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Wan Y, Su Z. The Impact of Resistance Exercise Training on Glycemic Control Among Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2024; 26:597-623. [PMID: 38623887 DOI: 10.1177/10998004241246272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background: The prevalence of type 2 diabetes mellitus (T2DM) presents a challenge for health organizations because of its high likelihood of morbidity and mortality. There is an increasing body of evidence exploring the efficacy of resistance training (RT) alone on glycemic control. Objective: To update the effectiveness of RT on glycosylated hemoglobin (HbA1c) and fasting glucose in adults diagnosed with T2DM. Methods: CINAHL (EBSDCO), PubMed, MEDLINE (Ovid), and EMBASE (Ovid) databases were searched from inception to 30 January 2024. Published randomized controlled trials (RCTs) of adult humans with T2DM assessing the impact of RT on HbA1c and fasting glucose compared with control condition were included. Data were pooled by the inverse-variance method and reported as mean differences (MDs) with 95% confidence intervals (CIs). Results: Forty-six RCTs totaling 2130 participants met the inclusion criteria. Meta-analysis demonstrated RT significantly reduced HbA1c (MD -0.50% [95% CI, -0.67, -0.34 %], p < .00,001) and fasting glucose (MD -12.03 mg/dl [95% CI, -19.36, -4.69 mg/dl], p = .001). Subgroup analyses found that exercise training durations, gender, and risk of bias had statistically significant effects on HbA1c levels and fasting glucose concentrations after resistance training. However, meta-regression analyses revealed that variables including year of publication, number of sessions per week, mean sample age, sample size, and study quality scores did not significantly affect the change in either HbA1c or glucose. Conclusion: Our meta-analysis with meta-regression delivers further evidence that RT programs are effective approach in attenuation of HbA1c and fasting glucose in individuals with T2DM.
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Affiliation(s)
- Yuwen Wan
- Faculty of physical education, Jiangxi Institute of Applied Science and Technology, Nanchang, China
| | - Zhanguo Su
- Faculty of physical education, Huainan Normal University, Huainan, China
- International College, Krirk University, Bangkok, Thailand
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2
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Silva LFR, Garcia BCC, Esteves EA, Mang ZA, Amorim FT, Dias-Peixoto MF, Gripp F, Tricoli V, de Castro Magalhaes F. The ASSIST trial: Acute effects of manipulating strength exercise volume on insulin sensitivity in obese adults: A protocol for a randomized controlled, crossover, clinical trial. PLoS One 2024; 19:e0302480. [PMID: 38805474 PMCID: PMC11132464 DOI: 10.1371/journal.pone.0302480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2024] [Indexed: 05/30/2024] Open
Abstract
Type 2 diabetes mellitus is a disease in which insulin action is impaired, and an acute bout of strength exercise can improve insulin sensitivity. Current guidelines for strength exercise prescription suggest that 8 to 30 sets could be performed, although it is not known how variations in exercise volume impact insulin sensitivity. Additionally, this means an almost 4-fold difference in time commitment, which might directly impact an individual's motivation and perceived capacity to exercise. This study will assess the acute effects of high- and low-volume strength exercise sessions on insulin sensitivity. After being thoroughly familiarized, 14 obese individuals of both sexes (>40 year old) will undergo 3 random experimental sessions, with a minimum 4-day washout period between them: a high-volume session (7 exercises, 3 sets per exercise, 21 total sets); a low-volume session (7 exercises, 1 set per exercise, 7 total sets); and a control session, where no exercise will be performed. Psychological assessments (feeling, enjoyment, and self-efficacy) will be performed after the sessions. All sessions will be held at night, and the next morning, an oral glucose tolerance test will be performed in a local laboratory, from which indexes of insulin sensitivity will be derived. We believe this study will aid in strength exercise prescription for individuals who claim not to have time to exercise or who perceive high-volume strength exercise intimidating to adhere to. This trial was prospectively registered (ReBEC #RBR-3vj5dc5 https://ensaiosclinicos.gov.br/rg/RBR-3vj5dc5).
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Affiliation(s)
- Luis Filipe Rocha Silva
- Graduate Program in Health Sciences, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Bruna Caroline Chaves Garcia
- Laboratory of Exercise Biology and Immunometabolism, Centro Integrado de Pós-Graduação e Pesquisa em Saúde, Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Elizabethe Adriana Esteves
- Graduate Program in Health Sciences, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
- Department of Nutrition, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Zachary Aaron Mang
- Post-doctoral Research Associate, Occupational Safety & Health, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Fabiano Trigueiro Amorim
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Marco Fabrício Dias-Peixoto
- Graduate Program in Health Sciences, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Fernando Gripp
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Valmor Tricoli
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Flavio de Castro Magalhaes
- Graduate Program in Health Sciences, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, United States of America
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
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Moosavi D, Vuckovic I, Kunz HE, Lanza IR. Metabolomic response to acute resistance exercise in healthy older adults by 1H-NMR. PLoS One 2024; 19:e0301037. [PMID: 38547208 PMCID: PMC10977811 DOI: 10.1371/journal.pone.0301037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/03/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The favorable health-promoting adaptations to exercise result from cumulative responses to individual bouts of physical activity. Older adults often exhibit anabolic resistance; a phenomenon whereby the anabolic responses to exercise and nutrition are attenuated in skeletal muscle. The mechanisms contributing to age-related anabolic resistance are emerging, but our understanding of how chronological age influences responsiveness to exercise is incomplete. The objective was to determine the effects of healthy aging on peripheral blood metabolomic response to a single bout of resistance exercise and whether any metabolites in circulation are predictive of anabolic response in skeletal muscle. METHODS Thirty young (20-35 years) and 49 older (65-85 years) men and women were studied in a cross-sectional manner. Participants completed a single bout of resistance exercise consisting of eight sets of 10 repetitions of unilateral knee extension at 70% of one-repetition maximum. Blood samples were collected before exercise, immediately post exercise, and 30-, 90-, and 180-minutes into recovery. Proton nuclear magnetic resonance spectroscopy was used to profile circulating metabolites at all timepoints. Serial muscle biopsies were collected for measuring muscle protein synthesis rates. RESULTS Our analysis revealed that one bout of resistance exercise elicits significant changes in 26 of 33 measured plasma metabolites, reflecting alterations in several biological processes. Furthermore, 12 metabolites demonstrated significant interactions between exercise and age, including organic acids, amino acids, ketones, and keto-acids, which exhibited distinct responses to exercise in young and older adults. Pre-exercise histidine and sarcosine were negatively associated with muscle protein synthesis, as was the pre/post-exercise fold change in plasma histidine. CONCLUSIONS This study demonstrates that while many exercise-responsive metabolites change similarly in young and older adults, several demonstrate age-dependent changes even in the absence of evidence of sarcopenia or frailty. TRIAL REGISTRATION Clinical trial registry: ClinicalTrials.gov NCT03350906.
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Affiliation(s)
- Darya Moosavi
- Department of Internal Medicine, Endocrine Research Unit, Division of Endocrinology, Mayo Clinic, Rochester, MN, United States of America
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States of America
| | - Ivan Vuckovic
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States of America
| | - Hawley E. Kunz
- Department of Internal Medicine, Endocrine Research Unit, Division of Endocrinology, Mayo Clinic, Rochester, MN, United States of America
| | - Ian R. Lanza
- Department of Internal Medicine, Endocrine Research Unit, Division of Endocrinology, Mayo Clinic, Rochester, MN, United States of America
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Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, McDermott MM, Swift DL, Webel AR, Lane A. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e217-e231. [PMID: 38059362 PMCID: PMC11209834 DOI: 10.1161/cir.0000000000001189] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.
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Hansen D, Coninx K, Beckers P, Cornelissen V, Kouidi E, Neunhauserer D, Niebauer J, Spruit MA, Takken T, Dendale P. Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease: why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network†. Eur J Prev Cardiol 2023; 30:1986-1995. [PMID: 37458001 DOI: 10.1093/eurjpc/zwad232] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
In Europe alone, on a yearly basis, millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynamic moderate-intensity resistance exercise 2 days/week). However, recent evidence shows that this one size does not fit all and that individual adjustments should be made according to the patient's underlying disease(s), risk profile, and individual needs, to maximize the clinical benefits of exercise. In this paper, we (i) argue that this general exercise prescription simply provided to all patients with CVD, or elevated risk for CVD, is insufficient for optimal CVD prevention, and (ii) show that clinicians and healthcare professionals perform heterogeneously when asked to adjust exercise characteristics (e.g. intensity, volume, and type) according to the patient's condition, thereby leading to suboptimal CVD risk factor control. Since exercise training is a class 1A intervention in the primary and secondary prevention of CVD, the awareness of the need to improve exercise prescription has to be raised among clinicians and healthcare professionals if optimized prevention of CVD is ambitioned.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Karin Coninx
- UHasselt, Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Beckers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp Hasselt, Belgium
| | - Véronique Cornelissen
- Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Neunhauserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Rehab-Center Salzburg, Ludwig Boltzmann Institute for digital Health and Prevention, Salzburg, Austria
| | - Martijn A Spruit
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
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Ribeiro AKPDL, Carvalho JPR, Bento-Torres NVO. Physical exercise as treatment for adults with type 2 diabetes: a rapid review. Front Endocrinol (Lausanne) 2023; 14:1233906. [PMID: 37842305 PMCID: PMC10569299 DOI: 10.3389/fendo.2023.1233906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a leading cause of disability-adjusted life years (DALY). Physical exercise is an effective non-pharmacological intervention to promote glycaemic control in T2DM. However, the optimal exercise parameters for glycemic control in individuals with T2DM remain unclear. Objective This study aimed to analyze the relationship between physical training variables - frequency, intensity, type, duration, volume, and progression - and glycemic control in individuals with T2DM. Methods A rapid systematic literature review was conducted on PubMed and LILACS databases. The PICOT strategy was employed to define the inclusion criteria. Eligible studies had to assess the impact of exercise parameters (frequency, intensity, type, duration, volume, and progression) on glycemic control indicators, primarily glycosylated hemoglobin (HbA1c). Randomized and non-randomized clinical trials were included in the review. The methodological quality of each study was assessed using the PEDro scale (PROSPERO - CRD 42021262614). Results Out of 1188 papers initially identified, 18 reports met the inclusion criteria and were included in the analysis. A total of 1,228 participants with T2DM (1086 in exercise groups) were included in the selected studies. Among these studies, 16 (88.9%) were RCTs and 2 (11.1%) were nRCTs. The age of participants ranged from 43.1 and 68.9 years, and the average intervention duration was 16.8 weeks. Data on adherence to the intervention, adverse events, detailed intervention protocol, and its impacts on glycaemic control, lipid profile, blood pressure, anthropometric measures, medication, body composition, and physical fitness are reported. Conclusion The evidence supports the safety and effectiveness of physical exercises as non-pharmacological interventions for glycemic control. Aerobic, resistance and combined training interventions were associated with reductions in HbA1c and fasting glucose. The diversity of the physical exercise intervention protocols investigated in the studies included in this review is an important limitation to generalizing evidence-based practice. The call for action is mandatory to implement large-scale education programs on the prevention of diabetes and public health policies aimed to include well-planned and supervised exercise programs as an essential part of the primary prevention of type 2 diabetes. Systematic Review Registration PROSPERO, identifier (CRD42021262614).
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Affiliation(s)
- Andressa Karoline Pinto de Lima Ribeiro
- Graduate Program in Attention and Clinical Study in Diabetes, Institute of Medical Sciences, Federal University of Pará, Belém, Pará, Brazil
- Neurodegeneration and Infection Research Laboratory, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
| | - Josilayne Patrícia Ramos Carvalho
- Neurodegeneration and Infection Research Laboratory, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
- Graduate Program in Human Movement Sciences, Institute of Health Sciences, Federal University of Pará, Belém, Brazil
| | - Natáli Valim Oliver Bento-Torres
- Graduate Program in Attention and Clinical Study in Diabetes, Institute of Medical Sciences, Federal University of Pará, Belém, Pará, Brazil
- Neurodegeneration and Infection Research Laboratory, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
- Graduate Program in Human Movement Sciences, Institute of Health Sciences, Federal University of Pará, Belém, Brazil
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Su W, Tao M, Ma L, Tang K, Xiong F, Dai X, Qin Y. Dose-response relationships of resistance training in Type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne) 2023; 14:1224161. [PMID: 37818093 PMCID: PMC10561623 DOI: 10.3389/fendo.2023.1224161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023] Open
Abstract
Background Globally, type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases. Resistance training (RT) is frequently employed to diminish Glycated Hemoglobin (HbA1c) and Fast Blood Glucose (FBG) levels in T2DM patients. Yet, the specific dose-response relationships between RT variables such as training duration, frequency, and intensity for T2DM remain under-researched. Objectives This meta-analysis aimed to elucidate the overarching effects of RT on HbA1c and FBG metrics and to provide dose-response relationships of RT variables. This was achieved by examining randomized controlled trials (RCTs) that reported reductions in HbA1c and FBG among T2DM patients. Methods Comprehensive literature searches were conducted up to 25th February 2023 across databases including EMBASE, Pubmed, Cochrane, CENTRAL, Web of Science, CNKI, Wanfang Data, VIP Database for Chinese Technical Periodicals, and the Chinese Biomedical Database. The Physical Therapy Evidence Database (PEDro) was leveraged to appraise the quality of selected studies based on predefined inclusion and exclusion criteria. The meta-analysis was conducted using Stata 16. Results 26 studies that include 1336 participants met the criteria for inclusion. RT significantly reduced HbA1c and FBG levels in comparison to control groups (P<0.05). Meta-regression analyses revealed that the number of repetitions per set (p=0.034) was a significant predictor of RT's efficacy on HbA1c. Subgroup analyses indicated that the most pronounced reductions in HbA1c and FBG occurred with a training duration of 12-16 weeks, intensities of 70-80% of 1 RM, training frequencies of 2-3 times per week, 3 sets per session, 8-10 repetitions per set, and less than a 60-second rest interval. Conclusion The beneficial impact of RT on HbA1c and FBG in T2DM patients is affirmed by this systematic review and meta-analysis. Moreover, the critical training parameters identified in this study are pivotal in enhancing HbA1c and FBG reductions, providing a reference for clinical staff to formulate RT exercise regiments for T2DM patients. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42023414616.
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Affiliation(s)
- Wanying Su
- Joint Surgery and Sport Medicine Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Meiyi Tao
- Nursing Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Lin Ma
- Endocrinology Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Ke Tang
- Nursing Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Fang Xiong
- Endocrinology Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xuan Dai
- Nursing Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Yuelan Qin
- Nursing Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
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Kirchner H, Weisner L, Wilms B. When should I run-the role of exercise timing in metabolic health. Acta Physiol (Oxf) 2023; 237:e13953. [PMID: 36815281 DOI: 10.1111/apha.13953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
The prevalence of type 2 diabetes is reaching epidemic proportions. First line therapy approaches are lifestyle interventions including exercise. Although a vast amount of studies reports on beneficial effects of exercise on metabolism in humans per se, overall data are contradictory which makes it difficult to optimize interventions. Innovative exercise strategies and its underlying mechanism are needed to elucidate in order to close this therapeutic gap. The skeletal muscle produces and secretes myokines and microRNAs in response to exercise and both are discussed as mechanisms linking exercise and metabolic adaptation. Aspects of chronophysiology such as diurnal variation in insulin sensitivity or exercise as a signal to reset dysregulated peripheral clocks are of growing interest in the context of impaired metabolism. Deep insight of how exercise timing determines metabolic adaptations is required to optimize exercise interventions. This review aims to summarize the current state of research on the interaction between timing of exercise and metabolism in humans, providing insights into proposed mechanistic concepts focusing on myokines and microRNAs. First evidence points to an impact of timing of exercise on health outcome, although data are inconclusive. Underlying mechanisms remain elusive. It is currently unknown if the timed release of mykokines depends on time of day when exercise is performed. microRNAs have been found as an important mediator of processes associated with exercise adaptation. Further research is needed to evaluate their full relevance. In conclusion, it seems to be too early to provide concrete recommendations on timing of exercise to maximize beneficial effects.
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Affiliation(s)
- Henriette Kirchner
- Institute for Human Genetics, Epigenetics and Metabolism Lab, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Leon Weisner
- Institute of Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
| | - Britta Wilms
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
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Intensity Differences of Resistance Training for Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11030440. [PMID: 36767015 PMCID: PMC9914423 DOI: 10.3390/healthcare11030440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Resistance training is used as adjunctive therapy for type 2 diabetes (T2DM), and the aim of this study was to investigate the differences in the treatment effects of different intensities of resistance training in terms of glycemia, lipids, blood pressure, adaptations, and body measurements. A comprehensive search was conducted in the PubMed, EMBASE (Excerpta Medica dataBASE), EBSCO (Elton B. Stephens Company) host, Cochrane Library, WOS (Web of Science), and Scopus databases with a cut-off date of April 2022, and reference lists of relevant reviews were also consulted. The literature screening and data extraction were performed independently by two researchers. RoB2 (Risk of bias 2) tools were used for the literature quality assessment, the exercise intensity was categorized as medium-low intensity and high intensity, and the meta subgroup analysis was performed using R Version. A fixed or random effects model was selected for within-group analysis based on the heterogeneity test, and a random effects model was used for the analysis of differences between subgroups. A total of 36 randomized controlled trials were included, with a total of 1491 participants. It was found that resistance training significantly improved HbA1c (glycated hemoglobin), fasting blood glucose, TG (triglycerides), TC (total cholesterol), and LDL (low-density lipoprotein cholesterol) levels in patients with T2DM and caused a significant reduction in systolic blood pressure, percent of fat mass, and HOMA-IR (homeostatic model assessment for insulin resistance) indexes. The effects of high and medium-low intensity resistance training on T2DM patients were different in terms of HOMA-IR, maximal oxygen consumption, weight, waist-to-hip ratio, and body mass indexes. Only medium-low intensity resistance training resulted in a decrease in HOMA-IR. In addition to weight (MD = 4.25, 95% CI: [0.27, 8.22], I2 = 0%, p = 0.04; MD = -0.33, 95% CI: [-2.05, 1.39], I2 = 0%, p = 0.76; between groups p = 0.03) and HOMA-IR (MD = 0.11, 95% CI: [-0.40, -0.63], I2 = 0%, p = 0.85; MD = -1.09, 95% CI: [-1.83, -0.36], I2 = 87%, p = < 0.01; between groups p = 0.0085), other indicators did not reach statistical significance in the level of difference within the two subgroups of high intensity and medium-low intensity. The treatment effects (merger effect values) of high intensity resistance training were superior to those of medium-low intensity resistance training in terms of HbA1c, TG, TC, LDL levels and diastolic blood pressure, resting heart rate, waist circumference, fat mass, and percentage of fat mass. Therefore, high intensity resistance training can be considered to be a better option to assist in the treatment of T2DM and reduce the risk of diabetic complications compared to medium-low intensity resistance training. Only one study reported an adverse event (skeletal muscle injury) associated with resistance training. Although results reflecting the difference in treatment effect between intensity levels reached no statistical significance, the practical importance of the study cannot be ignored.
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Peng Y, Ou Y, Wang K, Wang Z, Zheng X. The effect of low volume high-intensity interval training on metabolic and cardiorespiratory outcomes in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1098325. [PMID: 36686490 PMCID: PMC9845913 DOI: 10.3389/fendo.2022.1098325] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Aims The present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effect of low volume high-intensity interval training (LVHIIT) on the metabolic and cardiorespiratory outcomes in patients with type 2 diabetes mellitus (T2DM). Methods Relevant articles were sourced from PubMed, EBSCO, Web of Science, Embase, and the Cochrane Library from inception to October 2022. The study search strategy and all other processes were implemented in accordance with the PRISMA statement. Results Five randomized controlled trials that satisfied the inclusion criteria were included in this meta-analysis. The LVHIIT group had significantly lower fasting blood glucose levels (RR= -1.21; 95% CI= -2.02- -0.40, p = 0.0032) and HbA1c levels (RR= -0.65; 95% CI= -1.06- -0.23, p = 0.002) and higher levels of insulin resistance indicator HOMA-IR (RR= -1.34; 95% CI = -2.59- -0.10, p = 0.03) than the control group. Moreover, our results show that LVHIIT can reduce body mass (RR = -0.94, 95% CI = -1.37- -0.51, p<0.0001) and body mass index (RR = -0.31, 95% CI = -0.47- -0.16, p<0.0001). LVHIIT had a better therapeutic effect on blood lipid metabolism, such as total cholesterol, high-density lipoprotein, low-density lipoprotein and triglycerides. However, the change in fasting insulin levels was not statistically significant (RR= -1.43; 95% CI = -3.46- 0.60, p =0.17). Furthermore, LVHIIT reduced the systolic blood pressure (RR =-4.01, 95% CI = -4.82 - -3.21, p<0.0001) and improved peak oxygen uptake (VO2peak) compared to the control group (RR= 5.45; 95% CI = 1.38 - 9.52, p =0.009). Conclusion After a certain period of LVHIIT, glycaemic control, insulin resistance, body weight, lipid profile and cardiorespiratory outcomes were significantly improved in T2DM patients.
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Affiliation(s)
- Yang Peng
- West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Yiran Ou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- Department of Vascular Surgery, University Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenghao Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Xiaofeng Zheng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
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11
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Elbers RG, de Oude KI, Kastanidis T, Maes-Festen DAM, Oppewal A. The Effect of Progressive Resistance Exercise Training on Cardiovascular Risk Factors in People with Intellectual Disabilities: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16438. [PMID: 36554319 PMCID: PMC9778210 DOI: 10.3390/ijerph192416438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Progressive resistance exercise training (PRET) reduces cardiovascular risk factors (CVRF) in the general population. It is unknown if PRET also reduces these risk factors in adults with intellectual disabilities (ID). The aim is to present the protocol of an intervention study that investigates the effect of PRET on CVRF in adults with ID. We will use a repeated time series design with one study group. Adults with mild-to-moderate ID and at least two CVRF are eligible (Netherlands Trial Register, NL8382). During a 12-week baseline period, measurements take place at a 6-week interval. After this, the PRET programme starts for 24 weeks, after which all measurements will be repeated. We will use hierarchical regression models, adjusted for sport activity and medication use, to estimate the effect of PRET. After the intervention, the participants will be followed-up for 12 weeks. We will evaluate factors for successful implementation of exercise in daily life. Primary outcomes are: hypertension, obesity, hypercholesterolemia, diabetes, metabolic syndrome. Secondary outcomes are: physical fitness, sarcopenia, physical activity, activities of daily living, falls, challenging behaviour. If our results show that the PRET programme is effective, it may be a promising non-pharmacological intervention to reduce CVRF in adults with ID.
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Knaga J, Buresh R. Personalizing Activity Recommendations for Individuals with Type 2 Diabetes. ACSM'S HEALTH & FITNESS JOURNAL 2022. [DOI: 10.1249/fit.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Ferreira PPR, Silva LFR, Dias-Peixoto MF, Cassilhas RC, Gripp F, Amorim FT, Mang ZA, Esteves EA, Tricoli VA, Ferraresi C, Magalhães FDC. Effects of the association of different volumes of strength training with photobiomodulation therapy on insulin resistance: A protocol for a randomized, triple-blind, placebo-controlled trial. Contemp Clin Trials Commun 2022; 29:100984. [PMID: 36052175 PMCID: PMC9424937 DOI: 10.1016/j.conctc.2022.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 10/27/2022] Open
Abstract
Background Insulin resistance (IR) is the main risk factor for developing type 2 diabetes. Both strength training (ST) and photobiomodulation therapy (PBMt) reduce IR, but the effect of combining different volumes of ST with PBMt is unknown. Methods Overweight/obese individuals will be assigned to 4 groups (n = 12/group): ST with volume following international guidelines (3 sets per exercise - high volume) or one-third of this volume (1 set per exercise - low volume), combined with PBMt or placebo. ST will be performed for 20 sessions over 10 weeks and will consist of 7 exercises. The PBMt will be applied after training sessions using blankets with light emitters (LEDs) placed over the skin on the frontal and the posterior region of the body, following the parameters recommended by the literature. The placebo group will undergo an identical procedure, but blankets will emit insignificant light. To measure plasma glucose and insulin concentrations, oral glucose tolerance tests (OGTT) will be performed before and after the training period. Thereafter, IR, the area under the curve of glucose and insulin, and OGTT-derived indices of insulin sensitivity/resistance will be calculated. Expected impact on the field This study will determine the effects of different ST volumes on IR and whether the addition of PBMt potentiates the effects of ST. Because previously sedentary, obese, insulin-resistant individuals might not comply with recommended volumes of exercise, the possibility that adding PBMt to low-volume ST enhances ST effects on IR bears practical significance.
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Affiliation(s)
- Pedro Paulo Ribeiro Ferreira
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Luís Filipe Rocha Silva
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Marco Fabrício Dias-Peixoto
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Ricardo Cardoso Cassilhas
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Fernando Gripp
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Fabiano Trigueiro Amorim
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Zachary A. Mang
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Elizabethe Adriana Esteves
- Department of Nutrition, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
| | - Valmor A. Tricoli
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Cleber Ferraresi
- Deparment of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Flávio de Castro Magalhães
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil
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Holmes CJ, Racette SB, Symonds L, Arbeláez AM, Cao C, Granados A. Comparison of Bioelectrical Impedance Analysis with DXA in Adolescents with Cystic Fibrosis before and after a Resistance Training Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4037. [PMID: 35409718 PMCID: PMC8997924 DOI: 10.3390/ijerph19074037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this pilot study was to compare body composition metrics obtained by two portable bioelectrical impedance analysis (BIA) devices with dual-energy X-ray absorptiometry (DXA) among adolescents with cystic fibrosis (CF) before and after a resistance exercise training program. METHODS Participants with CF were assessed using DXA, single-frequency BIA (SFBIA), and multiple-frequency BIA (MFBIA) to quantify percent body fat (%Fat), fat mass (FM), and fat-free mass (FFM) at baseline and after a home-based resistance training intervention comprised of 36, 1 h sessions completed in 12-14 weeks. Repeated measures analysis of variance, paired samples t-tests, Cohen's d effect sizes, and Pearson's correlations were used to compare differences between and within methods at baseline and post-intervention. RESULTS Ten participants (15.8 ± 2.2 yr, 60.1 ± 15.1 kg) completed the assessments. At baseline, both SFBIA and MFBIA scales significantly underestimated %Fat and FM and overestimated FFM, with small to moderate effect sizes. Post-intervention, small, non-significant differences were found between DXA and both BIA scales for all body composition metrics. Significant changes in %Fat and FFM were observed with DXA. MFBIA displayed less constant error than SFBIA when compared to DXA for pre- and post-intervention assessments for %Fat (MFBIA: pre and post -2.8 and -0.8 vs. SFBIA: -4.6 and -2.0), FM (-0.4 and -0.4 vs. -3.0 and -1.1), and FFM (+0.8 and +0.6 vs. +3.1 and +1.3). Near-perfect correlations were observed at both time points between DXA and each BIA scale. Conclusions: Portable BIA results should be interpreted with caution, and further validation studies in CF patients are needed prior to clinical use.
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Affiliation(s)
- Clifton J. Holmes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
- Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Susan B. Racette
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
- Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Leslie Symonds
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63108, USA; (L.S.); (A.M.A.)
| | - Ana Maria Arbeláez
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63108, USA; (L.S.); (A.M.A.)
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
| | - Andrea Granados
- Nicklaus Children’s Hospital, Division of Pediatric Endocrinology and Metabolism, Miami, FL 33155, USA;
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15
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Holmes CJ, Racette SB, Symonds L, Arbeláez AM, Cao C, Granados A. Feasibility and Efficacy of Telehealth-Based Resistance Exercise Training in Adolescents with Cystic Fibrosis and Glucose Intolerance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3297. [PMID: 35328985 PMCID: PMC8950531 DOI: 10.3390/ijerph19063297] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023]
Abstract
The aims of this study were to (1) determine the feasibility of a home-based resistance exercise training (RET) program in patients with cystic fibrosis and impaired glucose tolerance using virtual personal training and (2) observe the effects completion of the RET program had on glucose metabolism, pulmonary function, body composition, and physical fitness. The feasibility of the program was defined as 80% compliance. Ten participants (15.80 ± 2.20 yr, 25.1 ± 7.4 kg/m2) began a home-based resistance training program consisting of 36 sessions supervised via online videoconferencing. Compliance scores of 78.9% (all participants) and 81.8% (without one outlier) were observed. A significant increase was observed in 2-h C-peptide levels (2.1 ng/mL; p = 0.04), with a moderate decrease in fasting glucose (-5.2 mg/dL; p = 0.11) and a moderate increase in 2-h insulin (35.0 U/mL; p = 0.10). A small decrease in the fat percentage (-1.3%; p = 0.03) was observed in addition to increases in fat-free mass (1.5 kg; p = 0.01) and the fat-free mass index (0.4; p = 0.01). Small, yet statistically significant increases were observed in V̇O2peak (0.1 L/min p = 0.01), V̇CO2peak (0.1 L/min; p = 0.01), and ventilation (5.3 L/min; p = 0.04). Telehealth-based RET is feasible in adolescents with CF and impaired glucose tolerance and elicits small yet favorable changes in insulin secretion, body composition, and exercise capacity.
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Affiliation(s)
- Clifton J. Holmes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
- Department of Medicine, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Susan B. Racette
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
- Department of Medicine, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Leslie Symonds
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA; (L.S.); (A.M.A.)
| | - Ana Maria Arbeláez
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA; (L.S.); (A.M.A.)
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
| | - Andrea Granados
- Department of Pediatrics, Division of Endocrinology and Metabolism, Nicklaus Children’s Hospital, Miami, FL 33155, USA;
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16
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Jansson AK, Chan LX, Lubans DR, Duncan MJ, Plotnikoff RC. Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2022; 10:10/2/e002595. [PMID: 35273011 PMCID: PMC8915309 DOI: 10.1136/bmjdrc-2021-002595] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 11/04/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases globally. Regular physical activity is regarded as one of the key components in T2DM management. Aerobic exercise was traditionally recommended; however, there is a growing body of research examining the independent effect of resistance training (RT) on glycemic control. This systematic review and meta-analysis aimed to conduct an update on the effects of RT on glycosylated hemoglobin (HbA1c) in adults with T2DM and examine the moderating effects of training effect (ie, muscular strength improvements), risk of bias and intervention duration. Peer-reviewed articles published in English were searched across MEDLINE, Embase, CINAHL, Scopus and SPORTDiscus from database inception until January 19, 2021. Each online database was systematically searched for randomized controlled trials reporting on the effects of RT on HbA1c in individuals with T2DM. Twenty studies (n=1172) were included in the meta-analysis. RT significantly reduced HbA1c compared with controls (weighted mean difference=-0.39, 95% CI -0.60 to -0.18, p<0.001, I2=69.20). Training effect significantly (p<0.05) moderated the results, with larger improvements in muscular strength leading to greater reductions in HbA1c (β=-0.99, CI -1.97 to -0.01). Intervention duration and risk of bias did not significantly moderate the effects. As a secondary analysis, this study found no significant differences in HbA1c when comparing RT and aerobic training (p=0.42). This study demonstrates that RT is an effective strategy to decrease HbA1c in individuals with T2DM. Importantly, RT interventions that had a larger training effect appeared more effective in reducing HbA1c, compared with interventions producing medium and small effects.PROSPERO registration number CRD42020134046.
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Affiliation(s)
- Anna K Jansson
- School of Education, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Active Living and Learning, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Li X Chan
- Centre for Active Living and Learning, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David R Lubans
- School of Education, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Active Living and Learning, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mitch J Duncan
- Centre for Active Living and Learning, The University of Newcastle, Callaghan, New South Wales, Australia
- School of Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Ronald C Plotnikoff
- School of Education, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Active Living and Learning, The University of Newcastle, Callaghan, New South Wales, Australia
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17
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Holmes CJ, Granados A. Resistance Training Recommendations for Children and Adolescents With Cystic Fibrosis-Related Diabetes. Strength Cond J 2022; 44:111-118. [PMID: 35874931 PMCID: PMC9307104 DOI: 10.1519/ssc.0000000000000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Cystic fibrosis (CF) is the most prevalent hereditary life-threatening disease in the Caucasian population. With the improvement in clinical care, individuals with CF are living longer, and CF-related diabetes (CFRD) has emerged as a major complication. The diagnosis of CFRD is associated with shortening survival, increasing morbidity, worsening physical capacity, and body composition. Engagement in exercise training has become a prominent nonpharmacologic intervention that aims to improve fitness and clinical outcomes in individuals with CF and CFRD. This column will specifically focus on the potential benefits of resistance training and provide recommendations for children and adolescents with CF and CFRD.
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Affiliation(s)
- Clifton J. Holmes
- Program in Physical Therapy, Washington University of Medicine, St. Louis, Missouri
| | - Andrea Granados
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Washington University of Medicine, St. Louis, Missouri
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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19
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The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med 2021; 10:jcm10215042. [PMID: 34768562 PMCID: PMC8584831 DOI: 10.3390/jcm10215042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes. It is associated with pain, paresthesia, sensory loss, muscle atrophy with fat infiltration, and muscular dysfunction typically starting distally in the feet and progressing proximally. Muscle deterioration within the leg and foot can lead to muscle dysfunction, reduced mobility, and increases the risk of disability, ulceration, and amputation. Exercise training is an established method for increasing the different components of physical fitness, including enhancing body composition and improving neuromuscular strength. A number of experimental studies have utilized exercise training to treat various impairments associated with DPN, such as nerve conduction velocity, pain tolerance, and balance. However, the broad spectrum of exercise training modalities implemented and differences in target outcome measurements have made it difficult to understand the efficacy of exercise training interventions or provide appropriate exercise prescription recommendations. Therefore, the aims of this review were to (1) briefly describe the pathophysiology of DPN and (2) discuss the effects of exercise training interventions on sensorimotor, metabolic, and physical functions in people with DPN.
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20
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Association of Adherence to a Mediterranean Diet with Excess Body Mass, Muscle Strength and Physical Performance in Overweight or Obese Adults with or without Type 2 Diabetes: Two Cross-Sectional Studies. Healthcare (Basel) 2021; 9:healthcare9101255. [PMID: 34682935 PMCID: PMC8535373 DOI: 10.3390/healthcare9101255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022] Open
Abstract
Overweight and obesity in older adults is associated with disability and is exacerbated by the presence of type 2 diabetes (T2DM). There is emerging evidence that adherence to a Mediterranean diet (MedDiet) reduces adiposity and attenuates physical disability. These cross-sectional studies explored the associations of adherence to a MedDiet with body mass index (BMI), adiposity, muscle strength, and physical performance in older adults without diabetes and in middle-aged or older adults with T2DM. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener. Fat mass and percent body fat were assessed by dual energy X-ray absorptiometry. Muscle strength was assessed using hand-grip strength, while physical performance was assessed using the Short Physical Performance Battery and gait speed. A total of n = 87 participants with T2DM (T2DM sample: 71.2 ± 8.2 years, BMI: 29.5 ± 5.9) and n = 65 participants without diabetes (non-T2DM sample: 68.7 ± 5.6 years, BMI: 33.7 ± 4.9) were included in these analyses. In the T2DM sample, when controlled for age, gender, and appendicular lean mass index, adherence to a MedDiet was inversely associated with BMI, fat mass, and percent body fat. However, this was no longer maintained in the fully adjusted models. Although, adherence to a MedDiet was positively associated with gait speed (β = 0.155; p = 0.050) independent of all covariates used. Adherence to a MedDiet may be a suitable dietary strategy for preserving lower body physical function in middle-aged and older adults with T2DM. However, these findings should be further investigated using well-designed randomised controlled trials and prospective cohort studies with a wider range of adherence scores to investigate temporal associations.
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21
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Qadir R, Sculthorpe NF, Todd T, Brown EC. Effectiveness of Resistance Training and Associated Program Characteristics in Patients at Risk for Type 2 Diabetes: a Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2021; 7:38. [PMID: 34050828 PMCID: PMC8164651 DOI: 10.1186/s40798-021-00321-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/18/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Resistance training (RT) is an effective intervention for glycemic control and cardiometabolic health in individuals with type 2 diabetes (T2D). However, the use of RT in individuals at risk for T2D to prevent or delay the onset of T2D, and RT program characteristics that are most effective are still unknown. The purpose of this review is to determine the effects of RT on cardiometabolic risk factors in those at risk for T2D and to examine RT program characteristics associated with intervention effectiveness. METHODS PubMed, Cochrane, Web of Science, and Embase databases were systematically searched for published controlled trials that compared cardiometabolic outcomes in adults with cardiometabolic risk for those that underwent an RT intervention with those that did not. A systematic review and meta-analysis was conducted to determine the effect of RT on glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body fat percentage (BF%), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG). Additional analyses examined effects of intervention duration and dietary intervention on FPG and TG. RESULTS Fourteen trials with 668 participants were included. For RT compared to controls, the standardized mean difference (SMD) was -1.064 for HbA1c (95% confidence interval [CI] -1.802 to -0.327; p=0.005), -0.99 for FPG (95% CI -1.798 to -0.183; p=0.016), -0.933 for TC (95% CI -1.66 to -0.206; p=0.012), -0.840 for BF% (95% CI -1.429 to -0.251; p=0.005), -0.693 for HDL (95% CI -1.230 to -0.156; p=0.011), -1.03 for LDL (95% CI -2.03 to -0.050; p=0.039), and -0.705 for TG (95% CI -1.132 to -0.279; p=0.001). CONCLUSIONS RT is beneficial for improving glycemic control, BF%, and blood lipids in those at risk for diabetes. The addition of a dietary component did not result in larger reductions in FPG and TG than RT alone. PROSPERO REGISTRATION ID CRD42019122217.
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Affiliation(s)
- Raza Qadir
- Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
| | - Nicholas F Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Lanarkshire, UK
| | - Taylor Todd
- School of Health Sciences, Oakland University, Rochester, MI, 48309, USA
| | - Elise C Brown
- School of Health Sciences, Oakland University, Rochester, MI, 48309, USA
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22
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Ferrari R, Domingues LB, Carpes LDO, Frank PDA, Schneider VM, Fuchs SC. Effects of combined training performed two or four times per week on 24-h blood pressure, glycosylated hemoglobin and other health-related outcomes in aging individuals with hypertension: Rationale and study protocol of a randomized clinical trial. PLoS One 2021; 16:e0251654. [PMID: 34038410 PMCID: PMC8153424 DOI: 10.1371/journal.pone.0251654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure. PURPOSE To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension. METHODS This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period. RESULTS Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.
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Affiliation(s)
- Rodrigo Ferrari
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Physical Education School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- * E-mail:
| | - Lucas Betti Domingues
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Leandro de Oliveira Carpes
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paula de Azevedo Frank
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Sandra C. Fuchs
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - the GET Study Group
- Sports and Exercise Training Study Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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23
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Shen Y, Yu L, Hua Z, Jia N, Zhou Y, Dong X, Ding M. The effects and acceptability of different exercise modes on glycemic control in type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e23963. [PMID: 33545979 PMCID: PMC7837820 DOI: 10.1097/md.0000000000023963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis. METHODS AND ANALYSIS Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use. TRIAL REGISTRATION NUMBER PROSPERO CRD42020175181. DISCUSSION The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods. ETHICS AND DISSEMINATION The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.
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Affiliation(s)
- Yuanlong Shen
- College of Physical Education, Shandong Normal University
| | - Lina Yu
- College of Physical Education, Shandong Normal University
| | - Zhen Hua
- Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University
| | - Ningxin Jia
- College of Physical Education, Shandong Normal University
| | - Yanan Zhou
- College of Physical Education, Shandong Normal University
| | - Xiaosheng Dong
- School of Physical Education, Shandong University, Jinan, Chian
| | - Meng Ding
- College of Physical Education, Shandong Normal University
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24
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Bekele BB, Manzar MD, Alqahtani M, Pandi-Perumal SR. Diabetes mellitus, metabolic syndrome, and physical activity among Ethiopians: A systematic review. Diabetes Metab Syndr 2021; 15:257-265. [PMID: 33484984 DOI: 10.1016/j.dsx.2020.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing appreciation for the impact of limited physical activity on the disease. This study aimed to determine whether the current research on DM in Ethiopia has sufficiently identified and focused on the importance of limited physical activity according to the Global Physical Activity Questionnaire (GPAQ) in the disease etiology. METHODS This was a systematic review, performed according to the PRISMA checklist. We searched primary studies of diabetes, diabetes-related complications, determinants, and magnitude of related morbidities in Ethiopia in PubMed, Medline, and ISI Web of Science databases. Reviews, editorial communications, reports, and letters were excluded. RESULTS Among 363 articles that were identified from all databases, 28 were included. It was found that 39% of the studies measured and included limited physical activity as a predisposing lifestyle factor in diabetes, while 17.86% either did not report or did not include this variable at all. Although 42.86% of the studies identified limited physical activity as an etiological factor in diabetes, it was not measured according to the GPAQ guidelines. CONCLUSIONS These data suggest that Ethiopian researchers do not give sufficient attention to the role of physical activity and its definition per GPAQ as a preventative factor for reducing the severity of diabetes symptoms. We suggest that physical activity research and promotion should be advocated in Ethiopia, and that researchers should seek advice on how to re-frame their work in the future.
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Affiliation(s)
- Bayu Begashaw Bekele
- Public Health Department, College of Health Sciences, Mizan-Tepi University, 260, Mizan-Aman, Ethiopia; Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, 4028, Hungary.
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physiotherapy, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia
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25
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El-Kotob R, Ponzano M, Chaput JP, Janssen I, Kho ME, Poitras VJ, Ross R, Ross-White A, Saunders TJ, Giangregorio LM. Resistance training and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab 2020; 45:S165-S179. [DOI: 10.1139/apnm-2020-0245] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this overview of systematic reviews was to determine the benefits and harms of resistance training (RT) on health outcomes in adults aged 18 years or older, compared with not participating in RT. Four electronic databases were searched in February 2019 for systematic reviews published in the past 10 years. Eligibility criteria were determined a priori for population (community dwelling adults), intervention (exclusively RT), comparator (no RT or different doses of RT), and health outcomes (critical: mortality, physical functioning, health-related quality of life, and adverse events; important: cardiovascular disease, type 2 diabetes mellitus, mental health, brain health, cognitive function, cancer, fall-related injuries or falls, and bone health). We selected 1 review per outcome and we used the GRADE process to assess the strength of evidence. We screened 2089 records and 375 full-text articles independently, in duplicate. Eleven systematic reviews were included, representing 364 primary studies and 382 627 unique participants. RT was associated with a reduction in all-cause mortality and cardiovascular disease incidence, and an improvement in physical functioning. Effects on health-related quality of life or cognitive function were less certain. Adverse events were not consistently monitored or reported in RT studies, but serious adverse events were not common. Systematic reviews for the remaining important health outcomes could not be identified. Overall, RT training improved health outcomes in adults and the benefits outweighed the harms. (PROSPERO registration no.: CRD42019121641.) Novelty This overview was required to inform whether there was new evidence to support changes to the recommended guidelines for resistance training.
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Affiliation(s)
- Rasha El-Kotob
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
| | - Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Michelle E. Kho
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | | | - Robert Ross
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Travis J. Saunders
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, ON N2J 0E2, Canada
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26
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Wake AD. Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:2909-2923. [PMID: 32884317 PMCID: PMC7443456 DOI: 10.2147/dmso.s262289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the improvements in clinical care of the patients, research updates, and public health interventions, there is still an increase in the prevalence, incidence, and mortality because of diabetes mellitus (DM). DM is a public health problem in both developed and developing countries. It has increased alarmingly, putting this disease in the dimension of an epidemic. Diabetes is associated with several complications which increase the risk of many serious health problems on the other side. Therefore, this review was aimed to discuss the antidiabetic effects of physical activity (PA) on type 2 DM (T2DM) by summarizing the significant studies on this topic. This review found that several studies have recommended the utilization of PA for the effective management of T2DM. PA is a non-pharmacologic therapy which is a significant strategy for the management of T2DM and is an appropriate lifestyle modification approach to be practiced by these patients. The studies showed that PA has antidiabetic effects which are evidenced by its substantial role in improving the blood glucose (BG) levels of the individuals with T2DM where it helps them to control their levels of glucose in the blood. It plays a significant role in glycemic control of this disease by lowering the BG levels through possible mechanisms such as decreasing insulin resistance, increasing production of glucose transporter type 4 (GLUT-4), lowering visceral adipose tissue (VAT), increasing pancreatic β-cell functions, using glucose for energy, and so on. In turn, the controlled glycemia helps to prevent the complications associated with uncontrolled T2DM and this would further improve the overall health of the patients and the burden on the health professionals as well. Finally, this review concludes that PA is the cornerstone in the management of T2DM. It also suggests that more attention is needed to its significance in the prevention, glycemic control, and its role in the management of the morbidity and mortality associated with T2DM. Practical PA recommendations and suggestions for the future direction of research in this area are also provided.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Assela, Oromia, Ethiopia
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27
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Brown EC, Franklin BA, Regensteiner JG, Stewart KJ. Effects of single bout resistance exercise on glucose levels, insulin action, and cardiovascular risk in type 2 diabetes: A narrative review. J Diabetes Complications 2020; 34:107610. [PMID: 32402840 DOI: 10.1016/j.jdiacomp.2020.107610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
AIMS Previous studies have reported beneficial effects of chronic resistance exercise in the prevention and treatment of type 2 diabetes. To clarify potential modulators of acute responses to resistance exercise, we reviewed the literature to determine the effects of a single bout of resistance exercise on cardiometabolic risk factors in type 2 diabetes. METHODS Pubmed and Embase were searched for studies investigating the effects of single bouts of resistance exercise on glucose and insulin levels, and cardiovascular disease risk in people with diabetes. Fourteen reports were identified and reviewed to formulate evidence-based resistance exercise prescription recommendations. RESULTS Glucose and insulin levels appear to decrease with resistance exercise with effects lasting up to 24 and 18 h, respectively. Bouts of resistance exercise may outperform aerobic exercise in reducing ambulatory blood pressure, with effects lasting up to 24 h. Moreover, resistance exercise after rather than before a meal may be more effective in reducing glucose, insulin, and triacylglycerol levels. However, reducing injectable insulin dosage prior to resistance exercise may blunt its favorable effects on glucose levels. CONCLUSIONS This review suggests that a single bout of resistance exercise may be effective for acutely improving cardiometabolic markers in people with diabetes.
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Affiliation(s)
- Elise C Brown
- School of Health Sciences, Oakland University, 433 Meadow Brook Rd, Rochester, MI 48309, USA.
| | - Barry A Franklin
- Preventative Cardiology/Cardiac Rehabilitation, Division of Cardiovascular Diseases, Beaumont Health and Wellness Center, Royal Oak, MI, USA.
| | - Judith G Regensteiner
- Center for Women's Health Research, School of Medicine, University of Colorado, Denver, CO, USA.
| | - Kerry J Stewart
- Division of Cardiology, School of Medicine, Department of Medicine, John Hopkins University, Baltimore, MD, USA.
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28
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Fokkert M, van Dijk PR, Edens MA, Díez Hernández A, Slingerland R, Gans R, Delgado Álvarez E, Bilo H. Performance of the Eversense versus the Free Style Libre Flash glucose monitor during exercise and normal daily activities in subjects with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:8/1/e001193. [PMID: 32784247 PMCID: PMC7418676 DOI: 10.1136/bmjdrc-2020-001193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Accurate blood glucose measurements are important in persons with diabetes during normal daily activities (NDA), even more so during exercise. We aimed to investigate the performance of fluorescence sensor-based and glucose oxidase-based interstitial glucose measurement during (intensive) exercise and NDA. RESEARCH DESIGN AND METHODS Prospective, observational study in 23 persons with type 1 diabetes when mountain biking for 6 days, followed by 6 days of NDA. Readings of the Eversense (fluorescence-based continuous glucose monitoring (CGM); subcutaneously implanted) and of the Free Style Libre (FSL; glucose oxidase-based flash glucose monitoring (FGM); transcutaneously placed) were compared with capillary glucose levels (Free Style Libre Precision NeoPro strip (FSLCstrip)). RESULTS Mean average differences (MAD) and mean average relative differences (MARD) were significantly different when comparing exercise with NDA (reference FSLCstrip); Eversense MAD 25±19 vs 17±6 mg/dL (p<0.001); MARD 17±6 vs 13%±6% (p<0.01) and FSL MAD 32±17 vs 18±8 mg/dL (p<0.01); MARD 20±7 vs 12%±5% (p<0.001).When analyzing the data according to the Integrated Continuous Glucose Monitoring Approvals (class II-510(K) guidelines), the overall performance of interstitial glucose readings within 20% of the FSLCstrip during exercise compared with NDA was 69% vs 81% for the Eversense and 59% vs 83% for the FSL, respectively. Within 15% of the FSLCstrip was 59% vs 70% for the Eversense and 46% vs 71% for the FSL. CONCLUSIONS During exercise, both fluorescence and glucose oxidase-based interstitial glucose measurements (using Eversense and FSL sensors) were less accurate compared with measurements during NDA. Even when acknowledging the beneficial effects of CGM or FGM, users should be aware of the risk of diminished accuracy of interstitial glucose readings during (intensive) exercise.
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Affiliation(s)
- Marion Fokkert
- Department of Clinical Chemistry, Isala, Zwolle, NA, The Netherlands
| | - Peter R van Dijk
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Diabetes Research Center, Isala, Zwolle, NA, The Netherlands
| | - Mireille A Edens
- Department Innovation and Science, Isala, Zwolle, NA, The Netherlands
| | | | | | - Rijk Gans
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elías Delgado Álvarez
- Sección de Diabetes, Universidad de Oviedo, Oviedo, Asturias, Spain
- Sección de Diabetes, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Henk Bilo
- Diabetes Research Center, Isala, Zwolle, NA, The Netherlands
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29
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Acosta-Manzano P, Rodriguez-Ayllon M, Acosta FM, Niederseer D, Niebauer J. Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis. Obes Rev 2020; 21:e13007. [PMID: 32067343 DOI: 10.1111/obr.13007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/31/2019] [Accepted: 01/16/2020] [Indexed: 12/29/2022]
Abstract
Resistance training (RT) is a powerful first-line intervention for the management of type 2 diabetes mellitus (T2DM). Nonetheless, the effects of the most frequent RT (hypertrophy training [HT] and muscular endurance training [MERT]) employed for the management of T2DM, and which type of RT might exert superior effects, remain elusive. Thus, this review aims to assess the effects of HT and MERT on glycaemic control, physical fitness, body composition, lipid profile, blood pressure, C-reactive protein, and quality of life in patients with T2DM; to analyse which particular RT is more effective; to assess the effects of general RT; and to identify RT components, characteristics of patients, and medications that could mediate the effects of RT. Randomized controlled trials (RCT) and non-RCT (RT≥ 4 weeks) in adults with T2DM were selected. Both HT and MERT improved HbA1c, insulin levels and sensitivity, muscle strength, body mass index, waist circumference, and fat mass. Additionally, HT improved glucose, cardiorespiratory fitness, fat percentage, lean body mass, lipid profile, systolic blood pressure, and C-reactive protein, and MERT improved weight. Overall, HT and MERT exert beneficial effects well comparable with aerobic training. Both types of RT can be used as potent therapeutic interventions for the management of T2DM depending on patients' limitations/preferences.
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Affiliation(s)
- Pedro Acosta-Manzano
- PA-HELP "Physical Activity for Health Promotion, CTS-1018" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain.,Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain
| | - María Rodriguez-Ayllon
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain.,PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Spain
| | - Francisco M Acosta
- Sport and Health University Research Institute (IMUDS), University of Granada, Granada, Spain.,PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Spain
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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30
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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
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31
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Jabardo-Camprubí G, Donat-Roca R, Sitjà-Rabert M, Milà-Villarroel R, Bort-Roig J. Drop-out ratio between moderate to high-intensity physical exercise treatment by patients with, or at risk of, type 2 diabetes mellitus: A systematic review and meta-analysis. Physiol Behav 2020; 215:112786. [DOI: 10.1016/j.physbeh.2019.112786] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
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32
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Gray ID, Kross AR, Renfrew ME, Wood P. Precision Medicine in Lifestyle Medicine: The Way of the Future? Am J Lifestyle Med 2020; 14:169-186. [PMID: 32231483 PMCID: PMC7092395 DOI: 10.1177/1559827619834527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.
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Affiliation(s)
- Ian D. Gray
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Andrea R. Kross
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Melanie E. Renfrew
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Paul Wood
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
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33
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Weterings S, Oppewal A, Hilgenkamp TIM. The feasibility of vigorous resistance exercise training in adults with intellectual disabilities with cardiovascular disease risk factors. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:488-495. [PMID: 31851774 PMCID: PMC7187317 DOI: 10.1111/jar.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The cardiovascular disease (CVD) risk is high in adults with intellectual disabilities. This CVD risk can potentially be decreased with a resistance training (RT) programme at vigorous intensity, following previous research on successful High-Intensity Training programmes. Our aim was to explore the feasibility of a vigorous RT-programme for adults with intellectual disabilities with CVD risk factors. METHOD Twenty-four adults with intellectual disabilities with at least one CVD risk factor participated in a 24-week RT-programme. The training intensity was increased from novice (50%1RM) to vigorous (75%-80%1RM). Feasibility was based on the achieved training intensity at the end of the RT-programme. RESULTS Nineteen participants finished the RT-programme. Feasibility was good as 58% (11 out of 19) of the participants worked out at vigorous intensity at the end of the programme. CONCLUSIONS It is feasible for the majority of adults with intellectual disabilities with CVD risk factors to exercise at vigorous intensity.
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Affiliation(s)
- Stijn Weterings
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Abrona, Healthcare Provider for people with intellectual disabilities, Huis ter Heide, The Netherlands
| | - Alyt Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
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34
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Hansen D, Kraenkel N, Kemps H, Wilhelm M, Abreu A, Pfeiffer AFH, Jordão A, Cornelissen V, Völler H. Management of patients with type 2 diabetes in cardiovascular rehabilitation. Eur J Prev Cardiol 2019; 26:133-144. [DOI: 10.1177/2047487319882820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy.
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Affiliation(s)
- Dominique Hansen
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
- Jessa Hospital, Heart Center Hasselt, Belgium
- BIOMED – Biomedical Research Center, Hasselt University, Belgium
| | - Nicolle Kraenkel
- Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, the Netherlands
| | | | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Portugal
| | - Andreas FH Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Germany
- DZD (German Centre for Diabetes Research), partner site Berlin/Nuthetal, Germany
| | - Alda Jordão
- Department of Internal Medicine, Hospital Pulido Valente, Portugal
| | | | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Germany
- Klinik am See, Rehabilitation Center for Internal Medicine, Germany
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Pezhman L, Sheikhzadeh Hesari F, Ghiasi R, Alipour MR. The impact of forced swimming on expression of RANKL and OPG in a type 2 diabetes mellitus rat model. Arch Physiol Biochem 2019; 125:195-200. [PMID: 29498886 DOI: 10.1080/13813455.2018.1446178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The importance of swimming in bone metabolism during type 2 diabetes (T2DM) is not well known. Receptor activator of nuclear factor-kB ligand (RANKL)/ osteoprotegerin (OPG) system as a critical pathway in bone remodeling may play a role in pathogenesis of T2DM. Hence, we tested this pathway and the possible beneficial effects of swim training on T2DM. MATERIALS AND METHODS Forty male rats were assigned to groups (n = 10): control(C), diabetic (D), exercised control (E), and diabetic exercised (DE). One week after the induction of diabetes, animals were subjected to swim. At the end of training, fasting blood sugar, insulin, bone and serum OPG and RANKL levels were measured. RESULTS Diabetes significantly increased OPG and decreased RANKL mRNAs and proteins in bone and serum and swim training could reverse these changes to control. CONCLUSION Swim training could partially compensate T2DM associated changes of bone and serum OPG/RANKL in rats.
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Affiliation(s)
- Laleh Pezhman
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | | | - Rafighe Ghiasi
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Reza Alipour
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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Jang JE, Cho Y, Lee BW, Shin ES, Lee SH. Effectiveness of Exercise Intervention in Reducing Body Weight and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus in Korea: A Systematic Review and Meta-Analysis. Diabetes Metab J 2019; 43:302-318. [PMID: 30604592 PMCID: PMC6581545 DOI: 10.4093/dmj.2018.0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/16/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea. METHODS Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model. RESULTS We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, -0.58%; 95% CI, -0.89 to -0.27; I²=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, -2.25 kg; 95% CI, -4.36 to -0.13; I²=17%) in the subgroup analysis. CONCLUSION Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.
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Affiliation(s)
- Ji Eun Jang
- Department of Medical Science, The Graduate School of Ewha Womans University, Seoul, Korea
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul, Korea
| | - Yongin Cho
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Byung Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Ein Soon Shin
- Research Agency for Clinical Practice Guidelines, Research Center, Korean Academy of Medical Sciences, Seoul, Korea
| | - Sun Hee Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Dominski FH, Silva RB, Vilarino GT, Amorim LMS, Andrade A. Pesquisa em treinamento de força no Brasil: análise dos grupos e produção científica. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2019. [DOI: 10.1016/j.rbce.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Zuo P, Shi J, Yan J, Yang L, Liu C, Yuan L, Lou Q. Effects of Insulin Therapy and Oral Hypoglycemic Agents on Glycemic Control for Type 2 Diabetes Mellitus Patients in China-A Case Control Study. Exp Clin Endocrinol Diabetes 2019; 129:374-378. [PMID: 30959531 DOI: 10.1055/a-0881-9611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of the study was to compare glycemic control in patients with type 2 diabetes (T2DM) receiving insulin therapy (IT) or oral hypoglycemic agents (OHA), and explore associations between treatment modality and pancreatic beta-cell function. METHODS A matched, case-control study was conducted from April, 2016 to November, 2016. 2 272 patients with T2DM were identified from electronic medical records at four academic hospitals in China. Based on 1 136 eligible patients using IT, eligible 1 136 OHA patients were matched by age and duration at a ratio of 1:1. Logistic regression was used to examine the relationship between IT and glycemic control. Multiple linear regression addressed impact factors of HOMA-β. RESULTS There was no significant difference between IT and OHA groups in gender, age, diabetes duration, body mass index (BMI), fasting plasma glucose (FPG), systolic blood pressure (SBP), serum lipids and smoking history (p>0.05). We stratified subjects by diabetes duration, only when the duration was less than 5 years, HbA1c in OHA group was superior to IT (P=0.017). There were no significant differences between groups in HbA1c when disease duration was≥5 years. Even in subjects with short diabetes duration (<5 years), IT did not significantly impact glycemic control (p=0.071, OR=0.577). Multiple linear regression analysis showed that IT (p=0.001), diabetes duration (p=0.038), BMI (P<0.001), sulfonylurea use (P=0.001) were significant and independent predictors of HOMA-β. CONCLUSIONS In patients with short diabetes duration (<5 years), oral hypoglycemic therapy achieved better glycemic control than insulin therapy. Moreover, insulin use was not an impact factor of poor glycemic control. In addition, using insulin can protect beta-cell function.
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Affiliation(s)
- PanPan Zuo
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Nursing College, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
| | - JianFeng Shi
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
| | - Juan Yan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Nursing College, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
| | - LiHong Yang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Nursing College, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
| | - Chao Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
| | - Li Yuan
- Department of Endocrinology, West China Hospital, West China School of Medicine, Sichuan University, Wuhou District, Chengdu, Sichuan Province, China
| | - QingQing Lou
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Qi Xia District, Nanjing, Jiangsu Province, China
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Seguro C, Viana R, Lima G, Galvão L, Silva L, Jardim T, Jardim P, Gentil P. Improvements in health parameters of a diabetic and hypertensive patient with only 40 minutes of exercise per week: a case study. Disabil Rehabil 2019; 42:3119-3125. [PMID: 30907139 DOI: 10.1080/09638288.2019.1583780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: The present study aimed to report the effects of 15 weeks of a minimal dose resistance training on blood glucose levels, blood pressure, heart rate, physical capacity, and quality of life of a 67 old woman with type 2 diabetes mellitus, cardiopathy and hypertension.Method: The Patient was sedentary with a family history of heart failure and coronary artery disease. She suffered a heart attack in 2013 and was submitted to six cardiac catheterizations and one angioplasty between the 2015 and 2017. On April 2017, she was initially untrained in resistance training and was followed for 15 weeks with the performance of 31 resistance training sessions. Resistance training followed a minimal dose approach with 4 exercises performed with 2 sets to muscle failure, twice a week.Results: After follow up, the Patient presented a reduction in blood glucose, systolic and diastolic blood pressure, and heart rate at rest. There were also improvements on body mass index, cardiorespiratory fitness and quality of life. These results were accompanied by a reduction in the amount of antihypertensive and anti-diabetic medications.Conclusions: These results suggest that only 40 min of resistance training per week might help to improve general health and quality of life in a patient with hypertension and type 2 diabetes mellitus.Implications for RehabilitationMinimal dose resistance training improved health parameters in a diabetic and hypertensive patient.Resistance training promoted a reduction in the drugs used to control blood pressure and blood glucose levels.
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Affiliation(s)
- Camila Seguro
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Ricardo Viana
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Gislene Lima
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Luan Galvão
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Lucas Silva
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Thiago Jardim
- Hypertension League Federal University of Goiás, Goiânia, Brazil.,Brigham & Women's Hospital Division of Cardiovascular Medicine, Boston, USA.,Harvard TH Chan School of Public Health Department of Health Policy and Management, Center for Health Decision Science, Boston, USA
| | - Paulo Jardim
- Hypertension League Federal University of Goiás, Goiânia, Brazil
| | - Paulo Gentil
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
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40
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Takenami E, Iwamoto S, Shiraishi N, Kato A, Watanabe Y, Yamada Y, Yamada S, Ishii N. Effects of low-intensity resistance training on muscular function and glycemic control in older adults with type 2 diabetes. J Diabetes Investig 2019; 10:331-338. [PMID: 30175458 PMCID: PMC6400238 DOI: 10.1111/jdi.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022] Open
Abstract
AIMS/INTRODUCTION The present study aimed to investigate the effects of low-intensity resistance training with slow movement and tonic force generation (LST) on muscular function and glucose metabolism in older patients with type 2 diabetes. MATERIALS AND METHODS A total of 10 patients with type 2 diabetes (age 68.2 ± 9.7 years) engaged in LST training twice a week for 16 weeks. Before the long-term intervention, they were subjected to the measurement of acute changes in blood factors relating to glycemic control as a result of a bout of LST. Body composition, muscular size and strength, and glycated hemoglobin were measured before and after the intervention. RESULTS The magnitudes of the acute changes in the blood factors were all small and were not considered harmful for glucose metabolism. The 16-week LST training caused significant increases in thigh muscle thickness and strength, and decreases in body fat mass and glycated hemoglobin. The change in glycated hemoglobin showed a significant negative correlation with the change in the isokinetic knee extension peak torque measured at a high angular velocity (180°/s). CONCLUSIONS The LST training was shown to be effective for gaining muscular size and strength, and improving glycemic control in older patients with type 2 diabetes. The mechanisms underlying this effect might involve the improvement of contractile function in fast glycolytic fibers.
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Affiliation(s)
- Eri Takenami
- Department of Life SciencesGraduate School of Arts and SciencesUniversity of TokyoTokyoJapan
| | | | - Noriko Shiraishi
- Clinical Laboratory DepartmentKitasato Institute HospitalTokyoJapan
| | - Akiko Kato
- Medical Fitness CenterKitasato Institute HospitalTokyoJapan
| | | | | | - Satoru Yamada
- Diabetes CenterKitasato Institute HospitalTokyoJapan
| | - Naokata Ishii
- Department of Life SciencesGraduate School of Arts and SciencesUniversity of TokyoTokyoJapan
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Li S, Liang M, Gao D, Su Q, Laher I. Changes in Titin and Collagen Modulate Effects of Aerobic and Resistance Exercise on Diabetic Cardiac Function. J Cardiovasc Transl Res 2019; 12:404-414. [PMID: 30820865 DOI: 10.1007/s12265-019-09875-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Diastolic dysfunction is a common complication that occurs early in diabetes mellitus. Titin and collagen are two important regulators of myocardial passive tension, which contributes to diabetic myocardial diastolic dysfunction. Exercise therapy significantly improves the impaired diabetic cardiac function, but its benefits appear to depend on the type of exercise used. We investigated the effect of aerobic and resistance exercise on cardiac diastolic function in diabetic rats induced by high-fat diet combined with low-dose streptozotocin injection. Interestingly, although resistance training had a more pronounced effect on blood glucose control than did aerobic training in type 2 diabetic rats, improvements in cardiac diastolic parameters benefited more from aerobic training. Moreover, aerobic exercise did significantly increase the expression levels of titin and decrease collagen I, TGFβ1 expression level. In summary, out data suggest that aerobic exercise may improve diabetic cardiac function through changes in titin-dependent myocardial stiffness rather than collagen-dependent interstitial fibrosis.
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Affiliation(s)
- Shunchang Li
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Min Liang
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Derun Gao
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Quansheng Su
- School of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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42
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Bassi D, Dibai-Filho AV, Durans LH, Mendes RG, Caruso FCR, Arakelian VM, Borghi-Silva A. Glycemic behavior in patients with type 2 diabetes during a short period of a combined training program. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-657420180003e0086-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Daniela Bassi
- Universidade Ceuma, Brazil; Universidade Ceuma, Brazil
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43
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Effects of resistance training on neuromuscular parameters in elderly with type 2 diabetes mellitus: A randomized clinical trial. Exp Gerontol 2018; 113:141-149. [DOI: 10.1016/j.exger.2018.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022]
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Codella R, Ialacqua M, Terruzzi I, Luzi L. May the force be with you: why resistance training is essential for subjects with type 2 diabetes mellitus without complications. Endocrine 2018; 62:14-25. [PMID: 29730785 DOI: 10.1007/s12020-018-1603-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
Physical activity, together with diet and pharmacological therapy, represents one of the three cornerstones in type 2 diabetes mellitus treatment and care. The therapeutic appeal of regular physical activity stems from: (i) its non-pharmacological nature; (ii) its beneficial effects on the metabolic risk factors associated with diabetes complications; (iii) its low costs. Evidence accumulated in the last years suggests that aerobic training-endurance training-constitutes a safe modality of intervention, achievable, and effective in diabetes treatment, whenever it is not limited by comorbidities. Aerobic training exerts insulin-mimetic effects and has been shown to lower mortality risk too. Anaerobic, intense physical activity, such as that of strength or power sports disciplines, is not univocally recognized as safe and simple to realize, however, it is important in stimulating energy and glucose metabolism. According to recent evidence, high-intensity training may be prescribed even in the face of cardiovascular diseases, peripheral vascular disease, or osteoarthritis. Some studies have shown resistance training to be more efficient than aerobic exercise in improving glycemic control. This review explores the most up-to-date indications emerging from literature in support of the beneficial effects of strength stimulation and resistance training in patients with type 2 diabetes without complications.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Marta Ialacqua
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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45
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Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes 2018; 42 Suppl 1:S54-S63. [PMID: 29650112 DOI: 10.1016/j.jcjd.2017.10.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/15/2022]
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46
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Aguiar SS, Sousa CV, Simões HG, Neves RVP, Costa F, de Souza MK, de Moraes MR, Prestes J, Sales MM, Haro AS, Willardson JM, Rosa TDS. Acute metabolic responses following different resistance exercise protocols. Appl Physiol Nutr Metab 2018; 43:838-843. [DOI: 10.1139/apnm-2017-0771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Resistance exercise (RE) can be an excellent modality for glycemic control. Studies have demonstrated that a single RE session can reduce glycemia in subjects with or without diabetes. Little is known about the dose–response effect of RE on glycemic control. This study aimed to investigate the acute metabolic responses after different RE protocols. Eighty-nine males were separated into six groups that completed RE protocols: 2 sets of 18 repetitions (2 × 18 at 50% of 1-repetition maximum (1RM); n = 19); 3 sets of 12 repetitions (3 × 12 at 70% of 1RM; n = 14); 4 sets of 9 repetitions (4 × 9 at 80% of 1RM; n = 13); 6 sets of 6 repetitions (6 × 6 at 90% of 1RM; n = 19); circuit (2 × 18 at 50% of 1RM; n = 12); and a control session (n = 12). The exercise sequence consisted of 8 exercises. An oral glucose tolerance test was conducted with metabolic measurements immediately after each RE protocol and every 15 min until 120 min of recovery. All groups exhibited significantly lower values (p < 0.05) in the glucose area under the curve (AUC) when compared with control over a 120 min monitoring period. The 6 × 6 group showed a significantly lower glucose AUC versus the 3 × 12 and 4 × 9 groups (p = 0.004; p = 0.001, respectively). As for blood lactate, the control and 6 × 6 groups exhibited lower AUC values versus all other groups (p < 0.05), and AUC for glucose and lactate concentration showed a negative and significant correlation (r = –0.46; p < 0.0001). It appears that a combination of 9–12 repetitions per set and 3–4 sets per muscle group might be optimal for acute postprandial glucose control.
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Affiliation(s)
- Samuel Silva Aguiar
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
| | - Caio Victor Sousa
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
| | - Herbert Gustavo Simões
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
| | - Rodrigo Vanerson Passos Neves
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
- Graduate Program in Translational Medicine, Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | - Fernando Costa
- Graduate Program in Translational Medicine, Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | - Michel Kendy de Souza
- Graduate Program in Translational Medicine, Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | - Milton Rocha de Moraes
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
| | - Jonato Prestes
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
| | | | - Anderson Sola Haro
- Graduate Program in Translational Medicine, Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | - Jeffrey M. Willardson
- Health and Human Performance Department, Montana State University Billings, Billings, MT, USA
| | - Thiago dos Santos Rosa
- Graduate Program in Physical Education, Universidade Católica de Brasília, Taguatinga-DF, Brazil
- Graduate Program in Translational Medicine, Universidade Federal de São Paulo, São Paulo-SP, Brazil
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47
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Hsieh PL, Tseng CH, Tseng YJ, Yang WS. Resistance Training Improves Muscle Function and Cardiometabolic Risks But Not Quality of Life in Older People With Type 2 Diabetes Mellitus: A Randomized Controlled Trial. J Geriatr Phys Ther 2018; 41:65-76. [DOI: 10.1519/jpt.0000000000000107] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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48
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Tian J, Lian F, Yang L, Tong X. Evaluation of the Chinese herbal medicine Jinlida in type 2 diabetes patients based on stratification: Results of subgroup analysis from a 12-week trial. J Diabetes 2018; 10:112-120. [PMID: 28418191 DOI: 10.1111/1753-0407.12559] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 04/09/2017] [Accepted: 04/11/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Chinese herbal medicine Jinlida can significantly enhance the hypoglycemic action of metformin. However, the population showing the best responses to Jinlida has not been clarified. The aim of the present study was to compare the efficacy of Jinlida in type 2 diabetes mellitus (T2DM) after stratification. METHODS Data were analyzed from a 12-week randomized placebo-controlled double-blind multicenter study with 192 T2DM patients (186 completed the study). The efficacy evaluation included HbA1c, fasting plasma glucose (FPG), and 2-h postprandial glucose (2hPG) levels stratified by baseline HbA1c, sex, age, body mass index (BMI), and duration of T2DM diagnosis. Homeostasis model assessment of insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell function (HOMA-β) were also evaluated stratified by baseline insulin levels. RESULTS In the Jinlida group, HbA1c was significantly reduced (P < 0.05). Greater reductions were observed in patients with baseline HbA1c >8.5%, in males and in those aged >60 years, with a BMI ≤24 kg/m2 , or with a duration of T2DM diagnosis >5 years (P < 0.05). Compared with baseline, Jinlida significantly alleviated insulin resistance (P < 0.05) in patients with baseline insulin levels >20 mU/L. Jinlida also significantly improved β-cell function in patients with baseline insulin levels ≤20 mU/L (P < 0.05). CONCLUSIONS Jinlida significantly improved glycemic control, with greater improvements in patients with poor glycemic control and male, elderly, of normal weight, or with a long disease course. Furthermore, Jinlida alleviated insulin resistance with hyperinsulinemia and promoted insulin secretion with hypoinsulinemia. These results need to be further confirmed in clinical trials.
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Affiliation(s)
- Jiaxing Tian
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Fengmei Lian
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Libo Yang
- Hebei Medical University Pharmaceutical Research Institute, Shijiazhuang, China
| | - Xiaolin Tong
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Ranasinghe C, Hills AP, Constantine GR, Finlayson G, Katulanda P, King NA. Study protocol: a randomised controlled trial of supervised resistance training versus aerobic training in Sri Lankan adults with type 2 diabetes mellitus: SL-DART study. BMC Public Health 2018; 18:176. [PMID: 29368598 PMCID: PMC5784545 DOI: 10.1186/s12889-018-5069-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/11/2018] [Indexed: 12/23/2022] Open
Abstract
Background The prevalence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) is rising globally. T2DM is particularly problematic in South Asia with an estimated 10–15% of Sri Lankans diagnosed with the disease. Exercise is known to improve blood glucose, lipid profiles, blood pressure and adiposity, key goals in the management of T2DM. However, much of the evidence to date has been gained from white Caucasians who have a different body composition and disease profile compared to South Asians. Similarly, the recreational exercise culture is new to Sri Lankans and the effects of exercise on T2DM has not been studied in this population. Methods The Sri Lanka Diabetes Aerobic and Resistance Training (SL-DART) Study will be comprised of 2 components. Component 1 is a 12-week randomized controlled trial (RCT) to compare the effects of a supervised progressive resistance exercise program (RT) and aerobic exercise program (AT) with standard treatment/control (CN). Sedentary Sri Lankan adults with T2DM (aged 35–65 years) and with no contraindications to exercise will be randomized into one of 3 groups (AT, RT, CN). Exercise sessions will be conducted 2 days/week for 3 months. Baseline and post-intervention biochemical (glycemic control, lipid and liver profiles, inflammatory markers), anthropometric (height, weight, body circumferences), body composition, physical fitness, food preference (liking and wanting food) and quality of life parameters will be measured and compared between groups. Component 2 will be a qualitative study conducted immediately post-intervention via in-depth interviews to assess the barriers and facilitators for adherence to each exercise program. Discussion SL-DART Study represents one of the first adequately powered methodologically sound RCTs conducted in South Asia to assess the effects of resistance and aerobic exercise in participants with T2DM. Triangulation of quantitative and qualitative outcomes will enable the design of a culturally appropriate therapeutic physical activity intervention for Sri Lankans with T2DM, and the initiation of a professionally driven and specialized clinical exercise prescription service. Trial registration Sri Lanka Clinical Trials Registry; SLCTR/2016/017. Date registered 17.06.2016. Universal trial number U1111–1181-7561.
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Affiliation(s)
- C Ranasinghe
- School of Exercise and Nutrition Sciences & Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Australia. .,Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka. No 25, Kynsey road, Colombo, 08, Sri Lanka.
| | - A P Hills
- College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - G R Constantine
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - G Finlayson
- School of Psychology, Faculty of Medicine and Health University of Leeds, Leeds, UK
| | - P Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - N A King
- School of Exercise and Nutrition Sciences & Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Australia
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Yang P, Swardfager W, Fernandes D, Laredo S, Tomlinson G, Oh PI, Thomas S. Finding the Optimal volume and intensity of Resistance Training Exercise for Type 2 Diabetes: The FORTE Study, a Randomized Trial. Diabetes Res Clin Pract 2017; 130:98-107. [PMID: 28601003 DOI: 10.1016/j.diabres.2017.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/15/2017] [Accepted: 05/16/2017] [Indexed: 11/18/2022]
Abstract
AIM To compare different volumes and intensities of resistance training (RT) combined with aerobic training (AT) for improvements in glycemic control and cardiovascular health for persons with type 2 diabetes (T2DM). METHODS Participants with T2DM were stratified by HbA1c and randomized: "usual care" (RT1), which consisted of moderate intensity (50% 1-repetition maximum [1-RM]), low volumeRT (initiated half-way through program); higher intensity (75% 1-RM) and higher volume (initiated at program onset) RT (RT2); or moderate intensity but higher volume RT (RT3). RT sets and repetitions were adjusted to maintain similar work and volume between RT2 and RT3. Walking or cycling (60-80% aerobic capacity)was prescribed 5 times/week, and RT was prescribed 2 times/week. An ANCOVA, adjusted for baseline and gender, assessed changes post-6months in glycemic control (HbA1c- primary outcome), aerobic capacity and anthropometrics. RESULTS Sixty-two participants (52.3±1.2years, 48% female) were randomized (RT1, n=20; RT2, n=20; RT3, n=22). Only post-training fasting glucose, without significant HbA1c change, was different between groups (RT1-RT3=-1.7mmol/L, p=0.046). Pre-post differences were found in pooled HbA1c (7.4±0.2%[57±2.2mmol/mol] vs. 6.7±0.2%[50±2.2mmol/mol], p<0.001), aerobic capacity (21.5±0.8vs. 25.2±0.8ml/kg/min, p<0.001), body mass (84.0±2.7vs. 83.0±2.7kg, p=0.022[DXA]), body mass index (30.8±0.9vs. 30.3±0.8kg/m2, p=0.02) and body fat (32.3±1.1vs. 31.3±1.2%, p<0.001). The trial was discontinued early; no HbA1c advantage was found with either RT2 or RT3 over RT1. CONCLUSIONS Combined AT+RT exercise improved glycemic control, cardiovascular risk factors and body composition after 6months for participants with T2DM, but differential effects between the prescribed intensities and volumes of RT were not found to effect HbA1c.
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Affiliation(s)
- Pearl Yang
- University Health Network - Toronto Rehab, Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada.
| | - Walter Swardfager
- University Health Network - Toronto Rehab, Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada; Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, Medical Sciences Building, Room 4207, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
| | - Daniel Fernandes
- Ross School of Business, University of Michigan, 701 Tappan Avenue, Ann Arbor, MI 48109, USA.
| | - Sheila Laredo
- Women's College Hospital, Department of Endocrinology, 76 Grenville, M5S 1B2 Toronto, Ontario, Canada.
| | - George Tomlinson
- Dalla Lana School of Public Health, Division of Biostatistics, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7, Canada; University Health Network - Toronto General Hospital, Department of Medicine, 200 Elizabeth Avenue, Toronto, Ontario M5G 2C4, Canada.
| | - Paul I Oh
- University Health Network - Toronto Rehab, Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada; Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 100 DevonshirePlace, Toronto, Ontario M5S 2C9, Canada.
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, 100 DevonshirePlace, Toronto, Ontario M5S 2C9, Canada.
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