Lipoprotein profile, glycemic control and physical fitness after strength and aerobic training in post-menopausal women with type 2 diabetes

Home-based circuit training improves blood lipid profile, liver function, musculoskeletal fitness, and health-related quality of life in overweight/obese older adult patients with knee osteoarthritis and type 2 diabetes: a randomized controlled trial during the COVID-19 pandemic

BACKGROUND

There is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown.

METHODS

This is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15-30 repetitions per exercise, 1 min passive rest between exercises; 2-4 rounds per session; 20-60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves.

RESULTS

HBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p < 0.05). Furthermore, HBCT induced meaningful increases in high-density lipoprotein (HDL-C), lower body muscular strength, endurance, function, mobility, and HRQoL in overweight/obese older adults with T2DM and KOA (p < 0.05).

CONCLUSION

The present outcomes recommend that an injury-free HBCT program may improve various indicators related to cardiometabolic health, musculoskeletal fitness, and HRQoL in elderly with overweight/obesity, T2DM and KOA. These findings offer valuable insights for clinicians and practitioners seeking evidence-based exercise interventions tailored for patients managing substantial metabolic and musculoskeletal health challenges in clinical practice.

Mechanisms underlying altered neuromuscular function in people with DPN

Diabetes alters numerous physiological functions and can lead to disastrous consequences in the long term. Neuromuscular function is particularly affected and is impacted early, offering an opportunity to detect the onset of diabetes-related dysfunctions and follow the advancement of the disease. The role of physical training for counteracting the deleterious effects of diabetes is well accepted but at the same time, it appears difficult to reliably assess the effects of exercise on functional capacity in patients with diabetic peripheral neuropathy (DPN). In this paper, we will review the specific characteristics of various neuromuscular dysfunctions associated with diabetes according to the DPN presence or not, and their changes over time. We present several propositions regarding the onset of neuromuscular alterations in people with diabetes compared to people with DPN. It appears that motor unit loss and neuromuscular transmission impairment are among the main mechanisms explaining the considerable degradation of neuromuscular function in the transition from a diabetic to neuropathic state. Rate of force development and contractile properties could start to decrease with the onset of preferential type II fiber atrophy, commonly reported in people with DPN. Finally, M_max amplitude could decrease with neuromuscular fatigue only in people with DPN, reflecting the fatigue-related neuromuscular transmission impairment reported in people with DPN. In this review, we show that the different neuromuscular parameters are altered at different stages of diabetes, according to the presence of DPN or not. The precise evaluation of these parameters might participate in adapting the physical training prescription.

Differential Effects of Amount, Intensity, and Mode of Exercise Training on Insulin Sensitivity and Glucose Homeostasis: A Narrative Review

As type 2 diabetes remains a leading cause of morbidity and mortality, identifying the most appropriate preventive treatment early in the development of disease is an important public health matter. In general, lifestyle interventions incorporating exercise and weight loss via caloric restriction improve cardiometabolic risk by impacting several key markers of insulin sensitivity and glucose homeostasis. However, variations in the effects of specific types of exercise interventions on these markers have led to conflicting results surrounding the optimal amount, intensity, and mode of exercise for optimal effects. Moreover, the addition of weight loss via caloric restriction to exercise interventions appears to differentially impact changes in body composition, metabolism, and insulin sensitivity compared to exercise alone. Determining the optimal amount, intensity, and mode of exercise having the most beneficial impact on glycemic status is both: (1) clinically important to provide guidelines for appropriate exercise prescription; and (2) physiologically important to understand the pathways by which exercise—with and without weight loss—impacts glycemic status to enhance precision lifestyle medicine. Thus, the purposes of this narrative review are to: (1) summarize findings from the three Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials regarding the differential effects of exercise amount, intensity, and mode on insulin action and glucose homeostasis markers; and (2) compare the STRRIDE findings to other published dose–response exercise trials in order to piece together the various physiologic pathways by which specific exercise interventions—with or without weight loss—impact glycemic status.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

The effect of physical activity on total homocysteine concentrations and cardiovascular risk in older Brazilian adults with type 2 diabetes

A low level of physical activity has a potential association with high levels of homocysteine, which implies an increased chance of older adults with type 2 diabetes mellitus developing cardiovascular disease (CVD). However, the effects of physical activity on homocysteine levels have been poorly explored in the literature. Therefore, this study compared homocysteine levels and cardiovascular risk among physically active and inactive older women with type 2 diabetes mellitus. Fifty-nine women with type 2 diabetes mellitus, between 60 and 91 years old, were evaluated. The level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) long version to identify active and inactive older women. Blood samples were collected and anthropometric, body composition, and blood pressure measurements were performed to determine homocysteine levels and cardiovascular risk. The results demonstrated that active older women with type 2 diabetes mellitus have lower homocysteine values (F = 17.79, p < 0.001, ηp² = 0.238), cardiovascular risk scores (F = 15.84, p = p < 0.001, ηp² = 0.217), and waist circumferences (F = 2.95, p = 0.013, ηp² = 0.049) when compared with inactive older women. It was concluded that there was a difference in the levels of homocysteine, cardiovascular risk, and waist circumference between active and inactive older women with type 2 diabetes. Active older women are less likely to have cardiovascular risk than inactive older women.

The effect of aerobic vs. resistance training on plasma homocysteine in individuals with type 2 diabetes

Elevated plasma homocysteine concentration is a risk factor for cardiovascular disease, which seems to be the main cause of increased mortality in patients with type 2 diabetes. Previous studies have demonstrated the effect of exercise on homocysteine levels and the magnitude of these benefits seems to depend on the type, mode and frequency of training. The present study aimed to compare the effects of aerobic and resistance training on plasma homocysteine in individuals with type 2 diabetes. The study included 15 individuals undergoing aerobic training, 14 subjects undergoing resistance training, and 18 individuals in the control group. Homocysteine, total cholesterol and fractions, glucose, and anthropometric measurements were conducted. The training program lasted 16 weeks. Aerobic training was performed twice a week and lasted 75 min, and resistance training was performed twice a week and lasted 75 min. Homocysteine levels were not significantly different between before and after training. High-density lipoprotein levels increased in both training groups and decreased in the control group. Glucose levels decreased after aerobic and resistance training. Body fat mass (percentage and total) decreased in both training group, but with more expression in the aerobic group. We conclude that 16-week aerobic and resistance training programs did not significantly affect plasma homocysteine levels in patients with type 2 diabetes. Nevertheless, these training programs yielded positive results in HDL control, plasma glucose, and body composition.

Effect of Strength Training on Plasma Levels of Homocysteine in Patients with Type 2 Diabetes

Background

The objective of this study was to analyze the effects of strength training on plasma homocysteine levels and cardiovascular risk factors in patients with type 2 diabetes.

Methods

The sample consisted of 14 diabetic women with a mean age of 68 ± 6 years. Biochemical evaluations and anthropometric measurements were taken before and after training. Training sessions lasted 50 min and comprised three sets of 8-12 repetitions each. The established load was 60% of 1 repetition maximum.

Results

After the training program, it was observed that the levels of homocysteine (average before 13.4 ± 2.9 and after 12.8 ± 3.3, P = 0.40), very low-density lipoprotein (LDL) (average before 41.9 ± 17.0 and after 36.2 ± 11.8, P = 0.47), total cholesterol (average before 214.4 ± 60.6 and after 190.2 ± 62.3, P = 0.09), triglycerides (average before 209.3 ± 85.4 and after 181.5 ± 59.2, P = 0.47), and blood glucose (average before 123.5 ± 30.4 and after 110.1 ± 24.7, P = 0.26) showed no significant changes, but the LDL (average before 129.1 ± 63.4 and after 95.7 ± 53.3, P = 0.04), high-density lipoprotein (average before 43.2 ± 12.0 and after 58.2 ± 15.6, P = 0.01), lean mass (average before 41.1 ± 5.7 and after 42.8 ± 5.4, P = 0.008), fat mass (average before 31.4 ± 8.8 and after 29.7 ± 8.5, P = 0.001), and percentage fat (average before 42.6 ± 4.0 and after 40.3 ± 4.6, P = 0.000) showed significant changes.

Conclusions

This study concluded that strength training does not improve homocysteine levels, but help to improve the lipoprotein profile in type 2 diabetic patients.

Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk?

BACKGROUND

The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes.

METHODS

Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention.

RESULTS

A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease.

CONCLUSIONS

A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.

Comparative Assessment of the Effects of Hatha Yoga and Physical Exercise on Biochemical Functions in Perimenopausal Women

INTRODUCTION

Menopause is a transitional phase in which some women experience discomfort, while others may exhibit variety of symptoms. The power of yoga therapy in relieving stress, enhancing health, improving fitness and managing symptoms of a variety of disorders is remarkable.

AIM

The current study was designed to study the effect of Hatha yoga therapy and regular physical exercise on the Fasting Blood Sugar (FBS), Glycated Haemoglobin (GHB), Thyroid Stimulating Hormone (TSH), serum cortisol and total plasma thiol levels in perimenopausal women.

MATERIALS AND METHODS

The study included 216 women with perimenopausal symptoms, 111 in test group (Hatha yoga) and 105 in control group (physical exercise). The duration of intervention was 45 minutes every day for 12 weeks. Blood samples were collected in the pre and post intervention period. Statistical significance was defined as p<0.05.

RESULTS

FBS and GHB (p≤0.05) showed a significant decrease after yoga therapy. Cortisol levels significantly (p≤0.05) increased in the post intervention period in the control group. However, it is maintained in the test group between the two time periods. The total plasma thiols level showed a rise in the post intervention period, significant rise (p≤0.001) in control group but not significant in the test group. The TSH levels were not altered in any group.

CONCLUSION

It is concluded that exercise helps in maintaining the sugar levels but calming effects of yoga practice is important in relieving stress and enhancing health in perimenopausal women.

Exercício físico e fatores de risco cardiovasculares em mulheres obesas na pós-menopausa

INTRODUÇÃO: o exercício físico tem sido recomendado, como estratégia terapêutica não farmacológica, no tratamento de importantes fatores de risco cardiovascular.OBJETIVO: analisar o impacto de um programa de exercício físico, adaptado à realidade das Unidades de Saúde da Família (USF), sobre a composição corporal, fatores de risco cardiovasculares e Escore de Framingham de mulheres obesas na pós-menopausa.MÉTODOS: 70 mulheres entre 50 e 79 anos, sedentárias, obesas e sem menstruar por no mínimo doze meses, foram distribuídas aleatoriamente em um grupo treinado (GT) (n=35) e um não treinado (GnT) (n=35). O GT participou de vinte semanas de um programa de exercícios físicos com três sessões semanais, constituído por atividades de monitoramento e aquecimento (10 min); 25 min de exercício de flexibilidade e força; 50 min de caminhada com intensidade entre 50 a 65% do VO2max; e 5 min de relaxamento. O GnT foi orientado a manter suas atividades normais.RESULTADOS: o GT apresentou reduções significativas do índice de massa corporal (30,1+3,7 vs. 29,3+3,7; p=0,0001), circunferência de cintura (93,3+10,3 vs. 89,1+10,4; p=0,0001), percentual de gordura (54,2+2,9 vs.53,2+3,3; p=0,0001), pressão arterial sistólica (128,0+14,6 vs. 119,2+10,3; p=0,0001), triglicerídeos (148,4+66,1 vs. 122,8+40,7; p=0,006), VLDL colesterol (29,7+13,2 vs. 24,5+8,0; p=0,005) e Escore de Framingham (13,08+4,0 vs. 11,77+4,1; p=0,010). No grupo não treinado foram observados aumentos significativos do percentual de gordura (55,0+4,0 vs. 57,0+3,8; p=0,0001), pressão arterial sistólica (128,6+10,5 vs. 133,7+12,0; p=0,001), glicemia de jejum (95,2+18,4 vs. 113,7+28,8; p=0,001) e Escore de Framingham (12,82+3,2 vs. 13,91+4,0; p=0,043), como também reduções do HDL colesterol (55,1+10,5 vs. 51,7+11,0; p=0,017).CONCLUSÃO: o programa de exercício físico adaptado às condições de USF foi efetivo na redução dos fatores de risco cardiovascular de mulheres obesas na pós-menopausa atendidas pelo programa SUS.

Personalized exercise for adolescents with diabetes or obesity

OBJECTIVE

This study examined adherence to a personalized, community-based exercise intervention by sedentary adolescents with type 1 or type 2 diabetes or those with obesity.

RESEARCH DESIGN AND METHODS

We conducted a pretest-posttest investigation to explore the application of an individualized exercise prescription based upon current fitness level for 39 adolescents (20 with type 1 diabetes, 9 with type 2 diabetes, and 10 obese) over 16 weeks in community settings. Subjects were recruited from a university-based pediatric endocrinology clinic in the southwestern United States. Adherence to the exercise prescription was monitored using accelerometers over the entire intervention period.

RESULTS

Moderate-to-vigorous physical activity (MVPA) levels significantly increased over sedentary baseline values (p < .001), but the average of 42.5 ± 22.1 min/day of MVPA determined at the end of the study was still less than the recommended 60 min/day. Perceptions of health were significantly increased for the total group following the intervention (p = .008). For those with type 1 diabetes, there was a significant association between MVPA duration and percentage change in HbA1c (r = -.526, p = .02).

CONCLUSIONS

Recruitment and retention of adolescent participation in daily exercise is challenging. Personalized approaches that include adolescent choices with family support and ongoing motivation can improve individual exercise adherence and a sense of personal health.

Combined exercise for people with type 2 diabetes mellitus: a systematic review

Type 2 diabetes mellitus has emerged as a major non-communicable chronic diseases in many countries. The importance of exercise in the prevention and management of this disease is evident. This paper briefly reviews the effects of combining aerobic and resistance exercises on glycemic control, and details the training and characteristics of various interventions in adults with type 2 diabetes mellitus. Literature searches were performed using electronic databases between the 1st of January 1950 and the 15th of September 2011. Of the 403 articles retrieved, 28 studies met our inclusion criteria. Combined exercise protocols seem to improve glycemic control to a greater extent than isolated forms of exercise. Nevertheless, length, duration, intensity, mode, number of exercises, sets and repetitions varied markedly among studies. Supervised training sessions, recommended structured exercises, and splitting aerobic and resistance training in separate sessions may be relevant for best results. Future studies should analyze the effects of different aerobic and resistance training modes, different training and progression methods, and whether one type of exercise is optimal, as these issues are likely to convey greater knowledge on type 2 diabetes mellitus management through combined exercise.

Uncomplicated resistance training and health-related outcomes: evidence for a public health mandate

Compared to aerobic training (AT), resistance training (RT) has received far less attention as a prescription for general health. However, RT is as effective as AT in lowering risk for cardiovascular disease, diabetes, and other diseases. There is a clear ability of RT, in contrast to AT, to promote gains, maintenance, or slow loss of skeletal muscle mass/strength. Thus, as an antisarcopenic exercise treatment, RT is of greater benefit than AT; given the aging of our population, this is of primary importance. In our view, a substantial barrier to greater adoption of RT is the incorrectly perceived importance of variables such as external load, intensity, and volume, leading to complex, difficult-to-follow regimes. We propose a more feasible and easier-to-adhere-to paradigm for RT that could affect how RT is viewed and adopted as a prescription for public health.

Cardiovascular fitness and quality of life in adolescents with type 1 or type 2 diabetes

PURPOSE

This descriptive study of adolescents with type 1 or type 2 diabetes examined the relationships between cardiovascular fitness and physical activity (PA) with generic or health-related quality of life (QoL), glycemic control, and lipids.

DESIGN AND METHODS

Graded ergometry testing for fitness, fasting assays for lipids, glycosylated hemoglobin (A1C), and self-reported PA and QoL instruments were completed with 151 adolescents.

RESULTS

Adolescents with type 2 diabetes had lower fitness. Fitness was associated with improved lipids, A1C, health perception, and athletic competence in adolescents with type 1 diabetes.

PRACTICE IMPLICATIONS

Interventions to encourage active lifestyles are imperative for adolescents with diabetes.

Efeitos do treinamento resistido na lipoproteína de baixa densidade

Os benefícios da prática regular do exercício físico estão claramente estabelecidos na literatura. Entretanto, a escolha do tipo de exercício ideal pode ser mais salutar para indivíduos com doenças específicas e patologias associadas. O propósito desta revisão foi verificar se o treinamento resistido (TR) exerce alguma alteração no colesterol da lipoproteína de baixa densidade (LDL-C). Foram observadas grandes diferenças na literatura, dificultando uma conclusão em relação aos benefícios do TR nesta revisão. No entanto, foi visto que o TR pode ser promissor na redução dos níveis de LDL-C, principalmente em homens e mulheres adultos, em pacientes com diabetes mellitus tipo 1 e tipo 2 e em mulheres pré-menopausa, não mostrando diferenças na população idosa. Os autores concluem que o TR é uma boa opção de exercício físico para indivíduos, principalmente quando o treinamento aeróbio (TA) é contraindicado.

Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes

BACKGROUND

The aim of this study was to compare the effects of 10 weeks of resistance or treadmill exercises on glycemic indices levels prior to and immediately following exercise in adults with type 2 diabetes.

RESEARCH DESIGN AND METHOD

Twenty inactive subjects (mean age 53.5 years) with type 2 diabetes enrolled in the study. Baseline HbA1c, blood glucose levels, heart rate, and blood pressure were measured for each subject prior to the initiation of the exercise program. Subsequently, subjects were matched to age, waist circumference and sex and assigned to either isocaloric resistance or treadmill exercise groups, which met 3 times per week for 10 weeks.

RESULTS

Both groups showed a reduction in pre and post-exercise blood glucose and HbA1c values. There was no change in resting blood pressure or heart rate in either group during the course of the 10 week intervention. The group receiving resistance exercises showed significant differences in the daily pre-exercise plasma glucose readings between the beginning and end of the exercise protocol (p < 0.001). There were significant improvements in the mean HbA1c reading pre and post training in both groups (p < 0.001). However, the greater reduction was noted in the resistance exercise group, and at 10 weeks their HbA1c levels were significantly lower than the group that received treadmill exercises (p < 0.006).

CONCLUSION

Ten weeks of resistance exercises were associated with a significantly better glycemic control in adults with type 2 diabetes compared to treadmill exercise.