercise. Significant hyperglycemia before exercise should preclude exercise because the stress of exercise can paradoxically exacerbate hyperglycemia and lead to ketoacidosis. Athletes should be aware of hypoglycemia symptoms and have rapidly absorbable glucose available in case of hypoglycemia. CONCLUSION Exercise is an important component of diabetes treatment, and most people with diabetes can safely participate in sports at recreational and elite levels with attention to appropriate precautions.
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Brochu M, Malita MF, Messier V, Doucet E, Strychar I, Lavoie JM, Prud'homme D, Rabasa-Lhoret R. Resistance training does not contribute to improving the metabolic profile after a 6-month weight loss program in overweight and obese postmenopausal women. J Clin Endocrinol Metab 2009; 94:3226-33. [PMID: 19567540 DOI: 10.1210/jc.2008-2706] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Limited data are available regarding the impact of caloric restriction (CR) in combination with resistance training (RT) on the metabolic profile of postmenopausal women. OBJECTIVE The objective of the study was to determine whether RT adds to CR in improving body composition and the metabolic profile. DESIGN AND SETTING This was a 6-month, randomized, clinical trial. PATIENTS Patients included 107 postmenopausal women (body mass index >27 kg/m(2)). INTERVENTION The intervention was a 6-month CR alone or in combination with a RT program. MAIN OUTCOME MEASURES Fat mass (FM), lean body mass (LBM), abdominal sc fat and visceral fat, fasting lipids, insulin sensitivity, resting blood pressure, and inflammation markers were measured. RESULTS Both groups were similar at baseline and significantly decreased body weight, body mass index, FM, percent FM, abdominal sc fat, and visceral fat after the study (P < 0.001), with greater losses of percent FM and trunk FM in the CR + RT group (P < 0.05). LMB significantly decreased in the CR (-0.9 +/- 2.4 kg) and the CR+RT (-0.4 +/- 2.2 kg) groups (P < 0.005), with no difference between them. Both groups significantly improved plasma triglycerides, fasting insulin level, glucose disposal, and markers of the inflammation profile after weight loss (P < 0.05), with no difference between groups. No improvements were observed for the other variables of interest in both groups. CONCLUSIONS CR+RT was associated with greater losses in percent FM and trunk FM compared with CR alone. However, CR+RT was not associated with additional improvements in the metabolic profile compared with CR alone.
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Affiliation(s)
- Martin Brochu
- Faculty of Physical Education and Sports, University of Sherbrooke, J1K 2R1, and Research Centre on Aging, Health and Social Services Centre, Sherbrooke University Institute of Geriatrics, Sherbrooke, Québec, Canada.
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65
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Cardiovascular and metabolic complications during androgen deprivation: exercise as a potential countermeasure. Prostate Cancer Prostatic Dis 2009; 12:233-40. [PMID: 19488067 DOI: 10.1038/pcan.2009.12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Apart from the well-established adverse musculoskeletal and sexual health effects of androgen deprivation therapy (ADT), evidence is accumulating of substantial ADT-related cardiovascular and metabolic complications, which may impact quality of life and overall survival. In this brief review we discuss (1) the incidence of cardiovascular and metabolic complications during/following ADT from large cohort studies, (2) the increased risk factors for cardiovascular and metabolic disease from cross-sectional and prospective studies and (3) the use of physical exercise as a countermeasure in this new era of ADT-related toxicity. It is clear that exercise has the potential to provide a myriad of benefits to men undergoing ADT that may result in reduced morbidity and mortality, and subsequently improve quality of life.
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Lipoprotein profile, glycemic control and physical fitness after strength and aerobic training in post-menopausal women with type 2 diabetes. Eur J Appl Physiol 2009; 106:901-7. [PMID: 19458961 DOI: 10.1007/s00421-009-1078-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2009] [Indexed: 12/20/2022]
Abstract
We studied the effects on blood lipids and physical fitness after a training program that combined strength and aerobic exercise in postmenopausal women with type 2 diabetes. Ten patients (55.0 +/- 5.2 years) followed four exercise sessions per week, two strength and two aerobic, and ten (59.4 +/- 3.2 years) served as a control group. Lipid profile, glycated hemoglobin (HbA(1c)), HOMA2 index, exercise stress and muscular testing were assessed at the beginning and after 16 weeks of training program. Exercise training increased significantly HDL-C (17.2%; P < 0.001) and decreased triglycerides (18.9%), HbA(1c) (15.0%), fasting plasma glucose (5.4%), insulin resistance (HOMA2 25.2%) and resting blood pressure (P < 0.01). After 16 weeks of training, exercise time (17.8%) and muscular strength increased significantly (P < 0.001). The results indicated that a combined strength and aerobic training program could induce positive adaptations on lipid profile, glycemic control, insulin resistance, cardiovascular function, and physical fitness in post-menopausal women with type 2 diabetes.
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Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009; 83:157-75. [PMID: 19135754 DOI: 10.1016/j.diabres.2008.11.024] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 11/08/2008] [Accepted: 11/17/2008] [Indexed: 11/15/2022]
Abstract
This paper systematically reviews the effect of resistance training (RT) on glycemic control and insulin sensitivity in adults with type 2 diabetes. Twenty studies were included, with the volume, frequency and intensity of RT varying markedly. Supervised RT improved glycemic control and insulin sensitivity, however, when supervision was removed compliance and glycemic control decreased. Evidence indicates the mechanisms behind the improvements to glucose tolerance require further elucidation. Although research demonstrates apparent benefits of RT for individuals with diabetes, further research is required to elucidate the minimum effective dose by describing frequency, intensity and the duration of acute and chronic improvements.
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Affiliation(s)
- B A Gordon
- Exercise Metabolism Group, School of Medical Sciences, RMIT University, Melbourne, Australia.
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69
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Exercise and glycemic control in diabetes: benefits, challenges, and adjustments to pharmacotherapy. Phys Ther 2008; 88:1297-321. [PMID: 18801852 DOI: 10.2522/ptj.20080114] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Exercise, along with dietary intervention, represents first-line therapy for diabetes mellitus. Aerobic exercise is recommended for its beneficial effects on glucose control as well as its abilities to retard the progression of other comorbidities common in patients with diabetes, such as cardiovascular disease. The capability of aerobic exercise to improve glycemic control in diabetes is well documented, although adherence to exercise regimens is problematic. More recently, the glucose-lowering effects of resistance training have also been documented; this form of exercise has additional benefits, such as the capability to counteract sarcopenia, which is common in older people with type 2 diabetes. Exercise in people with diabetes, however, also can present significant challenges to glycemic control. Excessive glucose lowering can occur under certain conditions, enhancing the threat of hypoglycemia; in other situations, hyperglycemia can be accentuated. An understanding of the interactions between specific antidiabetic medications and various forms and intensities of exercise is essential to optimizing glycemic control while minimizing the potential for acute derangements in plasma glucose levels. Exogenous forms of insulin and agents that stimulate insulin secretion in a glucose-independent manner (such as sulfonylureas and glinides) increase the propensity for hypoglycemia during low- to moderate-intensity aerobic exercise. In contrast, exercise protocols characterized by high intensity are more likely to result in episodes of hyperglycemia. Strategies to minimize inappropriate swings in glycemic control are reviewed.
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Lambers S, Van Laethem C, Van Acker K, Calders P. Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Clin Rehabil 2008; 22:483-92. [PMID: 18511528 DOI: 10.1177/0269215508084582] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. DESIGN A double-blind randomized controlled trial with patients receiving either combination (COM), endurance (END) or no training (C). SETTING Sint-Jozef hospital (Belgium), general practice (Holland). SUBJECTS Forty-six type 2 diabetes patients (17 female, 29 male). INTERVENTIONS COM versus END and C. Patients exercised for three months, three times a week for 1 hour. MAIN MEASURES Six-minute walk test (6MW T), peak Vo(2), strength in upper and lower limbs, sit-to-stand, height, weight, body mass index, fat mass, glycosylated haemoglobin (HbA1c), glycaemia, triglycerides, high-density lipoprotein (HDL), total cholesterol and quality of life (General Health Survey Short Form (SF-36)). RESULTS COM had significant better results on sit-to-stand (P<0.05), 6MW T (P<0.01), strength in upper (P<0.001) and lower limbs (P<0.001) compared with C. A different evolution among COM and C was found for HbA1c (P<0.05) and cholesterol (P<0.01), both decreased in COM and increased in C. HDL increased in COM and decreased in C (P<0.01). END had significant higher results on the 6MW T (P<0.01) compared with C. Compared with END, COM had significantly higher results on strength in upper (P<0.01) and lower limbs (P<0.01). The evolution of SF-36 items was not significantly different between the three groups. CONCLUSION In diabetes type 2 patients, COM had significant better effects on indices of physical condition, diabetes and cardiovascular risk compared with C. Compared with END, COM gave a tendency towards better results, however more research with a larger number of participants is needed.
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Moreira SR, Arsa G, Oliveira HB, Lima LCJ, Campbell CSG, Simões HG. Methods to identify the lactate and glucose thresholds during resistance exercise for individuals with type 2 diabetes. J Strength Cond Res 2008; 22:1108-15. [PMID: 18545200 DOI: 10.1519/jsc.0b013e31816eb47c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to compare different methods to identify the lactate threshold (LT) and glucose threshold (GT) on resistance exercise for individuals with type 2 diabetes. Nine men with type 2 diabetes (47.2 +/- 12.4 years, 87.6 +/- 20.0 kg, 174.9 +/- 5.9 cm, and 22.4 +/- 7.2% body fat) performed incremental tests (ITs) on the leg press (LP) and bench press (BP) at relative intensities of 10, 20, 25, 30, 35, 40, 50, 60, 70, 80, and 90% of one-repetition maximum (1RM) at each 1-minute stage. During the 2-minute interval between stages, 25 mul of capillary blood were collected from the earlobe for blood lactate [Lac] and blood glucose [Gluc] analysis (YSI 2700S). The LT in the LP and BP was identified at IT by the inflexion in [Lac] response as well as by an equation originated from a polynomial adjustment (LTp) of the [Lac]/% 1RM ratio responses. The lowest [Gluc] during the IT identified the GT. The analysis of variance did not show differences among the 1RM at the thresholds identified by different methods in the LP (LTLP = 31.0% +/- 5.3% 1RM; GTLP = 32.1% +/- 6.1% 1RM; LTpLP = 36.7% +/- 5.6% 1RM; p > 0.05) and BP (LTBP = 29.9% +/- 8.5% 1RM; GTBP = 32.1% +/- 8.5% 1RM; LTpBP = 31.8% +/- 6.7% 1RM; p > 0.05). It was concluded that it was possible to identify the LT and GT in resistance exercise by different methods for individuals with type 2 diabetes with no differences between them. The intensities (kg) corresponding to these thresholds were between 46% and 60% of the body weight on the LP and between 18% and 26% of the body weight on the BP, in which the exercise prescription would be done to this intensity in 3 sets of 20 to 30 repetitions each and 1 minute of rest while alternating the muscle groups for blood glucose control for individuals with characteristics similar to the participants.
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Affiliation(s)
- Sérgio R Moreira
- Programa de Mestrado e Doutorado em Educação Física da Universidade Católica de Brasília, Brasil.
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Lima LCJ, Assis GV, Hiyane W, Almeida WS, Arsa G, Baldissera V, Campbell CSG, Simões HG. Hypotensive effects of exercise performed around anaerobic threshold in type 2 diabetic patients. Diabetes Res Clin Pract 2008; 81:216-22. [PMID: 18571267 DOI: 10.1016/j.diabres.2008.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 04/28/2008] [Indexed: 12/17/2022]
Abstract
AIM To verify the occurrence of post-exercise hypotension (PEH) in type 2 diabetics (DM(2)) and the effects of exercise intensity on post-exercise blood pressure (BP). METHODS Eleven men and women with DM(2) (58.5+/-10.2 years; 160+/-0.1cm; 80.6+/-13.5kg; 31.2+/-3.8kg/m(2), 19+/-3.2mLkgmin(-1) of VO(2max), 155.0+/-39.2mgdL(-1) of fasting blood glucose and 126+/-10/75+/-7mmHg of resting BP) performed an incremental test (IT) for cardiovascular evaluation and anaerobic threshold (AT) determination. Then, participants randomly underwent 2 exercise sessions (90% and 110% AT) and a control session (CON). In all sessions, BP was measured at resting, during 20min of exercise/control and at each 15min through 120min of post-exercise recovery (R15-R120). RESULTS The mean results of systolic BP (SBP)/diastolic BP (DBP) over the 120min of recovery were 125+/-16/76+/-7mmHg, 122+/-13/75+/-6mmHg and 129+/-16/78+/-7mmHg, respectively for 90%, 110% and CON. Significant reductions of SBP occurred after 90% (R15-R45) and 110% (R15-R90), while only after 110% there were reductions of DBP (R15, R45) and MAP (R15, R45, R75, R90, R105). CONCLUSIONS Both exercise intensities evoked reductions in SBP while DBP and MAP were reduced only after 110%. Despite the higher intensity exercise to be more effective in promoting BP reductions, we suggest caution while prescribing exercise for DM(2).
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Diabetes alters contraction-induced mitogen activated protein kinase activation in the rat soleus and plantaris. EXPERIMENTAL DIABETES RESEARCH 2008; 2008:738101. [PMID: 18551177 PMCID: PMC2409431 DOI: 10.1155/2008/738101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 07/01/2007] [Accepted: 02/24/2008] [Indexed: 11/24/2022]
Abstract
The prescription of anaerobic exercise has recently been advocated for the management of diabetes; however exercise-induced signaling in diabetic muscle remains largely unexplored. Evidence from exercise studies in nondiabetics suggests that the extracellular-signal-regulated kinases (Erk1/2), p38, and c-JUN NH2-terminal kinase (Jnk) mitogen-activated protein kinases (MAPKs) are important regulators of muscle adaptation. Here, we compare the basal and the in situ contraction-induced phosphorylation of Erk1/2- p38- and Jnk-MAPK and their downstream targets (p90rsk and MAPKAP-K2) in the plantaris and soleus muscles of normal and obese (fa/fa) Zucker rats. Compared to lean animals, the time course and magnitude of Erk1/2, p90rsk and p38 phosphorylation to a single bout of contractile stimuli were greater in the plantaris of obese animals. Jnk phosphorylation in response to contractile stimuli was muscle-type dependent with greater increases in the plantaris than the soleus. These results suggest that diabetes alters intramuscular signaling processes in response to a contractile stimulus.
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Nuclear factor-kappa B signaling in skeletal muscle atrophy. J Mol Med (Berl) 2008; 86:1113-26. [PMID: 18574572 DOI: 10.1007/s00109-008-0373-8] [Citation(s) in RCA: 310] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 05/18/2008] [Accepted: 05/22/2008] [Indexed: 12/21/2022]
Abstract
Skeletal muscle atrophy/wasting is a serious complication of a wide range of diseases and conditions such as aging, disuse, AIDS, chronic obstructive pulmonary disease, space travel, muscular dystrophy, chronic heart failure, sepsis, and cancer. Emerging evidence suggests that nuclear factor-kappa B (NF-kappaB) is one of the most important signaling pathways linked to the loss of skeletal muscle mass in various physiological and pathophysiological conditions. Activation of NF-kappaB in skeletal muscle leads to degradation of specific muscle proteins, induces inflammation and fibrosis, and blocks the regeneration of myofibers after injury/atrophy. Recent studies employing genetic mouse models have provided strong evidence that NF-kappaB can serve as an important molecular target for the prevention of skeletal muscle loss. In this article, we have outlined the current understanding regarding the role of NF-kappaB in skeletal muscle with particular reference to different models of muscle wasting and the development of novel therapy.
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76
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Manders RJ, Koopman R, Beelen M, Gijsen AP, Wodzig WK, Saris WH, van Loon LJ. The muscle protein synthetic response to carbohydrate and protein ingestion is not impaired in men with longstanding type 2 diabetes. J Nutr 2008; 138:1079-85. [PMID: 18492837 DOI: 10.1093/jn/138.6.1079] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Protein ingestion stimulates muscle protein synthesis and improves net muscle protein balance. Insulin resistance has been suggested to result in a reduced muscle protein synthetic response to food intake. As such, we hypothesized that type 2 diabetes patients have a impaired muscle protein synthetic response to food ingestion. To test this hypothesis, 10 male type 2 diabetes patients using their normal oral glucose-lowering medication (68 +/- 2 y) and 10 matched, normoglycemic men (65 +/- 2 y) were randomly assigned to 2 crossover treatments in which whole body and muscle protein synthesis were measured following the consumption of either carbohydrate (CHO) or carbohydrate with a protein hydrolysate (CHO+PRO). Primed, continuous infusions with L-[ring-13C6]phenylalanine and L-[ring-2H2]tyrosine were applied and blood and muscle samples were collected to assess whole-body protein balance and mixed muscle protein fractional synthetic rate over a 6-h period. Whole-body phenylalanine and tyrosine flux were higher after the CHO+PRO treatment compared with the CHO treatment in the diabetes and control group (P < 0.01). Protein balance was negative following CHO but positive following CHO+PRO treatment in both groups. Muscle protein synthesis rates were higher in both groups following the CHO+PRO (0.086 +/- 0.014%/h) treatment than in the CHO treatment (0.040 +/- 0.003%/h; P < 0.01) with no difference between the diabetes patients and normoglycemic controls. We conclude that the muscle protein synthetic response to CHO or CHO+PRO ingestion is not substantially impaired in longstanding, type 2 diabetes patients treated with oral blood glucose-lowering medication.
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Affiliation(s)
- Ralph J Manders
- Department of Human Biology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands.
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77
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Praet SFE, van Rooij ESJ, Wijtvliet A, Boonman-de Winter LJM, Enneking T, Kuipers H, Stehouwer CDA, van Loon LJC. Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia 2008; 51:736-46. [PMID: 18297259 PMCID: PMC2292420 DOI: 10.1007/s00125-008-0950-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 01/14/2008] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Structured exercise is considered a cornerstone in type 2 diabetes treatment. However, adherence to combined resistance and endurance type exercise or medical fitness intervention programmes is generally poor. Group-based brisk walking may represent an attractive alternative, but its long-term efficacy as compared with an individualised approach such as medical fitness intervention programmes is unknown. We compared the clinical benefits of a 12-month exercise intervention programme consisting of either brisk walking or a medical fitness programme in type 2 diabetes patients. METHODS We randomised 92 type 2 diabetes patients (60 +/- 9 years old) to either three times a week of 60 min brisk walking (n = 49) or medical fitness programme (n = 43). Primary outcome was the difference in changes in HbA1c values at 12 months. Secondary outcomes were differences in changes in blood pressure, plasma lipid concentrations, insulin sensitivity, body composition, physical fitness, programme adherence rate and health-related quality of life. RESULTS After 12 months, 18 brisk walking and 19 medical fitness participants were still actively participating. In both programmes, 50 and 25% of the dropout was attributed to overuse injuries and lack of motivation, respectively. Intention-to-treat analyses showed no important differences between brisk walking and medical fitness programme in primary or secondary outcome variables. CONCLUSIONS/INTERPRETATION The prescription of group-based brisk walking represents an equally effective intervention to modulate glycaemic control and cardiovascular risk profile in type 2 diabetes patients when compared with more individualised medical fitness programmes. Future exercise intervention programmes should anticipate the high attrition rate due to overuse injuries and motivation problems.
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Affiliation(s)
- S F E Praet
- Department of Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands.
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Jarosz PA, Bellar A. Age-appropriate obesity treatment. Nurse Pract 2008; 33:24-32. [PMID: 18458625 DOI: 10.1097/01.npr.0000317485.58038.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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79
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LEVINGER ITAMAR, GOODMAN CRAIG, MATTHEWS VANCE, HARE DAVIDL, JERUMS GEORGE, GARNHAM ANDREW, SELIG STEVE. BDNF, Metabolic Risk Factors, and Resistance Training in Middle-Aged Individuals. Med Sci Sports Exerc 2008; 40:535-41. [DOI: 10.1249/mss.0b013e31815dd057] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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80
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Guttierres APM, Marins JCB. Os efeitos do treinamento de força sobre os fatores de risco da síndrome metabólica. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2008. [DOI: 10.1590/s1415-790x2008000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Medidas não-farmacológicas, como a atividade física, vêm sendo recomendadas para prevenção e tratamento de doenças crônicas não transmissíveis. OBJETIVO: Realizar revisão da literatura para verificar os mecanismos por meio dos quais o treinamento de força provoca alterações metabólicas e celulares, agindo positivamente sobre os fatores de risco da síndrome metabólica. METODODOLOGIA: Foram utilizadas as bases de dados Medline, Scielo, Science Direct e Capes. A busca foi restrita aos últimos 10 anos. Os termos utilizados para pesquisa foram: obesity, dislipidemy,hypertension, diabetes mellitus, metabolic syndrome, resistance training, weight lifting, exercise. RESULTADOS: O treinamento de força atua sobre parâmetros metabólicos e celulares promovendo efeitos positivos no controle e na prevenção dos fatores de risco relacionados à síndrome metabólica, tais como diminuição do peso corporal, aumento da sensibilidade à insulina, aumento da tolerância à glicose, diminuição dos níveis pressóricos de repouso e melhoria do perfil lipídico. CONCLUSÃO: A revisão dos artigos científicos apresentados fornece dados que permitem concluir que o treinamento de força pode contribuir de forma efetiva na diminuição dos fatores de risco relacionados à síndrome metabólica.
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81
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Praet SFE, van Loon LJC. Exercise: the brittle cornerstone of type 2 diabetes treatment. Diabetologia 2008; 51:398-401. [PMID: 18183362 PMCID: PMC2668613 DOI: 10.1007/s00125-007-0910-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 12/07/2007] [Indexed: 12/25/2022]
Abstract
Regular exercise has been recommended for diabetes patients for many years; however, it is not widely used clinically. This may be because of high costs, lack of reimbursement, low compliance and/or absence of proper infrastructure. Alternatively, structured exercise therapy may be underutilised because current guidelines do not include detailed information on the preferred type and intensity of exercise that should be applied to maximise the benefits of exercise for different subgroups of patients with type 2 diabetes. Based on available evidence and our own clinical research experience this article proposes that exercise therapy in type 2 diabetes might be more effective if (1) cardiac rehabilitation programmes served as a model for 'pre-cardiac diabetes rehabilitation'; (2) resistance exercise were prescribed for sarcopenic or severely deconditioned type 2 diabetes patients; and (3) a multidisciplinary approach and continued exercise training under personal supervision became standard therapy. Nevertheless, more clinical research is warranted to establish the efficacy of an approach that takes into account type 2 diabetes subpopulations at different stages of the disease and with different levels of comorbidity.
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Affiliation(s)
- S F E Praet
- Nutrition and Toxicology Research Institute Maastricht, Department of Human Movement Sciences, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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82
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Abstract
OBJECTIVE To explore the nature of functional impairment in older people with diabetes. RESEARCH DESIGN AND METHODS A population-based case-control study with detailed assessment of diabetes and functional status was undertaken. RESULTS Altogether, 403 case subjects and 403 matched control subjects were studied (median age 75 years, 51% female). Subjects with diabetes had more comorbidities than control subjects (mean 2.5 vs. 1.9, P < 0.0001) and were more likely to have severe functional impairment (4 vs. 1%, Barthel score <5, P < 0.001). Health status pertaining to physical function was reduced in case subjects (SF36 60 vs. 40, P < 0.0001). In a multivariate model controlling for age, hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, osteoarthritis, and dementia, diabetes remained significantly associated with mobility limitation (odds ratio 2.1, P < 0.001). CONCLUSIONS Older people with diabetes have considerable functional impairment associated with reduced health status. This population may benefit from comprehensive geriatric assessment and tailored diabetes management.
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83
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Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Adv Chronic Kidney Dis 2008; 15:83-96. [PMID: 18155113 DOI: 10.1053/j.ackd.2007.10.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The morbidity and mortality associated with chronic kidney disease (CKD) are primarily caused by atherosclerosis and cardiovascular disease, which may be in part caused by inflammation and oxidative stress. Aerobic exercise and resistance training have been proposed as measures to combat obesity, inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and progression of CKD. In non-CKD patients, aerobic exercise reduces inflammation, increases insulin sensitivity, decreases microalbuminuria, facilitates weight loss, decreases leptins, and protects against oxidative injury. In nondialysis CKD, aerobic exercise decreases microalbuminuria, protects from oxidative stress, and may increase the glomerular filtration rate (GFR). Aerobic exercise in hemodialysis patients has been reported to enhance insulin sensitivity, improve lipid profile, increase hemoglobin, increase strength, decrease blood pressure, and improve quality of life. Resistance training, in the general population, decreases C-reactive protein, increases insulin sensitivity, decreases body fat content, increases insulin-like growth factor-1 (IGF-1), and decreases microalbuminuria. In the nondialysis CKD population, resistance training has been reported to reduce inflammation, increase serum albumin, maintain body weight, increase muscle strength, increase IGF-1, and increase GFR. Resistance training in hemodialysis increases muscle strength, increases physical functionality, and improves IGF-1 status. Combined aerobic exercise and resistance training during dialysis improves muscle strength, work output, cardiac fitness, and possibly dialysis adequacy. There is a need for more investigation on the role of exercise in CKD. If the benefits of aerobic exercise and strength training in non-CKD populations can be shown to apply to CKD patients as well, renal rehabilitation will begin to play an important role in the approach to the treatment, prevention, and slowed progression of CKD.
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84
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Tsang T, Orr R, Lam P, Comino E, Singh MF. Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised double-blind sham-exercise-controlled trial. Age Ageing 2008; 37:64-71. [PMID: 17965035 DOI: 10.1093/ageing/afm127] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND a large proportion of adults with type 2 diabetes remain sedentary despite evidence of benefits from exercise for type 2 diabetes. Simplified Yang Tai Chi has been shown in one study to have no effect on insulin sensitivity in older adults. However, a modified Tai Chi form, Tai Chi for Diabetes (TCD) has recently been composed, claiming to improve diabetes control. METHODS subjects were randomised to Tai Chi or sham exercise, twice a week for 16 weeks. Primary outcomes were insulin resistance 72 h post-exercise (HOMA2-IR), and long-term glucose control (HbA(1c)). RESULTS thirty-eight subjects (65 +/- 7.8 years, 79% women) were enrolled. Baseline BMI was 32.2 +/- 6.3 kg/m(2), 84% had osteoarthritis, 76% hypertension, and 34% cardiac disease. There was one dropout, no adverse events, and median compliance was 100 (0-100)%. There were no effects of time or group assignment on insulin resistance or HbA(1c) ( -0.07 +/- 0.4% Tai Chi versus 0.12 +/- 0.3% Sham; P = 0.13) at 16 weeks. Improvement in HbA(1c) was related to decreased body fat (r = 0.484, P = 0.004) and improvement in insulin resistance was related to decreased body fat (r = 0.37, P = 0.03) and central adiposity (r = 0.38, P = 0.02), as well as increased fat-free mass (r = -0.46, P = 0.005). CONCLUSIONS TCD did not improve glucose homeostasis or insulin sensitivity measured 72 h after the last bout of exercise. More intense forms of Tai Chi may be required to produce the body composition changes associated with metabolic benefits in type 2 diabetes.
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Affiliation(s)
- Tracey Tsang
- School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Australia.
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85
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De Feyter HM, Praet SF, van den Broek NM, Kuipers H, Stehouwer CD, Nicolay K, Prompers JJ, van Loon LJC. Exercise training improves glycemic control in long-standing insulin-treated type 2 diabetic patients. Diabetes Care 2007; 30:2511-3. [PMID: 17626892 DOI: 10.2337/dc07-0183] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Henk M De Feyter
- Department of Biomedical NMR, Eindhoven University of Technology, Eindhoven, The Netherlands
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86
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Levinger I, Goodman C, Hare DL, Jerums G, Selig S. The effect of resistance training on functional capacity and quality of life in individuals with high and low numbers of metabolic risk factors. Diabetes Care 2007; 30:2205-10. [PMID: 17563342 DOI: 10.2337/dc07-0841] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are limited data on the effects of resistance training on the capacity to perform activities of daily living (ADLs) and quality of life (QoL) for individuals with a high number of metabolic risk factors (HiMF). In this study, we examined the effect of resistance training on the capacity to perform ADLs and QoL in individuals with HiMF and compared any benefits with individuals with a low number of metabolic risk factors (LoMF). RESEARCH DESIGN AND METHODS Fifty-five untrained individuals, aged 50.8 +/- 6.5 years, were randomized to four groups: HiMF training (HiMFT), HiMF control, LoMF training (LoMFT), and LoMF control. At baseline and after 10 weeks of resistance training, participants underwent anthropometric measurements and assessments of aerobic power (Vo(2peak)), muscle strength, capacity to perform ADLs, and a self-perceived QoL questionnaire. A repeated-measures ANOVA was used to examine the effect of training over time among groups. RESULTS Training increased lean body mass in both HiMFT (P = 0.03) and LoMFT (P = 0.03) groups. Total fat content and Vo(2peak) improved in the LoMFT group only. Muscle strength improved in both training groups (P < 0.01). Time to complete ADLs was reduced by 8.8% in the LoMFT group (P < 0.01) and 9.7% in the HiMF group (P < 0.01). Only the HiMFT group reported improvement in QoL. CONCLUSIONS Resistance training improved muscle strength and the capacity to perform ADLs in individuals with HiMF and LoMF. Resistance training improved QoL for the HiMF group, and this result was independent of changes in body fat content or aerobic power. Longer training regimens may be needed to improve QoL in individuals with LoMF.
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Affiliation(s)
- Itamar Levinger
- Centre for Ageing, Rehabilitation, Exercise and Sport, School of Human Movement, Recreation and Performance, Victoria University, Melbourne, Australia.
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87
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Praet SFE, van Loon LJC. Optimizing the therapeutic benefits of exercise in Type 2 diabetes. J Appl Physiol (1985) 2007; 103:1113-20. [PMID: 17656625 DOI: 10.1152/japplphysiol.00566.2007] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Other than diet and medication, exercise is considered one of the three cornerstones of good diabetes treatment. Nevertheless, current clinical guidelines on Type 2 diabetes provide no detailed information on the modalities of effective exercise intervention in the treatment of Type 2 diabetes. Based on a review of currently available literature, exercise modalities are being identified to maximize the benefits of exercise intervention in the treatment of different Type 2 diabetes subpopulations. Both endurance and resistance types of exercise have equal therapeutic strength to improve metabolic control in patients with Type 2 diabetes. When applying endurance-type exercise, energy expenditure should be equivalent to approximately 1.7-2.1 MJ/exercise bout on 3 but preferably 5 days/wk. In sarcopenic or severely deconditioned patients with Type 2 diabetes, focus should lie on the implementation of resistance-type exercise to attenuate and/or reverse the decline in skeletal muscle mass and strength. Before choosing the most appropriate exercise modalities, the patient's disease stage should be well characterized, and an ECG-stress test should be considered. Based on baseline aerobic fitness, level of co-morbidities, body composition, and muscle strength, patients should be provided with an individually tailored exercise intervention program to optimize therapeutic value. A multidisciplinary individualized approach and continued exercise training under personal supervision is essential to enhance compliance and allow long-term health benefits of an exercise intervention program.
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Affiliation(s)
- Stephan F E Praet
- Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands.
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88
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Burns N, Finucane FM, Hatunic M, Gilman M, Murphy M, Gasparro D, Mari A, Gastaldelli A, Nolan JJ. Early-onset type 2 diabetes in obese white subjects is characterised by a marked defect in beta cell insulin secretion, severe insulin resistance and a lack of response to aerobic exercise training. Diabetologia 2007; 50:1500-8. [PMID: 17393133 DOI: 10.1007/s00125-007-0655-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 02/23/2007] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Early-onset type 2 diabetes is associated with marked visceral obesity and extreme insulin resistance, but its pathogenesis and response to treatment are not completely understood. We studied physical fitness, whole-body and hepatic glucose turnover, and insulin secretion in young obese Irish subjects before and after 3 months of aerobic exercise training. We hypothesised that exercise alone, with stable diet, should improve insulin sensitivity. MATERIALS AND METHODS Anthropometric parameters and maximum volume of oxygen utilisation (VO(2max)) were measured in 13 subjects with type 2 diabetes and 18 non-diabetic control subjects, matched for age and BMI. Insulin sensitivity and hepatic glucose turnover were measured using the hyperinsulinaemic-euglycaemic clamp. Insulin secretion was assessed from an OGTT and a modified intravenous glucose tolerance test. Some subjects (seven type 2 diabetic, 14 non-diabetic control subjects) then completed a 12-week supervised aerobic exercise programme. All measurements were repeated on completion of the exercise programme. RESULTS Type 2 diabetic subjects had higher WHR, systolic blood pressure and triacylglycerols than non-diabetic control subjects. They were significantly more insulin-resistant as measured both by the clamp and oral glucose insulin sensitivity. They also displayed marked defects in insulin secretion in response to oral and intravenous glucose challenges. Exercise intervention had no significant effect on whole-body or hepatic insulin sensitivity or insulin secretion. VO(2max) increased significantly in the non-diabetic control subjects, but not in the type 2 diabetic subjects after exercise training. CONCLUSIONS/INTERPRETATION Young obese subjects with type 2 diabetes are severely insulin-resistant with marked loss of beta cell function compared with control subjects matched for age and obesity. Neither group responded metabolically to aerobic exercise intervention.
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Affiliation(s)
- N Burns
- Metabolic Research Unit, Department of Endocrinology, Hospital 5, St James' Hospital, Trinity College Dublin, Dublin 8, Ireland
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89
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Lakka TA, Laaksonen DE. Physical activity in prevention and treatment of the metabolic syndrome. Appl Physiol Nutr Metab 2007; 32:76-88. [PMID: 17332786 DOI: 10.1139/h06-113] [Citation(s) in RCA: 276] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Randomised controlled trials have shown that exercise training has a mild or moderate favourable effect on many metabolic and cardiovascular risk factors that constitute or are related to the metabolic syndrome (MetS). Epidemiological studies suggest that regular physical activity prevents type 2 diabetes, cardiovascular disease, and premature mortality in large part through these risk factors. Although randomized controlled trials with the prevention or treatment of the MetS as the main outcome have not been published, several large randomized controlled trials provide strong evidence that favourable lifestyle changes, including regular physical activity, are effective in the prevention of type 2 diabetes in individuals who are overweight and have impaired glucose tolerance. Compliance with the current recommendations to increase the total volume of moderate-intensity physical activity and to maintain good cardiorespiratory and muscular fitness appears to markedly decrease the likelihood of developing the MetS, especially in high-risk groups. Walking is the most common form of physical activity--it improves health in many ways and is generally safe. Therefore, brisk walking for at least 30 min daily can be recommended as the principal form of physical activity at the population level. If there are no contraindications, more vigorous physical exercise or resistance training should also be considered to obtain additional health benefits. Unstructured and low-intensity physical activity may also decrease the likelihood of developing the MetS, especially when substituted for sedentary behaviours such as watching television. The measurement of maximal oxygen consumption may provide an efficient means to target even individuals with relatively few metabolic risk factors who may benefit from more intensive intervention.
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Affiliation(s)
- Timo A Lakka
- Institute of Biomedicine, Department of Physiology, University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finland.
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90
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Abstract
Many of the known benefits of exercise in the general population are of particular relevance to the ESRD population. In addition, the poor physical functioning that is experienced by patients who are on dialysis is potentially addressable through exercise interventions. The study of exercise in the ESRD population dates back almost 30 yr, and numerous interventions, including aerobic training, resistance exercise training, and combined training programs, have reported beneficial effects. Recently, interventions during hemodialysis sessions have become more popular and have been shown to be safe. The risks of exercise in this population have not been rigorously studied, but there have been no reports of serious injury as a result of participation in an exercise training program. It is time that we incorporate exercise into the routine care of patients who are on dialysis, but identification of an optimal training regimen or regimens, according to patient characteristics or needs, is still needed to facilitate implementation of exercise programs.
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Affiliation(s)
- Kirsten L Johansen
- Nephrology Section, 111J, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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91
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Abstract
Underlying the pathogenesis of chronic disease is the state of oxidative stress. Oxidative stress is an imbalance in oxidant and antioxidant levels. If an overproduction of oxidants overwhelms the antioxidant defenses, oxidative damage of cells, tissues, and organs ensues. In some cases, oxidative stress is assigned a causal role in disease pathogenesis, whereas in others the link is less certain. Along with underlying oxidative stress, chronic disease is often accompanied by muscle wasting. It has been hypothesized that catabolic programs leading to muscle wasting are mediated by oxidative stress. In cases where disease is localized to the muscle, this concept is easy to appreciate. Transmission of oxidative stress from diseased remote organs to skeletal muscle is thought to be mediated by humoral factors such as inflammatory cytokines. This review examines the relationship between oxidative stress, chronic disease, and muscle wasting, and the mechanisms by which oxidative stress acts as a catabolic signal.
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Affiliation(s)
- Jennifer S Moylan
- Department of Physiology, University of Kentucky, 800 Rose Street, Room MS-509, Lexington, Kentucky 40536-0298, USA
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92
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Dela F, Kjaer M. Resistance training, insulin sensitivity and muscle function in the elderly. Essays Biochem 2006; 42:75-88. [PMID: 17144881 DOI: 10.1042/bse0420075] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ageing is associated with a loss in both muscle mass and in the metabolic quality of skeletal muscle. This leads to sarcopenia and reduced daily function, as well as to an increased risk for development of insulin resistance and type 2 diabetes. A major part, but not all, of these changes are associated with an age-related decrease in the physical activity level and can be counteracted by increased physical activity of a resistive nature. Strength training has been shown to improve insulin-stimulated glucose uptake in both healthy elderly individuals and patients with manifest diabetes, and likewise to improve muscle strength in both elderly healthy individuals and in elderly individuals with chronic disease. The increased strength is coupled to improved function and a decreased risk for fall injuries and fractures. Elderly individuals have preserved the capacity to improve muscle strength and mass with training, but seem to display a reduced sensitivity towards stimulating protein synthesis from nutritional intake, rather than by any reduced response in protein turnover to exercise.
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Affiliation(s)
- Flemming Dela
- Institute for Biomedical Sciences, University of Copenhagen, Denmark
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93
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Abstract
OBJECTIVE Nonalcoholic steatohepatitis (NASH) is a morbid liver disease with limited treatment. Depression and anxiety have been associated recently with insulin resistance and inflammatory states, factors that are relevant to the development of NASH. We hypothesized that depression and anxiety would be more prevalent in NASH patients and predict more severe histological findings on liver biopsy. METHODS Histories of major depressive disorder (MDD) and generalized anxiety disorder (GAD) were determined using a structured interview and DSM-IV criteria in 36 NASH subjects and 36 matched controls without liver disease who had undergone cholecystectomy. Histological changes on liver biopsy in NASH subjects were age-adjusted and compared in subjects with and without psychiatric disorders. A multivariate model incorporating other potential risk factors for NASH (female sex, body mass index, waist-to-hip ratio, and presence of diabetes) was used to determine independent effects of MDD and GAD on severity of histological findings. RESULTS NASH subjects had significantly increased lifetime rates of MDD (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4-10.2; p = .018) and GAD (OR 5.0, 95% CI, 1.7-14.9; p = .005). The onset of psychiatric illness preceded diagnosis of liver disease by 18 to 20 years. Each psychiatric disorder was associated with more severe histological features (p < .05 for each), the effect of GAD on fibrosis stage persisting in the multivariate model. CONCLUSIONS MDD and GAD are overrepresented in NASH subjects and are associated with more advanced liver histological abnormalities. Additional investigation will be required to determine if depression and anxiety affect the development or progression of NASH and serve as modifiable risk factors.
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Affiliation(s)
- Jill E Elwing
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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94
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Vincent KR, Vincent HK. Resistance Training for Individuals With Cardiovascular Disease. ACTA ACUST UNITED AC 2006; 26:207-16; quiz 217-8. [PMID: 16926683 DOI: 10.1097/00008483-200607000-00002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin R Vincent
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA 22908-1004, USA.
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Morse CI, Thom JM, Mian OS, Muirhead A, Birch KM, Narici MV. Muscle strength, volume and activation following 12-month resistance training in 70-year-old males. Eur J Appl Physiol 2005; 95:197-204. [PMID: 16003538 DOI: 10.1007/s00421-005-1342-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2005] [Indexed: 10/25/2022]
Abstract
In elderly males muscle plantar flexor maximal voluntary contraction (MVC) torque normalised to muscle volume (MVC/VOL) is reduced compared to young males as a result of incomplete muscle activation in the elderly. The aim of the present study was to determine the influence of a 12-month resistance training programme on muscle volume, strength, MVC/VOL, agonist activation and antagonist coactivation of the plantarfexors in elderly males. Thirteen elderly males aged 70 years and over (range 70-82 years), completed a 12-month whole body resistance-training programme (TRN), training three times a week. Another eight males (range 18-30 years), who maintained their habitual physical activity for the same 12-month period as the TRN group acted as controls (CTRL). Isometric plantarflexor maximal voluntary contraction (MVC) torque increased in the TRN group by 20% (P < 0.01), from 113.1 +/- 22.0 Nm to 141.5 +/- 19.2 Nm. Triceps surae volume (TS VOL) assessed using MRI, increased by 12%, from 796.3 +/- 78.9 cm(3) to 916.8 +/- 144.4 cm(3) . PF activation, measured using supramaximal double twitch interpolation, increased from 83.6+/-11.0% pre training, to 92.1 +/- 7.6% post training (P < 0.05). Dorsiflexion MVC and antagonist coactivation (assessed using surface electromyography) did not change with training. Plantarflexor MVC torque normalized for triceps surae muscle volume (MVC/VOL) was 142.6 +/- 32.4 kN m(-2) before training and 157.0 +/- 27.9 kN m(-2) after training (a non-significant increase of 8%). No significant change in any measurement was observed in the CTRL group. This study has shown that the gain in muscle strength in response to long-term (12-month) training in older men is mostly accounted for by an increased muscle volume and activation.
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Affiliation(s)
- Christopher I Morse
- Institute for Biophysical and Clinical Research into Human Movement (IRM), Manchester Metropolitan University, Alsager, Cheshire, UK.
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Stewart KJ. Exercise training: can it improve cardiovascular health in patients with type 2 diabetes? Br J Sports Med 2005; 38:250-2. [PMID: 15155419 PMCID: PMC1724815 DOI: 10.1136/bjsm.2004.012187] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K J Stewart
- Johns Hopkins Heart Health, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
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Stewart KJ. Role of exercise training on cardiovascular disease in persons who have type 2 diabetes and hypertension. Cardiol Clin 2005; 22:569-86. [PMID: 15501624 DOI: 10.1016/j.ccl.2004.06.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Exercise training is an essential component in the medical management of patients who have type 2 diabetes and hypertension. Regular exercise improves the cardiovascular health of individuals who have these conditions through multiple mechanisms (Fig. 1). These mechanisms include improvements in endothelial vasodilator function,left ventricular diastolic function, arterial stiffness.systematic inflammation, and reducing left ventricular mass. Exercise training also reduces total and abdominal fat, which mediate improvements in insulin sensitivity and blood pressure, and possibly, endothelial function. Persons who are in a prediabetic stage or those who have the metabolic syndrome may be able to prevent or delay the progression to overt diabetes by adopting a healthier lifestyle, of which increasing habitual levels of physical activity isa vital component. Most persons who have diabetes and hypertension or are at risk for these conditions should be able to initiate an exercise program safely after appropriate medical screen-ing and the establishment of an individualized exercise prescription. Despite the increasing amount of evidence that shows the benefits of exercise training, this modality of prevention and treatment continues to be underused. Although patients' lack of knowledge of the benefits of exercise or lack of motivation contributes to this underuse, a lack of clear and specific guidelines from health care professionals also is an important factor. Clinicians need to educate patients about the benefits of exercise for managing their type 2 diabetes and assist in formulating specific advice for increasing physical activity. Specific instructions should be given to patients, rather than general advice, such as "you should exercise more often." Many cardiac re-habilitation and clinical exercise programs can accommodate patients who have type 2 diabetes and hypertension. Such programs can establish individualized exercise prescriptions and provide an environment that is conducive for "lifestyle change" that underlies long-term compliance to exercise and risk factor modification.
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Affiliation(s)
- Kerry J Stewart
- Division of Cardiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Dunstan DW, Daly RM, Owen N, Jolley D, Vulikh E, Shaw J, Zimmet P. Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care 2005; 28:3-9. [PMID: 15616225 DOI: 10.2337/diacare.28.1.3] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training. RESEARCH DESIGN AND METHODS We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months. RESULTS Compared with the WL group, HbA1c decreased significantly more in the RT&WL group (-0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months. CONCLUSIONS In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.
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Affiliation(s)
- David W Dunstan
- International Diabetes Institute, Melbourne, Victoria, Australia.
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