Diabetes Type 2

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Clinical Care/Education/Nutrition
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High-Intensity Resistance Training Improves Glycemic Control in Older Patients With Type 2 Diabetes DAVID W. DUNSTAN, PHD1 ROBIN M. DALY, PHD2 NEVILLE OWEN, PHD3 DAMIEN JOLLEY, MSC2 MAXIMILIAN DE COURTEN, MD1 JONATHAN SHAW, MD1 PAUL ZIMMET, PHD1 ommend the use of resistance training as part of a well-rounded exercise program for older individuals. However, the role of progressive resistance training as a treatment regimen for improving the metabolic profile of older patients with type 2 diabetes has received little attention. Given that the prevalence of type 2 diabetes increases with age (9) and that aging is associated with a reduction in muscle strength and metabolic control, both of which are influenced by the progressive age-related decline in muscle mass (sarcopenia) (10), resistance training may represent an effective exercise alternative for older adults. Furthermore, several studies in older patients without diabetes have demonstrated that resistance training can improve muscular strength and may be an effective tool for the prevention of age-related sarcopenia (11–13). Due to the limited information on the role of resistance training for older patients with type 2 diabetes, it has been recommended that resistance training programs use moderate weights and high repetitions (7). However, it appears that the impact of progressive resistance training on muscle mass and muscle strength in both young and older individuals is more pronounced if higher training intensities (70 and 90% of the onerepetition maximum strength [1-RM]) are used (14). In older adults without diabetes, high-intensity progressive resistance training programs have been reported to have significant effects on daily energy expenditure (15), body composition (16), and insulin sensitivity (17,18). To date, no study has examined the long-term effects of high-intensity progressive resistance training in combination with moderate weight loss in subjects with type 2 diabetes. The absence of such data has precluded specific recommendations by the American Diabetes Association with respect to the merits of highintensity resistance training for older individuals with type 2 diabetes (7). The aim of this randomized controlled trial was to examine the effects of a 6-month high-intensity progressive resistance 1729

OBJECTIVE — To examine the effect of high-intensity progressive resistance training combined with moderate weight loss on glycemic control and body composition in older patients with type 2 diabetes. RESEARCH DESIGN AND METHODS — Sedentary, overweight men and women with type 2 diabetes, aged 60 – 80 years (n 36), were randomized to high-intensity progressive resistance training plus moderate weight loss (RT & WL group) or moderate weight loss plus a control program (WL group). Clinical and laboratory measurements were assessed at 0, 3, and 6 months. RESULTS — HbA1c fell significantly more in RT & WL than WL at 3 months (0.6 0.7 vs. 0.07 0.8%, P 0.05) and 6 months (1.2 1.0 vs. 0.4 0.8%, P 0.05). Similar reductions in body weight (RT & WL 2.5 2.9 vs. WL 3.1 2.1 kg) and fat mass (RT & WL 2.4 2.7 vs. WL 2.7 2.5 kg) were observed after 6 months. In contrast, lean body mass (LBM) increased in the RT & WL group (0.5 1.1 kg) and decreased in the WL group (0.4 1.0) after 6 months (P 0.05). There were no between-group differences for fasting glucose, insulin, serum lipids and lipoproteins, or resting blood pressure. CONCLUSIONS — High-intensity progressive resistance training, in combination with moderate weight loss, was effective in improving glycemic control in older patients with type 2 diabetes. Additional benefits of improved muscular strength and LBM identify high-intensity resistance training as a feasible and effective component in the management program for older patients with type 2 diabetes. Diabetes Care 25:1729 –1736, 2002

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