The effects of resistance training on muscle and body fat mass and muscle strength in type 2 diabetic women

Effect of a home-based physical activity program on metabolic syndrome in Ghanaian adults with type 2 diabetes: Protocol for a feasibility randomized controlled trial

AIM

To describe the protocol of a feasibility trial designed to test the preliminary effect of a 12-week culturally appropriate physical activity programme on metabolic syndrome markers and quality of life in Ghanaian adults with type 2 diabetes (T2DM).

DESIGN

Feasibility randomised controlled trial.

METHODS

Through random allocation, 90 adults with T2DM will be allocated to either the control group (CG) (n = 45) or the intervention group (IG) (n = 45). The IG will receive the physical activity programme in addition to their usual diabetes care; those in the CG will receive their usual diabetes care. Measurements will be performed at baseline and 12-week follow-up. The primary outcome is a change in metabolic syndrome markers in the IG compared to the CG. Secondary outcomes are: (a) a change in quality of life in the IG compared to the CG, (b) the feasibility of implementation.

RESULTS

Findings will inform the design of a future large-scale trial.

PATIENT OR PUBLIC CONTRIBUTION

Patients with T2DM and their healthcare professionals contributed to this study protocol by participating in semi-structured interviews towards the design of the physical activity programme.

CLINICAL TRIAL REGISTRATION NUMBER

The trial is registered in the Australian and New Zealand Clinical Trial Registry (registration number: ACTRN12622000323729p).

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.

IMPACTS OF MUSCLE TRAINING LOADS ON COLLEGE STUDENTS' PHYSICAL FITNESS

ABSTRACT Introduction: Due to the excessive value of contemporary intellectual education, the physical fitness of college students has become precarious. This gradual deficit requires innovative solutions to inhibit the negative impacts on the physical quality that inevitably impact students' learning ability. Objective: Verify the impacts of varied loads in muscular strength exercise on college students and their practical repercussions on the diversified development of physical education classes. Methods: We selected 90 non-sporting college students, sedentary and without physical diseases, divided into experimental group 1 with medium intensity load, experimental group 2 with a low-intensity load, and a control group. Before and after the experiment, the relevant fitness indicators were evaluated, and finally, the data were statistically integrated and analyzed. Results: Group 1 increased from 52.25 ± 5.57kg before training to 54.56 ± 6.02kg, with a very significant change; experimental group 2 increased from 53.32 ± 4.89kg before training to 54.21 ± 5.22kg, showing a very significant change as well. Conclusion: Establishing the intensity of load muscle training scientifically and rationally can improve college students' physical quality and muscle strength, and promote the healthy and coordinated development of their psychological and physical quality. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Effects of 12-Week Progressive Sandbag Exercise Training on Glycemic Control and Muscle Strength in Patients with Type 2 Diabetes Mellitus Combined with Possible Sarcopenia

Patients with type 2 diabetes mellitus (T2DM) are at a three-fold increased risk of developing sarcopenia compared to those without diabetes. The objective of this study was to investigate whether an intervention involving progressive sandbag exercises is beneficial to patients with T2DM and possible sarcopenia in terms of enhancing muscle strength and controlling blood sugar levels. Forty patients with T2DM and possible sarcopenia (age > 50 years) were recruited and randomly divided into resistance training and control groups. Resistance exercises for the upper and lower extremities were performed using sandbags (0.5 kg at the beginning to 1 kg after 1 month). Patients in the control group were asked to maintain their usual daily lifestyle. After 12 weeks, the training group were significant better than the control group in terms of glycosylated hemoglobin, the five times sit-to-stand test, skeletal muscle mass and calf circumference, and the physiological domain of the World Health Organization Quality of Life Questionnaire. In conclusion, these simple home exercises are beneficial to patients with T2DM combined with possible sarcopenia. This approach can assist patients in controlling their levels of glycosylated hemoglobin as well as improve physical fitness and quality of life.

Role of genetic factors (biology of telomeres) in cardiac rehabilitation

Cardiac rehabilitation (CR) is one of the effective healthcare types for cardiovascular patients. At the same time, the choice of the most effective CR methods for a particular patient remains a problem. An increasing number of studies are devoted to the application of genetic methods for studying human health. Particular attention is drawn to determining the telomere length. The review purpose was to analyze the literature on various studies on the significance of assessing the chromosome telomeres for characterizing human health and choosing effective CR methods. The article discusses issues related to the relationship between the telomere length and cardiovascular risk factors, dietary pattern, and psychological status of a person. We also assessed the effectiveness of various exercise types at the genetic level. In preparing the review, publications over the past 14 years were searched in the MEDLINE/PubMed, Scopus, Cochrane Library, PEDro, eLIBRARY, and Google Scholar databases. The presented facts indicate the need for further study and effective use of one of the genetic factors protecting chromosome telomeres in CR.

Current trends in the development of soy-based foods containing probiotics and paving the path for soy-synbiotics

In the world of highly processed foods, special attention is drawn to the nutrient composition and safety of consumed food products. Foods fortified with probiotic bacteria confer beneficial effects on human health and are categorized as functional foods. The salubrious activities of probiotics include the synthesis of vital bioactives, prevention of inflammatory diseases, anticancerous, hypocholesterolemic, and antidiarrheal effects. Soy foods are exemplary delivery vehicles for probiotics and prebiotics and there are diverse strategies to enhance their functionality like employing mixed culture fermentation, engineering probiotics, and incorporating prebiotics in fermented soy foods. High potential is ascribed to the concurrent use of probiotics and prebiotics in one product, termed as "synbiotics," which implicates synergy, in which a prebiotic ingredient particularly favors the growth and activity of a probiotic micro-organism. The insights on emended bioactive profile, metabolic role, and potential health benefits of advanced soy-based probiotic and synbiotic hold a promise which can be profitably implemented to meet consumer needs. This article reviews the available knowledge about strategies to enhance the nutraceutical potential, mechanisms, and health-promoting effects of advanced soy-based probiotics. Traditional fermentation merged with diverse strategies to improve the efficiency and health benefits of probiotics considered vital, are also discussed.

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

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.

Effect of resistance training with and without caloric restriction on visceral fat: A systemic review and meta-analysis

We performed a systematic review and meta-analysis to investigate the effect of resistance training (RT) with and without caloric restriction (CR) on visceral fat (VF). PubMed and Scopus were searched to identify original articles published through December 2020. Standardized mean differences and 95% confidence intervals (95% CIs) were determined, and separate analyses were conducted for RT versus control, and RT plus CR versus CR only. Thirty-four studies including 38 intervention arms and involving 2285 were included in the meta-analysis. RT effectively reduced VF [-24 (95% CI -0.34 to -0.13), p < 0.001; I²  = 4.17%, p = 0.40; 24 intervention arms] when compared with control. Based on subgroup analyses, reduction in VF was significant for individual with (p = 0.04) and without (p < 0.001) obesity as well as across medium-term (p = 0.001) and long-term (p = 0.002) interventions. Reduction in VF was significant for both middle-age (p = 0.03) and elderly (p = 0.001) adults but was not significant for pediatric (p = 0.08) participants. However, RT plus CR did not indicate superiority effect on VF [0.23 95% CI -0.04 to 0.51, p = 0.09; I²  = 58.76%, p = 0.003; 14 intervention arms] when compared with CR only. Our results confirm that RT may be effective for reducing VF, but adding RT with CR was not associated with a greater effect for reducing VF.

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AIM

Aim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes.

DATA SYNTHESIS

This metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing 'no exercise' as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (-0.3 [-0.1;-0.4]%, -1.44 [-2.22, -0.66]%, and -5.6 [-9.5, -1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, -0.4 [-0.6;-0.3], -0.2 [-0.4;-0.1], and -0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise.

CONCLUSIONS

Physical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.

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

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.

Strength Training and Insulin Resistance: The Mediating Role of Body Composition

The main objective of the present study was to assess the association between participation in strength training and insulin resistance. Another goal was to assess the influence of several potential confounding variables on the strength training and insulin resistance relationship. Lastly, the influence of waist circumference, fat-free mass (kg), body fat percentage, and the fat-free mass index on the association between strength training and insulin resistance was assessed. This cross-sectional study included 6,561 randomly selected men and women in the U.S. Data were collected using the precise protocol established by NHANES. HOMA-IR was used as the outcome variable to index insulin resistance. Both time spent strength training and frequency of strength training bouts were used as exposure variables. There was not a statistically significant relationship between strength training and insulin resistance in women. However, before and after controlling for 11 potential confounding variables, men who reported no strength training had significantly higher levels of HOMA-IR compared to men who reported moderate or high levels of strength training (F = 9.87, P < 0.0001). Odds ratios were also assessed. Men reporting no strength training had 2.42 times the odds of having insulin resistance compared to men reporting moderate levels of strength training (95% CI: 1.19-4.93). Similarly, men reporting no strength training had 2.50 times the odds of having insulin resistance compared to men reporting high levels of strength training (95% CI: 1.25-5.00). In conclusion, there was a strong relationship between strength training and insulin resistance in U.S. men, but not in U.S. women. Differences in waist circumference, fat-free mass (kg), body fat percentage, and the fat-free mass index, as well as demographic and lifestyle measures, do not appear to mediate the relationship. The present study was not a clinical trial.

Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial

Type 2 diabetes mellitus (T2DM) is significantly associated with osteoarthritis (OA). This study investigated the effects of two resistance exercise approaches on glycated hemoglobin (HbA1c) level and function performance. Enrolled were 70 older patients with both T2DM and knee OA. The dynamic group performed resistance exercises with an elastic resistance band. The isometric group underwent isometric contraction exercises. After the 12-week intervention, a significant within-group improvement (all p < 0.001) was observed for the chair stand test (CST; 10.8%, vs. 7.1%), timed up and go (TUG) test (12.6% vs. 7.6%), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function subscale (62.3% vs. 36.1%), and overall WOMAC (54.5% vs. 34.5%) in the dynamic and isometric group, respectively. In addition, in terms of between-group differences, the dynamic group had significant improvements in CST (p = 0.011), TUG (p < 0.001), WOMAC physical function subscale (p = 0.033), and overall WOMAC (p = 0.036) scores compared with the isometric group. However, no significant change in HbA1c was observed in either group. In conclusion, the dynamic resistance exercise significantly improved muscle strength, dynamic balance, and physical function in this comorbid population; however, there was no notable difference in change in HbA1c among different resistance exercises.

The effects of elastic resistance band training and green coffee bean extract supplement on novel combined indices of cardiometabolic risk in obese women

The main purpose of this study was to investigate the effects of elastic resistance band training (ERBT) and green coffee bean extract (GCBE) supplement on novel cardiometabolic indices in obese women. To this end, a total number of 60 obese women aged 30-50 years with a body mass index of > 30 kg/m² were selected for inclusion in this study and then they were randomly assigned to one of the following four groups: placebo (n = 15), GCBE supplement (n = 15), GCBE supplement + ERBT (n = 15), and placebo + ERBT (n = 15). Each commercially prepared GCBE supplement capsule used in this study contained 500 mg of GCBE supplement and it was also claimed by the manufacturer to have 50% chlorogenic acid (CGA) (250 mg). The participants in the placebo + ERBT and GCBE supplement + ERBT groups attended an 8-week ERBT program, 3 sessions / week, and 60 min each session. In the GCBE supplement + ERBT group, Framingham risk score (P = 0.018), atherogenic index of plasma (P = 0.003), and metabolic syndrome severity score (P = 0.001) significantly decreased. Taken together, the results of the present study supported the importance of supplemental and resistance-type training in improving obesity and novel cardiometabolic risk scores, despite the fact that longer nutritional and exercise interventions could enhance some cardiometabolic risk scores in obese women.

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

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.

Effects of a moderate-to-high intensity resistance circuit training on fat mass, functional capacity, muscular strength, and quality of life in elderly: A randomized controlled trial

Physical exercise is considered an important intervention for promoting well-being and healthy aging. The objective was to determine the effects of moderate-to-high intensity resistance circuit training on different parameters of body composition, functional autonomy, muscular strength and quality of life in elderly. A randomized controlled trial was conducted. A total of 45 subjects (27 females, 18 males) aged between 65–75 years old from Murcia (Spain) were divided by sex, and randomly to experimental group (n = 33, mean age 69 ± 3.2 years old) receiving 12 weeks of moderate-to-high intensity resistance circuit training and control group (n = 33, mean age 70 ± 4.1 years old) receiving no exercise intervention. Intra-group comparison, the experimental group showed a significant increment of lean body mass in women and men, which also presented a decrease of fat mass. Both sex presented a significant improve in functional autonomy, and significately higher values of muscular strength. But no changes were observed regarding quality of life in these groups. The control group did not show any differences pre and post-intervention in women, but in men presented an increment of body mass index and total weight post-intervention. No changes were showed in the other variables. Similar results were founded at inter-group comparison. The moderate-to-high intensity resistance circuit training showed increase in total lean body mass, improvements in functional capacity and significantly increase in upper and lower muscular strength in women and men. Progressive resistance circuit training should be promoted for the elderly as it has the potential to improve physical performance, thereby prolonging healthy independent aging.

Effects of low-intensity resistance training on muscular function and glycemic control in older adults with type 2 diabetes

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.

Resistance Exercise Intensity is Correlated with Attenuation of HbA1c and Insulin in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

We investigated the influence of resistance exercise (RE) with different intensities on HbA1c, insulin and blood glucose levels in patients with type 2 diabetes (T2D). Diabetes trials that compared RE group with a control were included in meta-analysis. Exercise intensities were categorized into low-to-moderate-intensity and high-intensity subgroups. Intensity effect on glycemic control was determined by meta-regression analysis, and risk-of-bias was assessed using Cochrane Collaboration tool. 24 trials met the inclusion criteria, comprised of 962 patients of exercise (n = 491) and control (n = 471). Meta-regression analysis showed decreased HbA1c (p = 0.006) and insulin (p = 0.015) after RE was correlated with intensity. Subgroup analysis revealed decreased HbA1c was greater with high intensity (−0.61; 95% CI −0.90, −0.33) than low-to-moderate intensity (−0.23; 95% CI −0.41, −0.05). Insulin levels were significantly decreased only with high intensity (−4.60; 95% CI −7.53, −1.67), not with low-to-moderate intensity (0.07; 95% CI −3.28, 3.42). Notably, values between the subgroups were statistically significant for both HbA1c (p = 0.03) and insulin (p = 0.04), indicative of profound benefits of high-intensity RE. Pooled outcomes of 15 trials showed only a decreased trend in blood glucose with RE (p = 0.09), and this tendency was not associated with intensity. Our meta-analysis provides additional evidence that high-intensity RE has greater beneficial effects than low-to-moderate-intensity in attenuation of HbA1c and insulin in T2D patients.

Effect of 12-Month Resistance Training on Changes in Abdominal Adipose Tissue and Metabolic Variables in Patients with Prediabetes: A Randomized Controlled Trial

OBJECTIVE

To examine the effects of resistance training relative to aerobic training on abdominal adipose tissue and metabolic variables in adults with prediabetes.

METHODS

105 participants with prediabetes were randomized into the resistance training group (RT, n = 35), aerobic training group (AT, n = 35), and control group (CG, n = 35). The participants completed supervised 12-month exercise; the control group followed the primary lifestyle without exercise intervention. The primary outcomes were visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) measured by computed tomography (CT). Secondary outcomes were body composition, lipid profile, and metabolic variables.

RESULTS

A total of 93 participants completed the study. There were nonsignificant differences between groups before intervention. After training, VAT decreased significantly in AT and RT compared with CG (P = 0.001 and P = 0.014, respectively). Although no significant difference in SAT was found across groups, SAT decreased significantly over time within each exercise group (all P = 0.001). Increase in muscle mass was greater in RT than that in AT and CG (P = 0.031 and P = 0.045, respectively). Compared with CG, fasting plasma glucose (FPG) decreased significantly in RT and AT (P = 0.003 and P = 0.014, respectively). There was a significant difference in the number of prediabetes who converted to diabetes among AT and RT, as compared with the control group (P = 0.031 and P = 0.011, respectively). No significant differences were observed in lipid, waist-to-hip ratio (WHR), body mass index (BMI), fasting insulin (FI), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), HOMA-IR, and HOMA-β across groups.

CONCLUSION

Both aerobic training and resistance training are effective in reducing abdominal adipose tissue and fasting plasma glucose in adults with prediabetes. Importantly, resistance training but not aerobic training is effective in augmenting muscle mass.

TRIAL REGISTRATION

The trial is registered with NCT02561377 (date of registration: 24/09/2015).

Effects of 8-week kettlebell training on body composition, muscle strength, pulmonary function, and chronic low-grade inflammation in elderly women with sarcopenia

OBJECTIVES

To examine the effect of kettlebell training on body composition, muscle strength, pulmonary function, and chronic low-grade inflammatory markers among elderly people with sarcopenia.

DESIGN

Randomized controlled trial.

SETTING

Community center and research center.

PARTICIPANTS

A total of 33 elderly women with sarcopenia (aged 65-75 years) were recruited.

INTERVENTION

The participants were randomly assigned to a kettlebell training (KT) group or a control (CON) group. The KT group received an 8-week training intervention involving 60-min sessions twice a week, whereas the CON group members continued their daily lifestyles without participating in any exercise training. Four weeks of detraining were organized to observe the retention effect of the training program on the KT group.

MEASUREMENTS

The participants' body composition, muscle strength, pulmonary function, and chronic low-grade inflammatory markers were measured and analyzed before training (at Week 0, W0), after 8 weeks of training (at Week 8, W8), and after 4 weeks of detraining (at Week 12, W12).

RESULTS

In the KT group, appendicular skeletal muscle mass (ASM) and the sarcopenia index measured at W8 and W12 were significantly higher than those at W0(p = .004; p = .005). At W8 and W12, the sarcopenia index was significantly higher in the KT group than the CON group(p = .020; p = .019). In the CON group, the skeletal muscle mass levels measured at W8 and W12 were significantly lower than that at W0(p = .029; p = .005), and the ASM and the sarcopenia index measured at W8 were significantly lower than those at W0(p = .037; p = .036). Additionally, the measured left handgrip strength(p = .006), back strength(p = .011; p = .018), and peak expiratory flow (PEF) (p = .008; p = .006) were significantly higher in the KT group than the CON group at W8 and W12. At W8, the measured right handgrip strength was significantly higher in the KT group than the CON group(p = .043). In the KT group, the back strength and PEF levels measured at W8 and W12 were significantly higher than those at W0(p = .000; p = .004), and the left and right handgrip strength levels at W8 were significantly higher than those at W0(p = .004; p = .013). By contrast, in the CON group, the left(p = .004; p = .006)and right(p = .002; p = .004)handgrip strength levels and PEF(p = .018; p = .012) measured at W8 and W12 were significantly lower than those at W0. Moreover, compared with the high-sensitivity C-reactive protein (hs-CRP) levels measured at W0, those measured at W8 and W12 were significantly lower in the KT group(p = .006; p = .013)but significantly higher in the CON group(p = .005; p = .009). There was no significant difference in hs-CRP, IL-6, TNF-α between the KT and CON group.

CONCLUSION

For elderly people with sarcopenia, participating in kettlebell training significantly increases the sarcopenia index, grip strength, back strength, and PEF. In addition, the retention effect of the training program continued after 4 weeks of detraining.

Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

INTRODUCTION

Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM.

METHODS

We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0.

RESULTS

A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower]) and total cholesterol (22.08 mg/dl lower]. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises.

CONCLUSION

Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises.

TRIAL REGISTRATION

Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .

Resistance training reduces metabolic syndrome and inflammatory markers in older women: A randomized controlled trial

BACKGROUND

This study analyzed the effects of a 12-week resistance training (RT) program without dietary interventions on metabolic syndrome (MetS) components and inflammatory biomarkers in older women.

METHODS

Fifty-three older women (mean [±SD] age 70.4 ± 5.7 years; mean body mass index 26.7 ± 4.0 kg/m² ) were randomly assigned to a training group (TG; n = 26) that performed 12 weeks of an RT program or a control group (CG; n = 27) that did not perform any type of physical exercise over the same period. Body composition (dual energy X-ray absorptiometry), muscular strength (one-repetition maximum tests), blood pressure (BP), and blood sample measurements were performed before and after intervention.

RESULTS

After the 12-week period, there were significantly reductions (P < 0.05) in glucose levels (-20.4% vs -0.3%), waist circumference (-1.5% vs +2.0%), and systolic BP (-6.2% vs +0.9%), and complete normalization of MetS prevalence (18% at baseline vs. 0% after 12-weeks RT) in the TG. Moreover, C-reactive protein and tumor necrosis factor-α concentrations decreased in the TG (-28.6% and -21.6%, respectively), but increased in the CG (+34.5% and +13.3%, respectively). In addition there were positive improvements in the MetS Z-score in the TG but not CG (-21.6% vs +13.3%, respectively).

CONCLUSION

The results suggest that a 12-week RT program seems to effectively reduce MetS components and inflammatory biomarkers in older women, regardless of dietary intervention. The RT-induced adaptations in body composition and inflammatory biomarkers appear to be related to healthy adaptations in risk factors for MetS.

Positive Effects of a Short-Term Intense Elastic Resistance Training Program on Body Composition and Physical Functioning in Overweight Older Women

The aim of this study was to investigate the effects of a resistance training program (RTP) in older overweight women (OOW) using two different types of elastic devices.

METHODS

This study was a randomized controlled trial with pre- and postintervention measures. Participants included OOW, aged 60-85 years, with no medical history of disease that would preclude them from engaging in physical exercise. Participants were randomly divided into the following groups: elastic tubes with handles group (ETG; n = 22), traditional elastic bands group ( n = 21), and control group (CG; n = 20). Exercise groups (EGs) performed the following supervised RTP: 8 weeks, twice weekly, six overall body exercises, and 3-4 sets of 10 repetitions at a rate of perceived exertion (RPE) of 7-9 on the OMNI-Resistance Exercise Scale of perceived exertion. The controls did not change their usual lifestyle. Outcome measures included body composition (BC; total and regional percentage of fat mass [FM] and fat-free mass [FFM]) and physical performance (PP; dynamic and isometric strength, flexibility, agility/dynamic balance, and endurance).

RESULTS

Both EGs exhibited significantly reduced FM in the upper limbs (ULs) and trunk and increased FFM in the UL, while the ETG exhibited a significantly increased trunk FFM. Both EGs improved in PP, and there were no intergroup differences. Trunk FM and FFM and meters walked differed significantly between the ETG and CG. The CG did not exhibit any significant changes.

CONCLUSION

Training with elastic devices at a moderate-high RPE produces short-term improvements in BC and PP in OOW.

Effects of order and sequence of resistance and endurance training on body fat in elementary school-aged girls

The purpose of this study was to analyse the effects of order and sequence of concurrent resistance and endurance training on body fat percentage (BFP) in a large sample of elementary school-aged girls. One hundred and twenty-six healthy girls, aged 10-11 years (10.95 ± 0.48 years), were randomly assigned to six groups to perform different training protocols per week for 8 weeks: Resistance-only (R), Endurance-only (E), Concurrent Distinct Endurance-Resistance (CDER), Concurrent Parallel Endurance-Resistance (CPER), Concurrent Parallel Resistance-Endurance (CPRE), and a Control group (C). In R and E, the subjects performed single sessions of resistance or endurance exercises, respectively (two days per week). In CDER, resistance-endurance training was performed on different days each week (four days per week). CPER and CPRE performed single-session combined endurance-resistance training or combined resistance-endurance training, respectively, each week (two days per week). After an 8-week training period, BFP decreased in all experimental groups (CPER: 13.3%, p< 0.05; CPRE: 13.8%, p<0.001; E: 1.9%, p>0.05; R: 5.0%, p>0.05; and CDER: 5.6%, p>0.05). However, a significant difference was found in CPER and CPRE when compared to CDER, E, and R, indicating that training sequence may influence BFP. All programmes were effective, but CPER and CPRE obtained better results for BFP than CDER, E, or R. The effects of concurrent resistance and endurance training on body fat percentage can be mediated by order and sequence of exercise. These results provide insight into optimization of school-based fat loss exercise programmes in childhood.

Improvement of obesity-linked skeletal muscle insulin resistance by strength and endurance training

Obesity-linked insulin resistance is mainly due to fatty acid overload in non-adipose tissues, particularly skeletal muscle and liver, where it results in high production of reactive oxygen species and mitochondrial dysfunction. Accumulating evidence indicates that resistance and endurance training alone and in combination can counteract the harmful effects of obesity increasing insulin sensitivity, thus preventing diabetes. This review focuses the mechanisms underlying the exercise role in opposing skeletal muscle insulin resistance-linked metabolic dysfunction. It is apparent that exercise acts through two mechanisms: (1) it stimulates glucose transport by activating an insulin-independent pathway and (2) it protects against mitochondrial dysfunction-induced insulin resistance by increasing muscle antioxidant defenses and mitochondrial biogenesis. However, antioxidant supplementation combined with endurance training increases glucose transport in insulin-resistant skeletal muscle in an additive fashion only when antioxidants that are able to increase the expression of antioxidant enzymes and/or the activity of components of the insulin signaling pathway are used.

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

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.

Protein timing during the day and its relevance for muscle strength and lean mass

Protein consumption and its association with changes in body composition, muscle function and different strategies to optimize the muscle protein synthetic response have received considerable attention. However, we are not aware of any epidemiological study examining the time-of-day consumption (afternoon versus evening) of protein on strength and lean mass. The purpose was to examine the associations between afternoon and evening protein consumption, at different protein thresholds (i.e. 15, 20, 25 and 30 g), in relation to leg lean mass and knee extensor strength in men. Dietary protein consumption was assessed using 24-h dietary interview format. Knee extensor strength was measured on an isokinetic dynamometer. Leg lean mass was estimated from whole-body DXA scans. Participants who consumed 20 g, 25 g and 30 g of protein in the evening had greater leg lean mass than those who consumed protein in the afternoon (P<0·05). However, there was no difference in leg lean mass for 15 g of protein consumption in the evening compared to the afternoon (P>0·05). For strength, there were no differences between evening and afternoon consumption of protein for 15 g, 20 g or 25 g (P>0·05); however, those consuming at least 30 g of protein in the evening had greater knee extensor strength compared to those consuming similar amounts in the afternoon (P = 0·05). These findings suggest that evening protein consumption is associated with greater leg lean mass and knee extensor strength when compared to afternoon protein consumption. Based on these findings, we cautiously hypothesize that there may be a circadian rhythm in muscle protein metabolism.

Resistance training to improve type 2 diabetes: working toward a prescription for the future

The prevalence of type 2 diabetes (T2D) is rapidly increasing, and effective strategies to manage and prevent this disease are urgently needed. Resistance training (RT) promotes health benefits through increased skeletal muscle mass and qualitative adaptations, such as enhanced glucose transport and mitochondrial oxidative capacity. In particular, mitochondrial adaptations triggered by RT provide evidence for this type of exercise as a feasible lifestyle recommendation to combat T2D, a disease typically characterized by altered muscle mitochondrial function. Recently, the synergistic and antagonistic effects of combined training and Metformin use have come into question and warrant more in-depth prospective investigations. In the future, clinical intervention studies should elucidate the mechanisms driving RT-mitigated mitochondrial adaptations in muscle and their link to improvements in glycemic control, cholesterol metabolism and other cardiovascular disease risk factors in individuals with T2D.

Exercise and ectopic fat in type 2 diabetes: A systematic review and meta-analysis

Ectopic adipose tissue surrounding the intra-abdominal organs (visceral fat) and located in the liver, heart, pancreas and muscle, is linked to cardio-metabolic complications commonly experienced in type 2 diabetes. A systematic review and meta-analysis was performed to determine the effect of exercise on ectopic fat in adults with type 2 diabetes. Relevant databases were searched to February 2016. Included were randomised controlled studies, which implemented≥4 weeks of aerobic and/or resistance exercise and quantified ectopic fat via magnetic resonance imaging, computed tomography, proton magnetic resonance spectroscopy or muscle biopsy before and after intervention. Risk of bias and study quality was assessed using Egger's funnel plot test and modified Downs and Black checklist, respectively. Of the 10,750 studies retrieved, 24 were included involving 1383 participants. No studies were found assessing the interaction between exercise and cardiac or pancreas fat. One study assessed the effect of exercise on intramyocellular triglyceride concentration. There was a significant pooled effect size for the meta-analysis comparing exercise vs. control on visceral adiposity (ES=-0.21, 95% CI: -0.37 to -0.05; P=0.010) and a near-significant pooled effect size for liver steatosis reduction with exercise (ES=-0.28, 95% CI: -0.57 to 0.01; P=0.054). Aerobic exercise (ES=-0.23, 95% CI: -0.44 to -0.03; P=0.025) but not resistance training exercise (ES=-0.13, 95% CI: -0.37 to 0.12; P=0.307) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes. These data suggest that exercise effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aimed at reducing visceral fat in obesity-related type 2 diabetes. Further studies are required to assess the relative efficacy of exercise modality on liver fat reduction and the effect of exercise on pancreas, heart, and intramyocellular fat in type 2 diabetes and to clarify the effect of exercise on ectopic fat independent of weight loss.

The impact of duration on effectiveness of exercise, the implication for periodization of training and goal setting for individuals who are overfat, a meta-analysis

Given the assumption that all methods of exercise, e.g., endurance (ET), resistance (RT), or combination of both (E+R), can induce a beneficial effect size (ES) for changes in body composition and health status of individuals who are overfat. Thus the aim and purpose of this study is to evaluate the current body of knowledge to address the question as to the impact that the duration of exercise has on its relative effectiveness for inducing health and body compositional changes in individuals who are overfat to assist with developing periodized exercise protocols and establishing short and long term goals. A tiered meta-analysis of 92-studies and 200-exercise groupings were used for establishing pooled ES within and between groupings based on the increments of 4-week of duration and study designs of ≤8, 9-16, 17-23, 24-36, and ≥36 weeks. Analysis based on random-effect of response indicates a continuum of effectiveness within and between ET, RT and E+R based on duration. Where beneficial effectiveness is not indicated for any measures until after 8-weeks of continuous training with progressive effectiveness being noted in changes to cardiorespiratory fitness, inflammatory cytokines, and alteration of metabolic status from 12-weeks through 32-weeks of continuous training. Results indicate a greater ES for RT and E+R versus ET early in intervention that equalizes with longer durations. Supporting the use of RT and E+R within a periodized program. And secondarily, goals should be established first on performance gains and second body composition or health status modifications for the individual who is overfat.

Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial

OBJECTIVE

The aim of this study was to assess the impact of a program of supervised physical exercises (WEB protocol) versus home-based exercises on body composition (lean mass and fat mass) in postmenopausal women.

METHODS

The initial sample comprised 60 women who were randomized into two groups. After exclusion, the final randomized sample included a supervised group (n = 16; mean age, 66.4 ± 6.5 y) and a home group (n = 18; mean age, 68.2 ± 6.0 y). Both groups underwent a 12-month intervention with physical exercises, including muscle impact exercises and strength and stretching consisting of two weekly sessions of 60 minutes. Body composition was determined by densitometry.

RESULTS

The supervised group exhibited increased lean mass in the upper limbs (P = 0.003) and lower limbs (P = 0.011), total lean tissue (P = 0.015), and appendicular lean mass index (P = 0.001) compared with baseline. The home group exhibited no differences in the lean mass assessments.

CONCLUSIONS

Our results suggest that regular supervised physical exercises with free weights and elastic bands can promote greater improvements in lean body mass than unsupervised exercises in postmenopausal women.

Effects of Elastic Band Resistance Training on Glucose Control, Body Composition, and Physical Function in Women With Short- vs. Long-Duration Type-2 Diabetes

This study examined whether the existing duration of type-2 diabetes influenced patient responses to progressive resistance training. Twenty-six women with type-2 diabetes were stratified into short- (3 ± 2 years; n = 12) or long-standing (10 ± 3 years; n = 14) disease groups. Patients participated in a high daily or high weekly frequency elastic band resistance training program that consisted of 2 daily sessions, 5 d·wk for 12 weeks. Glucose control, body composition, and physical function were evaluated pre- and posttraining. No significant diabetes duration × training interactions were detected for blood markers of glucose control (p > 0.05); however, there were significant main effects of training driven by comparable improvements in both cohorts (hemoglobin A1c, -13 to 18%; fasting glucose, -23 to 31%; postprandial glucose, -36 to 40%; insulin, -34 to 40%; C-peptide, -38 to 51%; p ≤ 0.05). Anthropometrics and body composition were also favorably modified in both the groups after training (weight, -5 to 9%; body mass index, -6 to 9%; waist-to-hip ratio, -3 to 5%; percent fat, -14 to 20%; p ≤ 0.05). Likewise, indices of physical function improved in both the groups after training (bicep curl repetitions, +15-33%; sit-and-stand repetitions, +45-47%; p ≤ 0.05). A few exceptions were noted in which patients with long-standing disease demonstrated greater pre-to-post gains (p ≤ 0.05) in grip strength (+11-13%) and peak exercise time (+19%) and load (+21%) during graded exercise, whereas those with shorter disease duration did not. Overall, these data suggest that patients with a long history of diabetes respond positively to resistance training and in a manner comparable to their recently diagnosed counterparts. Therefore, current inactivity in patients with long-standing disease should not deter from beginning an exercise program.

Strength Training Prevents Hyperinsulinemia, Insulin Resistance, and Inflammation Independent of Weight Loss in Fructose-Fed Animals

The aim of this study was to compare the effects of aerobic, strength, and combined training on metabolic disorders induced by a fructose-rich diet. Wistar rats (120 days old) were randomized into five groups (n = 8-14): C (control diet and sedentary), F (fed the fructose-rich diet and sedentary), FA (fed the fructose-rich diet and subject to aerobic exercise), FS (fed the fructose-rich diet and subject to strength exercise), and FAS (fed the fructose-rich diet and subject to combined aerobic and strength exercises). After the 8-week experiment, glucose homeostasis, blood biochemistry, tissue triglycerides, and inflammation were evaluated and analyzed. The strength protocol exerted greater effects on glucose homeostasis, insulin sensitivity, and liver lipid contents than other protocols (all P < 0.05). All three exercise protocols induced a remarkable reduction in inflammation, tissue triglyceride content, and inflammatory pathways, which was achieved through c-Jun NH2-terminal kinase (JNK) phosphorylation and factor nuclear kappa B (NFkB) activation in both the liver and the muscle. Our data suggest that strength training reduced the severity of most of the metabolic disorders induced by a fructose-rich diet and could be the most effective strategy to prevent or treat fructose-induced metabolic diseases.

Neuromuscular dysfunction in type 2 diabetes: underlying mechanisms and effect of resistance training

Diabetic patients are at higher risk of developing physical disabilities than non-diabetic subjects. Physical disability appears to be related, at least in part, to muscle dysfunction. Several studies have reported reduced muscle strength and power under dynamic and static conditions in both the upper and lower limbs of patients with type 2 diabetes. Additional effects of diabetes include a reduction in muscle mass, quality, endurance and an alteration in muscle fibre composition, though the available data on these parameters are conflicting. The impact of diabetes on neuromuscular function has been related to the co-existence of long-term complications. Peripheral neuropathy has been shown to affect muscle by impairing motor nerve conduction. Also, vascular complications may contribute to the decline in muscle strength. However, muscle dysfunction occurs early in the course of diabetes and affects also the upper limbs, thus suggesting that it may develop independently of micro and macrovascular disease. A growing body of evidence indicates that hyperglycaemia may cause an alteration of the intrinsic properties of the muscle to generate force, via several mechanisms. Recently, resistance exercise has been shown to be an effective strategy to counteract the deterioration of muscular performance. High-intensity exercise seems to provide greater benefits than moderate-intensity training, whereas the effect of a power training is yet unknown. This article reviews the available literature on the impairment of muscle function induced by diabetes, the underlying mechanisms, and the effect of resistance training on this defect. Copyright © 2015 John Wiley & Sons, Ltd.

Effects of a Stroke Primary Prevention Program on Risk Factors for At-Home Elderly

Background

To prevent stroke from occurring, stroke risk factors in at-risk subjects should be controlled and the diseases causing stroke should be managed. This study evaluated a nursing intervention to prevent stroke in at-risk elderly living at home. The program consisted of stroke and nutrition education as well as exercise guidance.

Material/Methods

This study targeted 93 elderly people living at home residing in E province with 1 or more stroke risk factors, including high blood pressure, diabetes, hyperlipidemia, obesity, smoking, or drinking alcohol. The 12-week program included a stroke education class once a week, a nutrition management class once a week, and exercise guidance 3 times a week. Each session lasted 50–70 min. Each disease education and nutrition management session lasted for 20 min and each exercise session lasted for 30–50 min.

Results

The experimental group’s body mass index (BMI) (t=8.27, p<.001), systolic blood pressure (t=2.39, p=.021), fasting blood sugar (t=0.39, p=.700), total cholesterol (t=4.18, p<.001), triglyceride levels (t=2.50, p=.016), and depression scores (t=5.48, p<.001) were significantly reduced and high-density phospholipid protein levels increased significantly by the end of the program (t=−2.94, p=.005).

Conclusions

Based on the results of this study, participating in a stroke prevention program enabled at-risk elderly participants who lived at home in rural areas to perform health-promoting behaviors. This program may reduce the incidence of stroke by reducing risk factors and managing stroke precursor diseases.

Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial

Background

The current recommendations on resistance training involving older adults have reported an improvement of body composition variables. Despite this, there is a lack of knowledge on how elastic resistance training (ERT) affects the muscle mass in older adults population. The purpose of this study was to determine the effects of a short-term ERT on muscle mass of health and untrained older adults.

Methods

Forty older adults were randomized into two groups of 20 individuals each: Control Group (CG = 66.2 ± 6.6 years) and Training Group (TG = 69.1 ± 6.3 years). TG underwent an ERT twice a week during 8 weeks and control group did not receive any specific intervention. The primary outcome was the upper and lower limbs muscle mass, measured by Dual-energy x-ray absorptiometry. The secondary outcomes were knee isokinetic peak torque (PT) at 60°/s and 120°/s speeds and isometric handgrip strength. A 2×2 mixed model (group [TG and CG] × time [pre and post]) analysis of variance (ANOVA) was applied to determine the effect on primary and secondary outcomes.

Results

The results of the ANOVA showed no significant effects in group x time interaction for (1) upper limbs fat free mass (F [1.38] = 1.80, p = 0.19, effect size [ES] = 0.1) and for (2) lower limbs fat free mass (F [1.38] = 0.03, p = 0.88, ES = 0.02). Regarding muscle strength, the ANOVA showed no significant effects in group x time interaction for (3) PT at 60°/s (F [1.38] = 0.33, p = 0.56, ES = 3.0), for (4) PT at 120°/s (F [1.38] = 0.80, p = 0.38, ES = 4.1) and for handgrip strength (F [1.38] = 0.65, p = 0.42-value, ES = 0.9). Analysis of PT in TG showed a significant change of 4.5 %, but only at 120°/s (p = 0.01) when comparing pre and post-training (time interaction).

Conclusions

Eight weeks of ERT did not show significant changes in muscle mass and strength of untrained older adults.

Trial registration

NCT02253615 (09/25/14)

Predicting aerobic fitness improvements after participation in a hybrid supervised and home-based exercise program in people with type 2 diabetes

OBJECTIVE

Structured, gym-based exercise training has been shown to be effective at improving aerobic fitness and glycemic control in persons with type 2 diabetes. However, community-based diabetes programs more commonly incorporate less structured programming, promoting exercise at home. The objectives of this study were to evaluate a community-based, hybrid exercise program encouraging home-based exercise for improving aerobic fitness, and to examine the components of exercise prescription that contribute to this fitness change.

METHODS

A retrospective analysis of 583 persons with type 2 diabetes who had participated in the Toronto Rehabilitation Institute's diabetes exercise program was performed. All subjects completed 6 months of structured aerobic and resistance exercise supervised once per week on-site, with 4 more unsupervised sessions per week completed at home. Cardiopulmonary fitness testing and anthropometric measures were performed at baseline and at program completion. A multivariate regression analysis examined the outcome of aerobic fitness (peak oxygen consumption), controlling for age, sex, body mass index, weight change, initial fitness at entry into the program and walking exercise performed (distance, duration and pace).

RESULTS

Peak oxygen consumption improved significantly from 19.1±0.2 at baseline to 21.9±0.3 mL·kg(-1)·min(-1) at 6 months (p<0.001). Weight and body mass index also improved significantly (p<0.001). The regression model was able to predict 76.9% of the variance in aerobic fitness, with distance walked contributing the most to improved exercise capacity.

CONCLUSIONS

A 6-month hybrid exercise program delivered in a community rehabilitation program setting successfully improved aerobic fitness in people living with type 2 diabetes.

Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials

Resistance exercise using free weights or weight machines improves glycaemic control and strength in people with type 2 diabetes. Resistance band training is potentially less expensive and more accessible, but the effects of resistance band training on glycaemic control and strength in this population are not well understood. This paper aims to systematically review and meta-analyse the effect of resistance band training on haemoglobin A1c (HbA1c) and strength in adults with type 2 diabetes. Database searches were performed in August 2013 (MEDLINE, SPORTDiscus, EMBASE, and CINAHL). Reference lists of eligible articles were hand-searched for additional studies. Randomised trials evaluating the effects of resistance band training in adults with type 2 diabetes on HbA1c or objectively measured strength were selected. Baseline and post-intervention HbA1c and strength were extracted for the intervention and control groups. Details of the exercise interventions and methodological quality were collected. Seven trials met inclusion criteria. Post-intervention-weighted mean HbA1c was nonsignificantly lower in exercise groups compared to control groups [weighted mean difference (WMD) = -0.18 percentage points (-1.91 mmol/mol); P = 0.27]. Post-intervention strength was significantly higher in the exercise groups compared to the control groups in the lower extremities (WMD = 21.90 kg; P < 0.0001), but not in the upper extremities (WMD = 2.27 kg; P = 0.13) or handgrip (WMD = 1.98 kg; P = 0.46). All trials were small and had methodological limitations. Resistance band training did not significantly affect HbA1c, upper extremity, or handgrip strength but significantly increased the strength of the lower extremities in people with type 2 diabetes.

Brain-derived neurotrophic factor correlated with muscle strength in subjects undergoing stationary bicycle exercise training

AIMS

Several central nervous disorders are associated with metabolic syndrome (MetS) and type 2 diabetes. Reduction in brain-derived neurotrophic factor (BDNF) is involved in the mechanism of central nervous dysfunction. BDNF is up-regulated after exercise, but it is not known whether increased BDNF is related to increases in muscle strength.

METHODS

In the present study, subjects with MetS or type 2 diabetes were enrolled in an exercise program. All participants underwent an indoor bicycle exercise program for twelve weeks. Serum BDNF was determined after overnight fasting. Muscle strength was assessed by extension of the dominant lower extremity.

RESULTS

A total of 33 subjects were enrolled in this study. The body mass index did not change significantly (from 30.4±6.0 to 30.2±5.8kg/m(2), P=0.436), but serum BDNF increased significantly (from 17.1±9.1 to 24.2±10.7ng/mL, P<0.001) after the study. The exercise-associated BDNF was significantly correlated with the increased strength in lower-extremity extension test (r=0.54, P=0.001). Using multivariate regression analysis, muscle-strength increment, but not body-weight change, was an independent factor for serum BDNF (95% CI=0.009-0.044, P=0.005).

CONCLUSIONS

After a twelve-week program of stationary bicycle exercise, serum BDNF concentration increased, and this change was positively correlated with muscle strength of lower-extremity extension, but not body weight. (

TRIAL REGISTRATION

NCT02268292, ClinicalTrials.gov).

The surprising influence of family history to type 2 diabetes on anaerobic performance of young male élite athletes

AIMS/HYPOTHESIS

It is known that family history to type 2 diabetes induces anthropometric changes in various populations. Regular physical activity can induce adaptations in these subjects regularizing body composition and anthropometric parameters. The aim of this study is therefore to understand if family history to type 2 diabetes affects anaerobic performance in young male élite athletes.

METHODS

Forty six young male élite athletes were tested. Thirty three without family history to type 2 diabetes (FH-) and thirteen with family history to type 2 diabetes (FH+). Anthropometric parameters, body composition, physiological parameters and athletic performance were assessed.

RESULTS

Weight (p 0,0050), BMI (p 0,0019), waist circumference (p 0,0090), hips circumference (p 0,0490) and WHR (p 0,0339) were different between the two groups, showing greater values for the FH + subjects. Body composition showed lower FM and higher FFM percentages for the FH + group compared to the FH-. Anaerobic performance tests showed differences between the groups highlighting that the FH + group had higher anaerobic performance values (Wingate test for FH + 512,77 ± 107,93 W vs Wingate test for FH- 447,94 ± 56,95 W).

CONCLUSIONS/INTERPRETATION

The élite athletes with FH + showed better anaerobic performances and a higher body mass. At this stage we cannot generalise, but in a sample of athletes we tested, all who were with FH + showed both interesting and unexpected results; if confirmed, this evidence may represent a remarkable knowledge for fitness coaches and professionals who are daily dealing with track and field athletes and their performances.

Skeletal muscle and organ masses differ in overweight adults with type 2 diabetes

Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differs in adults with type 2 diabetes (T2DM) compared with nondiabetic healthy controls has not been investigated. A subset of African-American and Caucasian participants with T2DM from the Look AHEAD (Action for Health in Diabetes) trial had body composition assessed and compared with a sample of healthy controls. Skeletal muscle mass (SMM), liver, kidneys, and spleen mass were quantified using a contiguous slice magnetic resonance imaging (MRI) protocol. Cardiac mass was quantified by either a cardiac gated MRI protocol or by echocardiography. MRI volumes were converted to mass using assumed densities. Dual-energy X-ray absorptiometry assessed LBM. Using general linear models adjusted for height, weight, sex, age, race, and interactions of diabetes status with race or sex, persons with T2DM (n = 95) had less LBM (49.7 vs. 51.6 kg) and SMM (24.1 vs. 25.4 kg) and larger kidneys (0.40 vs. 0.36 kg) than controls (n = 76) (all P < 0.01). Caucasians with T2DM had larger livers (1.90 vs. 1.60 kg, P < 0.0001) and spleens (0.29 vs. 0.22 kg, P < 0.01), and T2DM men had less cardiac mass than controls (0.25 vs. 0.30 kg, P < 0.001). In this sample, T2DM is characterized by less relative skeletal muscle and cardiac mass in conjunction with larger kidneys, liver, and spleen. Further investigation is needed to establish the causes and metabolic consequences of these race- and sex-specific organ mass differences in T2DM.

Changes in insulin sensitivity in response to different modalities of exercise: a review of the evidence

Type 2 diabetes is an increasingly prevalent condition with complications including blindness and kidney failure. Evidence suggests that type 2 diabetes is associated with a sedentary lifestyle, with physical activity demonstrated to increase glucose uptake and improve glycaemic control. Proposed mechanisms for these effects include the maintenance and improvement of insulin sensitivity via increased glucose transporter type four production. The optimal mode, frequency, intensity and duration of exercise for the improvement of insulin sensitivity are however yet to be identified. We review the evidence from 34 published studies addressing the effects on glycaemic control and insulin sensitivity of aerobic exercise, resistance training and both combined. Effect sizes and confidence intervals are reported for each intervention and meta-analysis presented. The quality of the evidence is tentatively graded, and recommendations for best practice proposed.

Resistance training for diabetes prevention and therapy: experimental findings and molecular mechanisms

Type 2 diabetes mellitus (T2D) is characterized by insulin resistance, impaired glycogen synthesis, lipid accumulation, and impaired mitochondrial function. Exercise training has received increasing recognition as a cornerstone in the prevention and treatment of T2D. Emerging research suggests that resistance training (RT) has the power to combat metabolic dysfunction in patients with T2D and seems to be an effective measure to improve overall metabolic health and reduce metabolic risk factors in diabetic patients. However, there is limited mechanistic insight into how these adaptations occur. This review provides an overview of the intervention data on the impact of RT on glucose metabolism. In addition, the molecular mechanisms that lead to adaptation in skeletal muscle in response to RT and that are associated with possible beneficial metabolic responses are discussed. Some of the beneficial adaptations exerted by RT include increased GLUT4 translocation in skeletal muscle, increased insulin sensitivity and hence restored metabolic flexibility. Increased energy expenditure and excess postexercise oxygen consumption in response to RT may be other beneficial effects. RT is increasingly establishing itself as an effective measure to improve overall metabolic health and reduce metabolic risk factors in diabetic patients.

Impacto do treinamento resistido na força e hipertrofia muscular em HIV-soropositivos

O presente estudo investigou o efeito de 24 semanas de treinamento resistido (TR) sobre a força e hipertrofia muscular de pacientes HIV-soropositivos. Participaram deste estudo 45 voluntários submetidos à terapia antirretroviral fortemente ativa (HAART), destes, 23 realizaram 3 sessões semanais, com 10 repetições a 80% 1RM. O teste de 1RM foi realizado de acordo com a metodologia proposta por Kraemer e Fry (1995), para estimativa da hipertrofia muscular adotou-se as equações de Frisancho (1984). Em comparação aos valores, o TR melhorou a força de 1RM nos exercícios de agachamento em 49% (21,0±4,9 vs. 31,2±5,1; P=0,001), supino reto em 13% (34,3±8,1 vs. 39,8±9,4; P=0,04), cadeira extensora em 34,1% (26,3±7,1 vs. 37,1±6,6; P=0,01), tríceps em 51% (22,9±4,0 vs. 38,3±4,9; P=0,001), pulley costas em 31,5% (31,7±3,9 vs. 41,7±4,4; P=0,01), cadeira flexora em 37,2% (18,9±3,4 vs. 27,3±3,2; P=0,01) e rosca bíceps em 60% (27,9±6,9 vs. 40,4±4,5; P=0,001). Não foram observadas diferenças (P<0,05) entre os valores basais e finais para o grupo controle. Observou-se aumento significativo (P<0,05) na área muscular do braço isenta de massa óssea, no grupo TR (52,8±14,5 cm²) em relação ao controle (39,5±12,4 cm²). Ademais, o TR resultou em significativa (P<0,05) redução da glicemia sanguínea de jejum (96,5±18,3 vs. 90,5±12,6), pressão arterial sistólica (126,3±14,3 vs. 120,0±10,0) e circunferência de cintura (83,0±12,5 vs. 80,6±10,2). Conclui-se que seis meses de TR resultaram em melhora na força e hipertrofia, ademais, o treinamento aplicado contribuiu para a regulação das variáveis metabólicas dos pacientes. Uma vez que a HAART é inevitável ao HIV-soropositivo, recomenda-se que o exercício físico seja realizado no intuito de dirimir os efeitos colaterais advindos desta terapia.