Finding the Optimal volume and intensity of Resistance Training Exercise for Type 2 Diabetes: The FORTE Study, a Randomized Trial

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

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.

The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to determine the magnitude of the effect of combined exercise training on glucose metabolism markers, adipokines, and inflammatory cytokines in non-diabetic sedentary adults. PubMed, Web of Science, Scopus, Cochrane Library electronic databases and reference lists of included studies were explored for randomized controlled trials (RCTs) that included physically inactive adults and provided combined training interventions (aerobic plus resistance exercise). Effects on fasting glucose and insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), HbA1c, adiponectin, leptin, IL-6, TNF-α, and C-reactive protein (CRP) in exercise vs control groups were analyzed using random effects meta-analysis. The Cochrane Risk of Bias Tool for Randomized Trials 2.0 (RoB 2) was used to assess the risk of bias. A total of 24 RCTs were included in the quantitative analysis. Combined exercise training significantly decrease fasting glucose (standardized mean difference, SMD: - 0.474, 95% CI [- 0.829, - 0.120], p = 0.009, 35 study arms), fasting insulin (SMD: - 1.024, 95% CI [- 1.502, - 0.545], p < 0.001, 27 study arms), HOMA-IR (SMD: - 0.946, 95% CI [- 1.450, - 0.442], p < 0.001, 23 study arms), TNF-α (SMD: - 0.972, 95% CI [- 1.361, - 0.582], p < 0.001, 10 study arms), and CRP (SMD: - 0.507, 95% CI [- 0.818, - 0.196], p = 0.001, 14 study arms). No significant effects were observed for HbA1c, adiponectin, leptin, and IL-6 levels. Random effects meta-regression models by age, sex, and intervention length were not able to explain any of the variation in the effect size of HOMA-IR. Findings from this systematic review and meta-analysis suggest that combined exercise training improves some glucose metabolism markers and inflammatory parameters in sedentary adults without diabetes.

Physical Exercise Methods and Their Effects on Glycemic Control and Body Composition in Adults with Type 2 Diabetes Mellitus (T2DM): A Systematic Review

The prevalence of T2DM represents a challenge for health agencies due to its high risk of morbidity and mortality. Physical Activity (PA) is one of the fundamental pillars for the treatment of T2DM, so Physical Exercise (PE) programs have been applied to research their effectiveness. The objective of the study was to analyze the effects of PE methods on glycemic control and body composition of adults with T2DM. A systematic review without meta-analysis was performed, using the PubMed database. Quasi-experimental and pure experimental clinical trials were included, which were available free of charge and were published during 2010-2020. In the results, 589 articles were found and 25 passed the inclusion criteria. These were classified and analyzed according to the methods identified (AE, IE, RE, COM, and others), duration and variable(s) studied. It is concluded that PE is effective for glycemic control and body composition in adults with T2DM using different methods (AE, IE, RE, COM, and others), both in the short and long term. Adequate organization of PE components such as frequency, duration, volume, and intensity, is essential.

Physical exercise as treatment for adults with type 2 diabetes: a rapid review

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).

Physiological Responses and Adaptations to Lower Load Resistance Training: Implications for Health and Performance

Resistance training is a method of enhancing strength, gait speed, mobility, and health. However, the external load required to induce these benefits is a contentious issue. A growing body of evidence suggests that when lower load resistance training [i.e., loads < 50% of one-repetition maximum (1RM)] is completed within close proximity to concentric failure, it can serve as an effective alternative to traditional higher load (i.e., loads > 70% of 1RM) training and in many cases can promote similar or even superior physiological adaptations. Such findings are important given that confidence with external loads and access to training facilities and equipment are commonly cited barriers to regular resistance training. Here, we review some of the mechanisms and physiological changes in response to lower load resistance training. We also consider the evidence for applying lower loads for those at risk of cardiovascular and metabolic diseases and those with reduced mobility. Finally, we provide practical recommendations, specifically that to maximize the benefits of lower load resistance training, high levels of effort and training in close proximity to concentric failure are required. Additionally, using lower loads 2-3 times per week with 3-4 sets per exercise, and loads no lower than 30% of 1RM can enhance muscle hypertrophy and strength adaptations. Consequently, implementing lower load resistance training can be a beneficial and viable resistance training method for a wide range of fitness- and health-related goals.

Exercise in the Prevention and Treatment of Type 2 Diabetes

Type 2 diabetes is a systemic, multifactorial disease that is a leading cause of morbidity and mortality globally. Despite a rise in the number of available medications and treatments available for management, exercise remains a first-line prevention and intervention strategy due to established safety, efficacy, and tolerability in the general population. Herein we review the predisposing risk factors for, prevention, pathophysiology, and treatment of type 2 diabetes. We emphasize key cellular and molecular adaptive processes that provide insight into our evolving understanding of how, when, and what types of exercise may improve glycemic control. © 2023 American Physiological Society. Compr Physiol 13:1-27, 2023.

The physiological, perceptual, and thermoregulatory responses to facemask use during exercise

The use of masks in public settings and when around people has been recommended to limit the spread of Coronavirus disease 2019 (COVID-19) by major public health agencies. Several different types of masks classified as either medical- or non-medical grade are commonly used among the public. However, concerns with difficulty breathing, re-breathing exhaled carbon dioxide, a decrease in arterial oxygen saturation, and a decrease in exercise performance have been raised regarding the use of mask during exercise. We review the current knowledge related to the effect of different masks during exercise on cardiorespiratory, metabolic, thermoregulatory, and perceptual responses. As such, the current literature seems to suggest that there are minimal changes to cardiovascular, metabolic, and no changes to thermoregulatory parameters with facemask use. However, differences in ventilatory parameters have been reported with submaximal and maximal intensity exercise to volitional fatigue. Literature on perceptual responses to exercise indicate an impact on ratings of perceived exertion, dyspnea, and overall discomfort dependent on mask use as well as exercise intensity. In conclusion, data from the current literature suggests a minimal impact on physiological, perceptual, and thermoregulatory responses dependent on the type of mask used during exercise.

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

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.

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

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

Short-term circuit resistance training improves insulin resistance probably via increasing circulating Adropin

Aim and background

The underlying mechanism of exercise-induced insulin resistance (IR) improvement is unclear. Adropin is a multifunctional peptide has a significant role in the regulation of physical activity and insulin sensitivity. Thus, the aim of this study was to evaluate the effects of various circuit resistance (CRT) intensities on circulating adropin levels and IR and their relation.

Method

Forty-five voluntarily male men randomly were divided into 5 groups; control and 4 groups of CRT (20%, 40%, 60% and 80% of one-repetition maximum (1-RM)). Training groups performed CRT protocol 3 times a week for 6 weeks. Blood samples were drawn before and 48 h after the last training session and used for analyzing serum levels of adropin, glucose and insulin.

Results

The results showed that varying CRT intensities were associated with adropin elevation in comparison to the control group. Further analysis revealed that plasma adropin is higher in the 20% 1-RM group compared to the 40% 1-RM group. Furthermore, fasting insulin and glucose, as well as IR, were decreased in response to different CRT intensities. In addition, these reductions were significantly correlated with adropin level.

Conclusion

It can be speculated that different CRT intensities improve IR probably via increasing adropin level, and should be considered as an effective training method for diminishing glucose metabolism disorders.

The effects of adding high-intensity of effort resistance training to routine care in persons with type II diabetes: An exploratory randomized parallel-group time-series study

AIMS

This study considered the effects of supervised, low volume, high intensity of effort resistance training compared to continued routine care in persons with type II diabetes.

METHODS

We utilized a randomized parallel-group time-series design. All participants completed baseline testing (T0) and then participated in an educational training intervention regarding the management of their diabetes and were followed up for six months, during which they received routine care before being retested (T1). Participants were then randomly allocated to either continue with routine care (CON) or receive the high intensity of effort resistance training intervention (HIT). Participants from both groups were retested again after six months (T2). All participants were followed up for a further 12 months before being finally tested (T3). Data were available from 57 participants who completed the whole duration of the study (HIT, n = 29; CON, n = 28) for measures of anthropometry (body mass, waist circumference, and BMI), body composition (body fat mass, body fat percentage, lean mass, and visceral fat mass), total body water, phase angle, HbA1c, fasted blood glucose, and subjective wellbeing (WHO-5).

RESULTS

During the initial 6-months of routine care significant improvements were noted for waist circumference, body fat mass, lean mass, body fat percentage, lean mass percentage, visceral fat mass, HbA1c, fasted blood glucose, and subjective wellbeing. During the successive 6-months (intervention) and 18-months (follow-up), data suggest that many of these positive changes during the initial 6-months were negated or reversed for CON. In contrast, participants engaging in HIT continued to show positive changes for waist circumference, body fat mass, lean mass, body fat percentage, lean mass percentage, and visceral fat. For blood markers and wellbeing, HbA1c continued to decrease, fasted blood glucose decreased, and subjective wellbeing continued to increase. These positive responses were still evidenced and significantly different compared to CON after the 12-month follow-up.

CONCLUSION

The results of this exploratory pragmatic trial suggest that the addition of high intensity of effort RT alongside routine care can have a positive impact on a range of outcomes in type 2 diabetics having undergone prior routine care.

The Physiological Role of Irisin in the Regulation of Muscle Glucose Homeostasis

Irisin is a myokine that primarily targets adipose tissue, where it increases energy expenditure and contributes to the beneficial effects of exercise through the browning of white adipose tissue. As our knowledge has deepened in recent years, muscle has been found to be a major target organ for irisin as well. Several studies have attempted to characterize the role of irisin in muscle to improve glucose metabolism through mechanisms such as reducing insulin resistance. Although they are very intriguing reports, some contradictory results make it difficult to grasp the whole picture of the action of irisin on muscle. In this review, we attempted to organize the current knowledge of the role of irisin in muscle glucose metabolism. We discussed the direct effects of irisin on glucose metabolism in three types of muscle, that is, skeletal muscle, smooth muscle, and the myocardium. We also describe irisin’s effects on mitochondria and its interactions with other hormones. Furthermore, to consider the relationship between the irisin-induced improvement of glucose metabolism in muscle and systemic disorders of glucose metabolism, we reviewed the results from animal interventional studies and human clinical studies.

Significant Dose-Response between Exercise Adherence and Hemoglobin A1c Change

INTRODUCTION

The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose-response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics.

METHODS

Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose-response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression.

RESULTS

Median overall adherence was 84.9% (interquartile range, 74.4%-93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol) decrease in HbA1c (β = -0.0076, R = -0.170, P = 0.021). Significant dose-response relationships were identified for aerobic (β = -0.0142, R = -0.313, P = 0.016) and combined training (β = -0.0109, R = -0.259, P = 0.041), but not resistance training (β = 0.0068, R = 0.153, P = 0.233). Dose-response relationships in all training groups combined were significant in subgroups younger than 55 yr (β = -0.0113, R = -0.286, P = 0.005), males (β = -0.0123, R = -0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol) (β = -0.013, R = -0.263, P = 0.011).

CONCLUSIONS

There was a dose-response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose-response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines.

Physical fitness and activity changes after a 24-week soccer-based adaptation of the U.S diabetes prevention program intervention in Hispanic men

PURPOSE

One third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an exercise intervention implementing the Center for Disease Control and Prevention National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men.

METHODS

Overweight and obese Hispanic men, aged 30-57 years with prediabetes at screening were recruited from the community. Trained soccer coaches led 30-min facilitated discussion of the NDPP modules after each RS session, with two weekly sessions delivered over 12 wks, then once a wk until 24 wks. The 1-h RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included objectively measured physical activity via fitness tracker, physical fitness via validated field tests, global positional system soccer specific metrics and behavior change questionnaires. Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline, 12 and 24 wks. All analyses were conducted as intent-to-treat and generated using SAS v 9.4.

RESULTS

Hispanic males (n = 41; mean age 41.9 [6.2 SD] years) were obese at baseline (mean BMI 32.7, standard error [0.7]). After 24 wks of the NDPP+RS intervention, there were significant beneficial changes in vertical jump (2.8 [1.3] cm; p = 0.048), agility and lower extremity muscular power (figure 8-run) at 12 wks (-4.7% change; p = 0.001) and 24 wks (-7.2% change; p < 0.0001), predicted VO2 max (12 wks: 1.9%; p = 0.007; 24 wks 1.0%; p = 0.036), modified push-ups increased 22% (p < 0.0001) at 12 wks and 31% (p < 0.0001) at 24 wks, dynamic sit-ups increased 10% (p = 0.005) at 12 wks and 15% (p < 0.0001) at 24 wks.

CONCLUSION

Among middle-aged Latino men, broad-ranging significant improvements in physical fitness were observed after 24 wks participating in lifestyle education plus RS in a single arm feasibility trial.

Gender-dependent evaluation of football as medicine for prediabetes

PURPOSE

Training intensity and health effects of football were investigated gender specifically in individuals with prediabetes.

METHODS

Participants with prediabetes (age 60 ± 6 years) were randomised into a football and dietary advice group (FD-men n = 13 and FD-women n = 14) or a dietary advice only group (D-men n = 12 and D-women n = 11). FD performed football training (twice/week for 16 weeks), while both groups received dietary advice. Body composition, bone variables, blood pressure, blood lipid profile and peak oxygen uptake (VO2peak) were determined pre- and post-intervention.

RESULTS

Mean heart rate during football training was 79 ± 2 and 80 ± 3% HRmax for FD-men and FD-women, respectively, with peak heart rate values of 96 ± 1 and 97 ± 2% HRmax, with no gender differences. VO2peak increased more (P < 0.05) in FD-men and FD-women than in D-men and D-women. However, relative delta change in VO2peak was 21 ± 14% in FD-women, which was greater (P < 0.05) than in FD-men (11 ± 12%). Reduction in SBP and DBP, respectively, was similar in FD-men (- 10.8 ± 13.0 and - 7.3 ± 11.8 mmHg) and FD-women (- 11.3 ± 11.0 and - 7.1 ± 6.2 mmHg), with within-gender differences for men. Total plasma cholesterol and LDL cholesterol decreased (P < 0.05) by - 0.7 ± 1.1 and - 0.5 ± 0.9 mmol L-1, respectively, in FD-women and - 0.2 ± 0.4 and - 0.2 ± 0.3 mmol L-1 in FD-men, with no significant gender differences (P = 0.08). Body fat content was lowered (P < 0.05) by 3 and 4%-points in FD-men and FD-women, respectively.

CONCLUSION

Gender-mixed football training combined with dietary advice causes broad-spectrum health effects for men and women with prediabetes, with minor gender-specific differences. Thus, the intensity and training-induced effects of football training are also high for elderly women with prediabetes.

Exercise Intensities as Factors of Metabolic Outcomes in Type 2 Diabetes: A Systematic Review

Exercise is effective to prevent and treat type 2 diabetes, although currently underutilized. This review analyzes the metabolic response to exercise performance at various intensities in individuals with type 2 diabetes. These findings provide insight into the development of safe and efficacious exercise prescriptions and education. We conducted a systemic review of the literature to examine the association of various exercise protocols with metabolic outcomes in type 2 diabetes. Between 1984 and 2018, 29 studies were categorized per exercise mode and intensity levels according to the American College of Sports Medicine standards. The most consistent improvement was found in HbA1c following moderate- to high-intensity exercise—post-exercise fasting glucose improved to a lesser extent. Low-intensity exercise improved HOMA-IR (homeostasis model assessment for insulin resistance) levels. Glucose and HbA1c improved most following interval compared with continuous exercise, irrespective of intensity. A comparison of high-intensity exercise with moderate-intensity exercise demonstrated few differences in HbA1c, fasting glucose, fasting insulin, and HOMA-IR. Irrespective of exercise intensity, HbA1c improvements were observed, suggesting a delayed progression to diabetes-related complications. Initial low-intensity exercise, with increased quantities when feasible, will contribute to metabolic improvements. The variability in methodology and measurement contributed to inconsistent outcomes; additional research with larger samples sizes is warranted.

Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease

Age is a primary risk factor for a number of chronic diseases including mobility disability, cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer. Most physical activity guidelines emphasize the performance of 150 min of moderate-to-vigorous or 75 min of vigorous aerobic exercise training (AET) weekly for reduction of chronic disease risk. Nonetheless, there is an emerging body of evidence showing that resistance exercise training (RET) appears to be as effective as AET in reducing risk of several chronic diseases. It may also be that RET is more effective than AET in some regards; the converse is likely also true. We posit that the perceived divergent exercise mode-dependent health benefits of AET and RET are likely small in most cases. In this short review, our aim is to examine evidence of associations between the performance of RET and chronic health disease risk (mobility disability, T2D, CVD, cancer). We also postulate on how RET may be influencing chronic disease risk and how it is a critical component for healthy aging. Accumulating evidence points to RET as a potent and robust preventive strategy against a number of chronic diseases traditionally associated with the performance of AET, but evidence favors RET as a potent countermeasure against declines in mobility. On the basis of this review we propose that the promotion of RET should assume a more prominent position in exercise guidelines particularly for older persons.

The association of resistance training with mortality: A systematic review and meta-analysis

BACKGROUND

The benefits of aerobic exercise are well-studied; there is no consensus on the association between resistance training and major adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to address this issue.

DESIGN AND METHODS

We searched for randomized trials and cohort studies that evaluated the association between resistance training and mortality and cardiovascular events. Two investigators screened the identified abstracts and full-texts independently and in duplicate. Cochrane tools were used to assess the risk of bias. We calculated hazard ratios and 95% confidence intervals using random effect models.

RESULTS

From the 1430 studies identified, 11 (one randomized trial and 10 cohort studies) met the inclusion criteria, totaling 370,256 participants with mean follow-up of 8.85 years. The meta-analysis showed that, compared with no exercise, resistance training was associated with 21% (hazard ratio (95% confidence interval (CI)), 0.79 (0.69-0.91)) and 40% (hazard ratio (95% CI), 0.60 (0.49-0.72)) lower all-cause mortality alone and when combined with aerobic exercise, respectively. Furthermore, resistance training had a borderline association with lower cardiovascular mortality (hazard ratio (95% CI), 0.83 (0.67-1.03)). In addition, resistance training showed no significant association with cancer mortality. Risk of bias was low to intermediate in the included studies. One cohort study looked at the effect of resistance training on coronary heart disease events in men and found a 23% risk reduction (risk ratio, 0.77, CI: 0.61-0.98).

CONCLUSION

Resistance training is associated with lower mortality and appears to have an additive effect when combined with aerobic exercise. There are insufficient data to determine the potential beneficial effect of resistance training on non-fatal events or the effect of substituting aerobic exercise with resistance training.